Community satisfaction with the quality of maternal and child health services in Southeast Nigeria

OBJECTIVES: To assess community perception, practices and satisfaction with the quality of maternal and child health services and the willingness and ability to pay for the services, after the introduction of the Bamako initiative programme. DESIGN: A cross sectional study using pre-tested questionnaire and focus group discussions was undertaken in May 1999. Variables explored were rating of quality of services, level of satisfaction with the services and willingness to pay for quality improvements as well as ability to pay for services. SETTING: Oji-river local government area of Enugu State, Nigeria. SUBJECTS: A random sample of 405 households from a sample frame of primary health care house numbers and another purposive sample of women and males were involved. RESULTS: Most respondents (90.6%) rated the services to be at least good. Another 95.9%, 94.3% and 95.8% of the respondents were, satisfied with the childhood immunisation, antenatal care and childbirth services respectively. Eighty nine percent of respondents were willing to pay for health services if drugs were readily available, while 92.4% would pay if there is overall improvement in quality. Majority of them were also able to pay for services. However, long waiting queues, providers' behaviours and lack of doctors militated against the utilisation of maternal and child health services. CONCLUSION: Bamako initiative programme improved drug availability and physical appearance of the health centres thereby leading to high levels of consumer satisfaction and people are willing and able to pay for primary health care services if there are quality improvements, as the Bamako initiative achieved. Continuous improvement of services, especially constant drug availability would motivate people to pay for services.