An assessment of health services utilization and patient satisfaction: A research on maternal and child health services in Somalia

This study aims to reveal the socio-demographic, pregnancy and birth-related health services utilization characteristics of women using maternal and child health services, to determine the level of satisfaction with the services, and to find the differences in patient satisfaction according to socio-demographic, pregnancy, and birth-related health services utilization characteristics in Somalia. The study which was planned as a cross-sectional and descriptive type, aimed to reach the entire universe by not choosing a sample. According to this, data were collected at WADAJIR Maternal and Child Health Center in Somalia between 09:00-17:00 on 2 August–2 September 2019. Within a month, 813 patients visited the center. Following the inclusion criteria of the study (being between the reproductive ages of 15-49, being pregnant, having children, being sane, and volunteering to participate in the study), 500 respondents participated in the study. The data related to this research were collected by survey method. The questionnaires used for data collection were structured in 3 parts. The questions in the first two parts of the questionnaires were divided according to the factors of the behavioral model (predisposing, enabling, and need). The data in the third part of the questionnaires were collected based on the short form of the patient satisfaction questionnaire (PSQ-18) developed by Rand Corporation to examine the level of patient satisfaction. Kruskal-Wallis Test and Mann-Whitney U test were used in the hypothesis analysis of the data. Descriptive statistics distribution was shown as mean (min–max) for non-normal variables, and frequency and (%) for nominal variables. As the result of the research, 45% of mothers visited health institution for their children, 69% preferred a state health institution, 52.4% have 3 prenatal visits, 50.8% gave birth at home, 37% gave birth outside the health institution due to the misconception of the health services provided in the health institutions, 45% of the decisions on the place of giving birth were taken from the family, 97.4% were normal birth, 49% were not visited postnatal care, 60.8% accessed health institution by walking, 50.6% specified blood tests as the insufficient service in the health institution, 78% used traditional practices when the child gets sick, 46.2% got information about health from family or neighbors, 58.2% had poor health status, 58.4% did not receive health education during pregnancy, and 70.4% reported that they did not have family planning awareness. The mean total patient satisfaction score (X̄=46.00; ±7.720) was found to be moderate. The mean score of patient satisfaction subdimensions including general satisfaction (X̄=4,00; ±1,400), technical quality (X̄=8,00; ±3,786), interpersonal manner (X̄=4,00; ±2,373), communication (X̄=5,00; ±1,751), financial aspects (X̄=8,00; ±2,003), time spent with the doctor (X̄=4,00; ±2,068), accessibility and convenience (X̄=8,00; ±3,863) was also found as moderate. Based on this, it can be said that satisfaction with maternal and child health services is at a moderate level. Statistical differences were detected between sociodemographic data together with health services use and total patient satisfaction and subdimensions according to age, education, number of children, the reason for visiting the health institution, place of delivery, and perceived health status. Statistical differences were not found between total patient satisfaction together with subdimensions and the variables of marital status, income level, pregnancy status, mode of transportation to health institution, and health education support. This study suggests improving the awareness and education related to maternal and child health services at the point of service delivery. In order to reflect access problems, the research presents increasing the service capacity, convenient transportation, developing regulations toward health services providing institutions, and the acquisition of communication skills to students during university education. Developing cost-effective policies and programs related to resource use, quality improvement and health services management can create a significant impact. The study sees it as an important step for Somali health sciences universities to offer undergraduate and postgraduate programs in health management, and from this perspective, the country can consider approaches that prioritize the professionalization of health managers to improve health care delivery and combat poor governance. The study recommends conducting in-depth research on patient satisfaction, especially in maternal and child health services. Keywords: Health Services Utilization, Health Policy, Health Management, Mother and Child, Patient Satisfaction.