A descriptive study of private clinics in a malaria endemic area on the kenyan coast: quality of care and patient compliance
Abuya, Timothy Osebe
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The private health care system has grown rapidly in many developing countries, however, little is known about the sector's quality of care (QOC). Assessing QOC offered through private health care delivery systems is important in developing context specific interventions. In Kenya private provision accounts for 49% of all health facilities. This study sought to describe QOC provided to febrile children presenting in rural private clinics (PCs) on the Kenyan Coast. Data collection methods included structured observations of consultations and exit interviews in PCs, follow up interviews with users, and in depth interviews with private practitioners (PPs) and the district health management team (DHMT). The results of this study indicated that PCs had the basic structural features essential for health care delivery. In 62% (n=92) of consultations, assessment of symptoms and signs to reach a diagnosis was consistent with normal medical practice. About 72% (n=88) of cases were diagnosed as malaria, and 88% (81/92) were prescribed an antimalarial (AM) drug. Of those prescribed an AM, the choice of drug and dosage was in accordance with national guidelines in (44/81) 54% and (34/88) 42% respectively. In (26/62) 42% of cases, follow up was appropriate and 88% and 86% of caretakers complied with instructions on AM and antipyretics respectively. The average consultation time was 15.36 minutes (95% CI 13.4-17.32). These findings suggest that QOC problems exist in PCs, and that there was room for improvement. Factors affecting QOC were complex and, therefore, potential approaches to improve standards are multiple. However, specific approaches to the improvement of case management were discussed with PPs and DHMT as presented here alongside appropriate recommendations emerging from this study. Rural private clinics are potentially an important channel through which febrile illnesses can be promptly and effectively treated. The study is relevant for district level managers who have an oversight role for health care delivery in the district.
- MST-Zoological Sciences