CLIENTS' SATISFACTION AND WILLINGNESS TO PAY FOR IMMUNISATION SERVICES IN URBAN AND RURAL PRIMARY HEALTH CENTRES OF ENUGU STATE, NIGERIA

Abstract

Immunisation has greatly reduced the burden of infectious diseases and in developing countries, is the building blocks for primary health care. Judging from the impressive outcome of quality improvements in health care in the developed countries, developing countries are presently showing interest in assessing the quality of their health care. The World Bank has severally advised developing countries to ensure their health services are client oriented as clients' satisfaction with healthcare services in Africa is one of the most important factors determining its utilization. The study was conducted to determine clients' satisfaction with immunisation services and also their willingness to pay for such services in urban and rural primary health centers of Enugu state, Nigeria. The study employed a health facility based cross sectional analytical design. A three stage sampling method was used to select 800 clients who presented with their children/wards in the 18 primary health centers selected for the study and they were interviewed using an adapted questionnaire. Clients' satisfaction with immunisation services was evaluated using a composite index. Data analysis was done using SPSS statistical software, version 15 and level of significance was determined at a value of less than 0.05. Multivariate logistic regression was used to identify the factors associated with clients satisfaction with immunisation services and also their willingness to pay for the services. The mean age of the clients was 28.9±4.5 years in the urban area and 26.7±5.1 in the rural. The major reason why the clients chose the primary health centers for immunisation services was because of proximity in the urban, and availability of vaccines in the rural area. Majority of the clients, 84.5% of those in the urban and 94.3% in the rural were satisfied with the immunisation services received. Provider related factors were relevant in determining clients satisfaction with immunisation services. Majority of the clients, 54.5% of the urban clients and 55.3% of those in the rural were willing to pay for immunisation services. The major reason for the unwillingness of the clients to pay for immunisation services in the two study groups was the perception that immunisation is the responsibility of government. Clients satisfaction with immunisation services was a determining factor on their willingness to pay for the services. Good client provider relationship resulted in high levels of client satisfaction with immunisation services and this is capable of increasing the utilization of the primary health centers for other child health services. Such good relationships also would motivate clients to pay for health services. Also, improving clients' satisfaction may go a long way in increasing economic value clients placed on immunization services.