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Abstract
WHO framework for health system performance assessment identifies three main goals on which health systems should be evaluated. Health is the defining goal for the health system is to improve the health of the population. Responsiveness: The second main goal is to enhance the responsiveness of the health system to the legitimate expectations of the population for the non-health improving dimensions of their interaction with the health system Fairness of financial contribution, the third main goal of health systems is fairness in financing and financial risk protection for households. Responsiveness has two main aspects: respect of persons and client orientation. The first incorporates issues such as dignity, autonomy and confidentiality, while the latter relates to prompt attention, quality of basic amenities, choice of care provider and access to social support networks during care.
The aim of this study was to measure the revel and distribution of responsiveness of the health system in Yemen, to assess the importance of different responsiveness domains, and to estimate the response category cut-point shift for population subgroups.
Descriptive cross-section study was conducted in Ministry of Public Health general hospitals in seven governorates in the Republic of Yemen, namely as Amanat AI-Asema, Aden, Taiz, AI- Hodeida, Sana’a, Ibb, and Lahj.
The aim of study population comprised patients who attended the study setting, aged 18 years and above. Sample size of 1050 patients was interviewed.
Multistage cluster sampling procedures; were used to produce a randomly representative sample. The sampling frame contained 20 sampling governorates which consisted of the different governorates ordered according to region (North - South) in order to ensure an implicit stratification. From the 20 goveinorates, seven governorates were selected randomly. Finally, in each governorate, 150 adults aged 18 years and above were selected systematic.
Data collection methods used was face-to-face interviewing method, using the Arabic version of the WHO Health and Responsiveness Survey Questionnaire. It includes, the main section concerns respondent’s evaluation of the responsiveness of the inpatient and outpatient components of the health system: The questions cover all 8 domains of responsiveness for inpatient services, and 7 domains for outpatient services (social support domain asked only to inpatients), and The questionnaire includes vignettes, which are a set of hypothetical scenarios corresponding to different responsiveness domains. There are four different sets of questionnaires, each set including 14 scenarios, related to 2 domains (seven scenarios for each domain).
Thirty nine point eight percent reported poor health system responsiveness In ambulatory care compared to 34.3 % in hospital inpatient care.
- As regards inpatient care responsiveness, the best performing domain was social support, followed communication, and choice, being rated as poor by 13.6%,22.0% and 22.0% respectively. The worst performing domains were basic amenities, and confidentiality being rated as poor by 60.2% and 52.0% of patients respectively.
- As regards ambulatory care responsiveness, the best performing domain was choice, and communication, being rated as poor by 19.3%, and 28.8% respectively. The worst performing domains were basic amenities, confidentiality, and prompt attention, being rated as poor by 652%,52.7%, and 50.6% of patients respectively.
- As regards inpatient care responsiveness, the best performing governorate, with the smallest percent of patients rating overall responsiveness as poor, was Lahj governorate (21.5 %), followed Aden Governorate (29.1%) and Ibb governorate (31.6%). The worst performing governorates with the greatest proportion of patients rating overall responsiveness as poor was AL-Hodieda governorate (49.3%) and Sana’a Governorate (40.7%).
- As regards ambulatory care responsiveness, the best performing governorate, with the smallest percent of patients rating overall responsiveness as poor, was Lahj governorate (30.8 %), followed Ibb governorate (37.2%) and Amanet Elasema governorate (38.4%). The worst performing governorates with the greatest proportion of patients rating overall responsiveness as poor were AL-Hodieda governorate (47.0%), Sana’a Governorate (43.8%) and Taiz governorate (42.3%).
Only 55.4% of patients reported no discrimination in inpatiet services. The most common causes of discrimination were lack of money (29.1 %),followed social class (25.6%).
- Thirty one point eight percent of surveyed patients consider prompt attention to be the most important responsiveness domain, while 35.1 % of surveyed patients consider choice to be the least important responsiveness domain.
- There were significant difference in responsiveness rating according to age, educational level, and health status for most domains of inpatient and ambulatory responsiveness. Older patients, less educated ones, and those reporting bad health states were less likely to report poor responsiveness.
- Expectations of patients differed according to age, education level, and health states.
Expectations were significantly higher for the younger patients, the more educated, and those in better health states.
Adjustment of percent of patients reporting poor responsiveness in the different governorates for both inpatient and ambulatory care revealed small changes. However, ranks of governorates remained unchanged for all domains with very few exceptions. Similarly, changes in cut-off shift for the responsiveness category of very good was minimal
The main recommendations of the present study are:
- Ministry of Health and Population should focus on equality of distribution of health services according to population size and needs.
Promotion and encourage private sector to invest in the health sector. Establishing a reception section at each hospital.
Using high quality criteria for hospital cleaning.
Establishing social medical insurance especially for poor falnilies.
Training and qualifying health staff technical and administrative staff on the privacy of patient and how to deal and good communicate with the patient.