customer satisfaction baseline survey report for kilifi county government ministry of health

CUSTOMER SATISFACTION BASELINE SURVEY REPORT FOR KILIFI COUNTY

GOVERNMENT MINISTRY OF HEALTH

KIMTUX ENTERPRISES LIMITED,

BOX 16669 MOMBASA Contact: 072 713 4649/0725247351

CUSTOMER SATISFACTION BASELINE SURVEY

REPORT

(Ministry of Health of Kilifi County)

Commissioned by the Kilifi County Government

Kilifi Office

April 2016

Lead Consultant:

Kimali Jean,

Lead Researcher:

Martin Otundo,

TOTAL SOLUTIONS

1

TABLE OF CONTENTS 1

LIST OF TABLES AND CHARTS 2

ACKNOWLEDGEMENTS 3

ACRONYMS AND ABBREVIATIONS 4

EXECUTIVE SUMMARY 5

1.0 INTRODUCTION 7

1.1 Overview of the Kilifi County Ministry of Health 7

1.1.1 Health Access 8

1.1.2 Morbidity 8

1.1.3 Nutrition Status 8

1.1.4 Immunization Coverage 9

1.1.5 Access to Family Services /Contraceptive Prevalence 9

1.1.6 Satisfaction of Millennium Development Goal 4: Reduce Child Mortality 9

1.1.7 Satisfaction of Millennium Development Goal 5: Improve Maternal Health 9

1.2 Background of Customer Satisfaction in Kenya and Kilifi county 9

1.3 Objectives of the Customer Satisfaction Survey 10

1.3.1 Customer Care and Monitoring 10

1.3.2 Survey Objectives 11

2.0: METHODOLOGY 11

2.1 Research Design 11

2.2 Target Population 11

2.3 Sample Size 11

2.4 Data Collection Instruments and Procedure 12

2.4.1 Desk review 12

2.4.2 Field Survey 12

2.4.3 Research Framework 13

2.4.4 Field Administration 13

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2.4.5 Data Specification and collection 13

2.5 Data Analysis 13

2.6 Limitations of the Study 14

3.0: BASELINE FINDINGS AND ANALYSIS 15

3.1 Response Rate 15

3.2 Basic Information of the Respondents. 15

3.2 General Responses about Customer Satisfaction and their Discussions 16

3.2.1 Patient Registry Section 16

3.2.2 Triage Section 18

3.2.3 Examination Section (Doctor/Physician) 19

3.2.4 Laboratory Section 20

3.2.5 X-ray Section 22

3.2.6 Pharmacy Section 23

3.2.7 Cash Payment Office/Section 24

3.2.8 Rating Customer Satisfaction on a Likert Scale 25

3.2.9 Recommendations by the Patients about the Health Facilities 26

4: 0 CONCLUSIONS AND RECOMMENDATIONS 27

4.1 Conclusions 27

4.2 Recommendations 28

References 29

Appendices 30

Appendix 1: SURVEY QUESTIONNAIRE 30

LIST OF TABLES AND CHARTS

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TABLES

Table 3.1: Patients Information 15

Table 3.2: Time Spent at the Patient Registry Section 17

3.2.2 Triage Section 18

Table 3.4 Time taken at Examination (Doctor/Physician) Section 19

Table 3.5 Time taken at Laboratory Section 21

Table 3.6 Time taken at X-ray Section 22

Table 3.7 Time taken at Pharmacy Section 23

Table 3.8 Time taken at Cash Payment Section 24

Table 3.9: Rating Customer Satisfaction 26

ACKNOWLEDGEMENTS

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On behalf of Kimtux Enterprise, we would like to convey sincere thanks and gratitude to

everyone who contributed to the successful completion of this Kilifi county Ministry of

Health baseline survey. This includes the co-partner heads (Mr. E. Mugabe and Mr. Kimali)

for the endless support given. The work of our lead researcher and data analyst (Mr. M.

Otundo) is indeed appreciated earnestly.

Sincere gratitude goes to the management and staff of Kilifi county Ministry of Health who

did give out this work. We also extend our deepest appreciation to the supervisors and

enumerators, staff and county ministry management; we note with gratitude their

contributions towards this study.

We would also like to thank the development partners for their support in this effort of

enhancing sustainable livelihoods in this region. Their financial, technical and material

support is greatly appreciated.

Finally, we would like to thank all community members who participated at various levels of

the study for their cooperation during the survey. We reiterate that the findings have been

handled as confidential and were only used for purposes of statistical compilation of this

report.

Lead Consultants

Kimali Jean 0721246744

Martin Otundo 0721246744

ACRONYMS AND ABBREVIATIONS

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ASAL: Arid and Semi Arid Lands

SPSS: Statistical Program for Social Scientists

NGOs: Non-Governmental Organizations

UTI: Urinal Track Infection

WHO: World Health Organization

EXECUTIVE SUMMARY

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The customer satisfaction baseline survey was conducted in Kilifi County’s ministry of

health in the month of April 2016 to inform stakeholders on the performance of the ministry

and predict the future trends of performance as stipulated in the county governments’ act of

employees’ evaluation. This study focused on one category of customers’ and this included

the services delivery in terms of times spent at the various sections of the health services

providers.

The Kilifi county Ministry of Health on average has done better in providing its services to

its patients. This is indicated by an overall rating which got an average support of 66.6% on a

scale. The patients rate the payment section and the doctor’s section as some of the areas that

are on average doing well as opposed to the previous times. The better services have been

attributed to issues like, better work environment provided by the county government e.g

improving on general infrastructure by building and lighting various

dispensaries/hospitals/health centres, hiring more personnel, procuring more medicine,

medical equipment and many more.

Due to its better services than it was previously, a greater percentage of the respondents

argued that they can recommend their close people for services in the health centres. From

the field report, 66% of the respondents argued that they could recommend their close

people to the various facilities while the remaining 34% argued that they could recommend

their family people or friends to these health facilities.

The research recommended that: The county hospitals should adopt modern systems of

keeping records at the registry points so that the information about the patients can

automatically be generated and avoid the long queues and manual checking of the records of

the patients; The county government should come up with equipped laboratories with

various equipment of testing various diseases. The x-rays also should be extended to other

points in the county as opposed to two major hospitals. This shall help in reducing the

congestions and times wasted in scrambling for the services; and; The county government

should increase the variety of drugs in its store so that the poor people of Kilifi can be saved

of the trouble of being sent to various points to buy medicine while they are already drained

with life demanding need food and water. The government should callable with other bodies

like donors to get more medicine for its people. ‘Finally the government should better the

health infrastructure, increase the number of employees and increase the coverage of

dispensaries and health centres across the county. This shall help reduce congestion and

eliminate the challenges of wasted time and services delivery.

1.0 INTRODUCTION

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1.1 Overview of the Kilifi County Ministry of Health

Kenya took a great leap in adapting the new Constitution in August 2010. With the new

Constitution comes an expansive Bill that created the county governments under devolution.

With the 47 counties created, there are at least 11 ministries with each county that are aimed

at steering and driving Kenya to the middle level economy by 2030. Among the most

strategic ministry is the ministry of health that deals with one on one with the lives of the

citizens. County Background report of Kilifi shows that, Kilifi County is one of the six coastal

counties. It borders Kwale County to the South West, Taita Taveta to the West, Tana River to

the North, Mombasa to the South and the Indian Ocean to the East. Kilifi covers an area of

approximately 12,609.7 square kilometres.

It had an estimated population of 1,109,735 as per the National Census of 2009. With an

annual population growth rate of 2.9% assuming constant rates of fertility and mortality, the

population is estimated to rise to 1,399,509 by the year 2017. The male to female ratio is

about 1:1 with 52.1% female, Male 47.9%. Women of reproductive age comprises of 23.2% of

the population. A significant proportion of the population is composed of <15 years (47.5%)

with the youth making up 19.4%, the age group 25-59 years making up 28% and the elderly

comprise 5% of the population. Children under one year make up 3.6% and those less than 5

years 17.3% of the population. The life expectancy of the county is 56 years, (KDSP 2005/10).

It comprises of seven sub-counties namely; Malindi, Magarini, Ganze, Rabai, Kaloleni, Kilifi

South and Kilifi North. County’s Vision is to be a leading, prosperous and secure county for

high quality life while it’s Mission is to provide an enabling environment and participatory

resource management for efficient and effective service delivery for all. Core Values include:

i. The rule of law, democracy and participation of the people. ii. Human dignity, equity,

social justice, inclusiveness, equality, human rights, nondiscrimination and protection of the

marginalized. iii. Good governance, integrity, transparency and accountability; and, iv.

Sustainable development.

The county has four main livelihoods zones including Marginal Mixed Farming (MMF)

comprising 44 percent of the population, cash cropping/dairy (22 percent), Mixed Farming

(11 percent) and ranching (two percent). Other livelihood zones include fishing and

mangrove (three percent), formal employment (14 percent) and forest/tourism and casual

labour (two percent each). The county is served with a relatively above score roads network;

with major road networks being the Malindi-Mombasa Highway that links the county to

Tana Delta and Lamu counties, The Mombasa-Nairobi highway that links the county to

Mombasa and other up country counties while the Kaloleni Mariakani road makes

accessibility to interior parts of the county from the main Nairobi –Mombasa highway.

The ministry of health is a very important organ of this county. According to the information

available in the recently launched website by the county government in its strategic paper of

2013/2017, the ministry information can be well understood as outlined below:

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1.1.1 Health Access

The county has nine level 4 public hospitals, 20 level 3 public health Centres, 197 level 2

public dispensaries, one mission hospital, two private hospitals, one armed forces hospital,

five private nursing homes and 107 private clinics. The bed capacity in hospitals is 498, in

health Centres is 30 and in nursing homes is 16. The doctor/patient ratio is 1:42,625, clinical

officer/patient ratio is 1:30,194 while the nurse/patient ratio is 1:3,396. Malindi, Kilifi and

Mariakani sub-county hospitals are the only referral hospitals in the county. Kilifi sub-

county hospital hosts KEMRI that is involved in various health research activities. The

inpatient bed capacity in health facilities in the county is 508 beds.

1.1.2 Morbidity

The average morbidity rates in the county are 12.9 percent with females having higher

morbidity rates at 15.4 percent as compared with men at 9.9 percent. The most common

causes of morbidity in the county are malaria/fever, lower respiratory infections, stomach

ache, diarrhea and flu.

1.1.3 Nutrition Status

The population under five years was estimated to be 210,916 as at 2012 and is projected to

reach 231,413 in 2015 and 254,032 in 2017 in the county. Stunting and wasting in children less

than five years is quite high in the county with 48.8 percent of the children being stunted.

The stunting could be linked to the poor infant and young child feeding practices. The

county needs to strengthen projects and programmes that are aimed at reducing this trend.

There is need to increase nutrition services as well as to increase coverage and manage

children who are malnourished. There is need to establish community units where they

haven’t been established in the county as this will increase case referrals for malnourished

children.

1.1.4 Immunization Coverage

The national immunization coverage is 77 per cent compared to that of the county which is

78.7 per cent. This shows a slight margin between county and national figures but advocacy

and mobilization of community members is required to improve the rates.

1.1.5 Access to Family Services /Contraceptive Prevalence

The county has been experiencing rapid population growth at 3.05 percent due to high

fertility, improved child survival and influx of people from outside the county to

government planned settlement schemes and other private schemes hence increasing the

demand for health services. The contraceptive prevalence rate is low at 37.3 percent thus

implying a low utilization of family planning services. This is further exhibited by relatively

low Anti-Natal Clinics attendance by pregnant women at 50.5 percent.

1.1.6 Satisfaction of Millennium Development Goal 4: Reduce Child Mortality

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The county’s target under this goal is to reduce under- five mortality rate by two thirds by

2015. The infant mortality rate in the county is 71 per 1,000 live births while Under-five

mortality rate is 87 per 1,000 live births. Immunization coverage against measles is 85

percent. Drugs for prevention of mother to child transmission of HIV are available in almost

all Government health facilities in the county. Despite the efforts put by the government and

stakeholders in this sector the county is still below the national status. Increased efforts in

health campaigns & awareness, equipping and staffing of health facilities are some of the

strategies that can be adopted if this target is to be met by 2015.

1.1.7 Satisfaction of Millennium Development Goal 5: Improve Maternal Health

The county’s target under this goal is to reduce by three quarter the maternal mortality rate.

Proportion of births attended by skilled personnel is at 30 percent while maternal mortality

rate is 488 per 100,000live births and antenatal care coverage of 22 percent as per the as at

2012. The county has contraceptive prevalence rate of 34% and a family planning uptake of

39.86 percent. The proportion of births attended to by skilled personnel is 43.8 percent,

maternal mortality rate of 488 per 100,000 live births and contraceptive use of 45.5 percent as

per the national status. The progress towards achievement of this MDG targets is low

compared to the national status and this is a result of cultural believes & religious practices,

high incidences of poverty levels, in accessibility of health facilities, poor infrastructure,

inadequate health personnel among other factors.

It is essential that such ministry survey is able to measure its achievements and provide

information about its successes and failures ensuring consistent, accurate and meaningful

data. It is in this context that Kimtux in collaboration with Kilifi county government’s

ministry of health conducted this baseline survey.

1.2 Background of Customer Satisfaction in Kenya and Kilifi county

European Commission Report of 2015 shows that, customer satisfaction is a term frequently

used in marketing. While it's often abbreviated as CSAT, it is more correct to abbreviate it as

CSat. It is a measure of how products and services supplied by a company meet or surpass

customer expectation. Customer satisfaction is defined as "the number of customers, or

percentage of total customers, whose reported experience with a firm, its products, or its

services (ratings) exceeds specified satisfaction goals." In a survey of nearly 200 senior

marketing managers, 71 percent responded that they found a customer satisfaction metric

very useful in managing and monitoring their businesses.

It is seen as a key performance indicator within business and is often part of a Balanced

Scorecard. In a competitive marketplace where businesses compete for customers, customer

satisfaction is seen as a key differentiator and increasingly has become a key element of

business strategy. "Within organizations, customer satisfaction ratings can have powerful

effects. They focus employees on the importance of fulfilling customers' expectations.

Furthermore, when these ratings dip, they warn of problems that can affect sales and

profitability. These metrics quantify an important dynamic. When a brand has loyal

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customers, it gains positive word-of-mouth marketing, which is both free and highly

effective."

Therefore, it is essential for businesses to effectively manage customer satisfaction. To be able

do this, firms need reliable and representative measures of satisfaction. "In researching

satisfaction, firms generally ask customers whether their product or service has met or

exceeded expectations. Thus, expectations are a key factor behind satisfaction. When

customers have high expectations and the reality falls short, they will be disappointed and

will likely rate their experience as less than satisfying. The Kilifi County ministry of health is

committed to satisfying their customers’ needs and this is why such a survey was conducted.

1.3 Objectives of the Customer Satisfaction Survey

1.3.1 Customer Care and Monitoring

The importance of a customer to an organization while generally accepted by management

and staff is sometimes not fully incorporated in the budgets, planning, organizational

structure, corporate strategies and other aspects of the organization that would help

actualize the concept and thereby emphasize the importance of placing customer needs at

the core of corporate objectives.

There is need to:

Develop an overall understanding of who the customer is to the organization

Highlight the importance and methods of determining customer needs

Determine the customer satisfaction levels as determined by the time taken in

services delivery.

Determine the general perception about the county health services with regards to

service delivery.

Propose appropriate action plan for addressing the emerging issues for

recommendations and suggestions for interventions and for further improvement.

Facilitate quality provision of services to patients and to develop sets of ideas and

principles to revitalize the hospitals in Kilifi County in order to create positive /

conducive customer relations.

Instill positive attitudes and beliefs towards their customers and other stakeholders,

and realization of the broad spectrum of the "corporate customer" and his ever-

growing needs and wants.

In understanding the customer segments of the Ministry, the consultant tried to understand

and appreciate who the customer is (children, male, and female), the time of service as

scored against the expectations of the customers, the customers’ views towards the

employees and the proposed future adjustments for better results for the ministry. Generally,

in trying to unravel customer satisfaction, the consultant aimed at determining customer

satisfaction levels, weaknesses and strengths in the services provided to the customers and

identify any gaps and areas requiring improvement.

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1.3.2 Survey Objectives

The survey aimed at coming up with recommendations which are backed by findings in the

field and within the Ministry, which were to enable the Ministry to:

Strengthen its capacity to plan and implement a customer satisfaction strategy

Enable it to set up a coordination mechanism that prioritizes customer satisfaction

Provides the necessary expertise that ensures the attainment of high standards in the

area of customer satisfaction.

2.0: METHODOLOGY

This section discusses the methodology that was employed in the research process. It details

the research design, the population to be studied, the nature of data to be collected and data

analysis technique used.

2.1 Research Design

The research was executed broadly along the lines of the set objectives. Descriptive research

design, using summary statistics was adopted that showed the different levels of satisfaction

with different issues as percentages. The study generally examined every issue in terms of

whether the different kinds of the Ministry’s customers were satisfied or not and if so the

degree of satisfaction of lack thereof was then asked as a follow up. This method was able to

isolate services that are doing well and those which need to be looked into by the Ministry.

The survey depended on the literature provided by the Ministry, which helped in

developing survey instruments.

2.2 Target Population

The target population for this survey was the patients who visited the various public health

providence facilities (the hospitals, dispensaries and health centres) in a continuous running

one week schedule. The total target population was therefore 11,815 customers in a week

running; also averaged as 1680 customers/clients per day. The population came from the

patients served by the various health facilities in the 7 sub-counties (21 health facilities).

2.3 Sample Size

The total number of questionnaires developed that were sent out was 323 daily in the various

hospitals. This was calculated by use of Yamane formula of 1970

According to Mugenda and Mugenda (2003), when a population is less than 10,000 for social

researches, a desired sample of 10% can be adopted. However, this has to be more than 30

respondents for better data analysis. For this study, the sample was given by the formula

below.

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n = N

1 + N (e) 2

n = Desired sample size when population is less than 10,000.

e= sampling error

N = Population size

At 95% confidence level, the sampling error is 0.05. Therefore the desired sample was:

N= 1680 = 323

1 + 1680(0.05)2

Given that the target population was heterogeneous due to the nature of the factors related

to the medical facilities in the Kilifi County, stratified sampling was used to allow full

participation of the patients/respondents.

2.4 Data Collection Instruments and Procedure

The study used the following methods to collect data:

2.4.1 Desk review

Relevant secondary material, which included among other documentation in the Ministry of

health, background documents and the Ministry’s service charter were reviewed before

embarking on the fieldwork. The website of the Ministry of health that was recently

launched was also visited to elicit valuable information. Various documents like the county

health strategy papers were also reviewed for more information. This review was meant to

get a proper understanding of the Ministry.

2.4.2 Field Survey

A field survey covering clients of the Ministry was conducted. The survey employed a

questionnaire distribution’s criteria- for customers seeking medical attention from different

hospitals/dispensaries/health units in Kilifi. The survey tools were administered to a

representative sample of clients with the aim of getting representative ideas on selected

survey themes. The questionnaires were presented by 50 research assistants who tirelessly

worked in the health providence facilities in the county for over two weeks composed of

continuous schedule of Monday to Friday. The reason behind the extended time in the field

was to allow the research assistants run a continuous questionnaires administration to the

various patients from the various health facilities.

It is worth noting that this was done because the survey aimed at getting detailed

information form the clients/customers/patients without raising suspicion among the

employees. If such suspicion was allowed to come into play, the employees could influence

the results or be biased in the services providence; influencing the outcome of the survey.

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2.4.3 Research Framework

The sample of clients was drawn based on the areas served by the various health facilities as

provided by Ministry of Health of Kilifi County. The sample was stratified according to sub

counties that included areas under Ganze Sub County, Kaloleni Sub County, Kilifi North,

Kilifi South, Malindi Sub County, and Magarini Sub County. Patients/customers were

subjected to exit survey using random sampling technique at points of exit in the Ministry of

Health’s health providers countywide. In cases where the respondents were not able to read

and write, the research assistants helped them to fill the questionnaires and in cases where

the patient was the child, the guardian or the parent was allowed to give information on

their behalf.

2.4.4 Field Administration

To administer the questionnaires research assistants were recruited and trained in data

collection techniques. The research assistants were also picked from the local community

(Mijikenda) for easy translation of the information when required. In this regard, the

Principal researchers went through the questionnaire and discussed each question in great

detail to avoid any misinterpretation. The questionnaires were pre-tested in various health

centres in the neighbouring Mombasa county health services providers of Mlaleo, Makadara;

Likoni and Changamwe, and necessary adjustments were then made before commencement

of the survey.

2.4.5 Data Specification and collection

The study used a customized survey data collection instrument, (Individual (patient)

customer satisfaction questionnaire). The individual customer satisfaction questionnaire was

used to collect information from customers seeking medical services from the various

medical facilities in the county. The instruments were pre-tested using the test retest method

among 40 respondents from the 4 mentioned medical facilities in Mombasa county and

adjusted as appropriate.

2.5 Data Analysis

The study used SPSS version 20.2 package to analyze the quantitative data generated

through the questionnaires. The data generated was then used to establish association

between study variables.

2.6 Limitations of the Study

In some of the hospitals like those in the rural areas in Kaloleni, patients were not

ready to give information since they thought it was to be used against them.

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However, the suspicion was eliminated by explaining to them that the research

aimed at getting information that could allow them get better services.

Some of the respondents did not seem to understand the questions and made no

effort to ask for assistance in filling the questionnaire hence ending up not

participating in the study.

The survey was more of an investigation research that needed a lot of privacy more

specifically from the medics so that they could not influence their working rates. This

in a way limited the explanations of the research assistants in their continuous visits

to the health facilities. However, this was solved by letting the hospital heads

understand that a basic work environment study was going on as detailed in the

questionnaire that was given to keep the medics busy.

3.0: BASELINE FINDINGS AND ANALYSIS

This section presents the findings from the field; it analyzed the data and interprets it by use

of frequency tables, graphs and central tendencies measures.

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3.1 Response Rate A total number of questionnaires distributed each day were 323. This was done for 5 days and in each day; those valid questionnaires were sorted and accepted for the study. The average then was computed. After the calculations, a total of 250 questionnaires were fit for the study. Therefore the response rate was 77.4%. This high response rate was linked to the fact that the research assistants were very committed and understood the dynamics of the local community. 3.2 Basic Information of the Respondents. The major information that was sought from the clients touched on their nature of

relationship with the county ministry and how long they have been clients and this is

indicated by the table below:

Table 3.1: Patients Information

The baseline survey results indicated that, the female gender dominated the hospitals,

followed by the male and finally the children. This was represented by 60%, 30% and 10%

respectively. The dominance of the female gender in the hospitals can be explained well by

the World Health Organisation (2015) that shows; in Africa, women and children are more

prone to diseases like malaria, measles, family injuries and lifestyle diseases like

Personal detail Tag Frequency Percentage

Gender

Male 75

30%

Female Children Total

150

25

250

60%

10% 100%

Age brackets

0-10 Years

11 – 20 Years

21 – 30 Years

31 – 40 Years

41 – 50 Years

51 –60 Years

Above 60 Years

25

38

38

50

75

12

12

10%

15% 15% 20% 30% 5% 5%

Total 250 100%

Average Total 250 100%

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malnutrition, blood pressure, breast/cervical cancer, fistula ,obesity and many more due to

family chores. Also, from the survey, it is indicative of the role played by women in taking

care of the children and aged in the community.

Interestingly, ages between 41 – 50 years and 31 – 40 years dominated the survey with 30%

and 20% respectively. This can be explained by the GOK (2014) in its survey report that

shows, a great percentage of the people seeking medical help from the public facilities are

those in the mid late 30’s and early 50’s. These brackets are composed of almost old parents

who did not benefit very much by accessing better education, securing formal jobs, investing

for their health, have not had children who have secured better jobs to take care of their bills

and many more.

However, the trend has changed with ages between 0-10 years who are 10%, 11 – 20 years

who are 15%, and 21 – 30 years who are 15% because they have not on strong cases visited

the public hospitals regularly. This is a true trend in the country whereby people between

the ages of 20’s and 30’s have either some formal employment and with the information era,

they feel that better medical services are provided at the private hospital or they can buy

drugs across the pharmaceutical shops. 0-10 Years is composed of children who seem not to

be very pronounced due to the fact that most of the parents prefer taking their kids to private

hospital. Finally a reduction in the ages between 51 –60 years and above 60 years as

represented by 5%, could be explained by the fact most of the aged in Kilifi county are poor

(World Bank, 2014), are discriminated by the public (Unite For Sight, 2015) and many more.

3.2 General Responses about Customer Satisfaction and their Discussions

A number of questions were asked in the questionnaire that comprised of both open

ended and closed ended questions. The questions were asked in relation to the time

taken to be served in various sections that were classified into: a) Patient Registry

Section, b) Triage Section, c) Examination (Doctor/Physician), d) Laboratory, e)

X-ray, f) Pharmacy, and, e) Cash Payment Office.

3.2.1 Patient Registry Section

The survey sought to establish the time taken for patients to be served in the

Patient Registry section. This is the first section where the patients visit

immediately in the hospital. The questions included the specific time brackets

spent, the expected time and some reason for the time spent at the section.

The response on the time taken for contact with the medical centre staff is as

indicated in the table 3.2 below:

Table 3.2: Time Spent at the Patient Registry Section

Time in Minutes Frequency Percentage

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From the baseline survey, on average over 64% of the respondents who were

represented by 160 respondents indicated that they spent 11-20 min in the patient

registry section. This was followed by the time bracket of 21-30 min that attracted 14% of

the respondents, above 45 min that attracted 10%, 0-10 min that attracted 8% and finally the

31-40 min that attracted 4%.On average, it was found that the time stipulated for services in

the section was 0-10 minutes, although the patients had to wait for a doubled time length

that went to almost over 20minutes.

According to the patients, they expected to be served in less than 10 minutes. A minimum

contact time can be supported by the information from the county health department

indicating that the government has taken strategic measures like integrating of modern

technology equipment and has increased the number of employees over time since the health

deployment is done at the county levels unlike the times when it was under the old

constitution. A report by the Kilifi County Government (2015) has shown that it has

increased the number of nurses and medical doctors serving in various hospitals and health

centres in the county since it came to power by over 45%, adopted electricity and new

infrastructural facilities like piped water, new buildings, modern equipment like x-rays and

computers by a trending rating of over 51.12%; double than its neighbouring counties like

Tana River and Taita Taveta.

When asked to give reasons as to why they felt heir were delays at this section than expected,

on average 57% of the patients argued that, some attendants looked disorganized, some had

no experience in tracing the records well, some wanted small requirement like an

identification card; that is not held by most of the locals.30% of the respondents blamed it on

the fact that attendants were somewhat discriminative whereby a fellow worker from

another area will come in with his/her patient, head to the inner serving point, get his/her

client served while others are waiting on the queue. This could occasionally be followed by

stories that distracted the employee serving the patients and led to time wasting. Worst hit is

Kilifi Hospital that occurred at a frequency of 42.1% and Malindi Hospital that occurred at

37.3% followed by the others.

0 – 10 min

11 – 20 min

21 – 30 min

31 – 40 min

Above 45 min

20

160

35

10

25

8%

64%

14%

4%

10%

Total 250 100%

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3.2.2 Triage Section

The survey sought to establish the time taken for patients to be served in the Triage

Section. This is the second section where the patients visit in the hospital. The

questions included the specific time brackets spent, the expected time and some

reason for the time spent at the section.

Table 3.3 Time taken at Triage Section

From the baseline survey, on average over 70% of the respondents who were

represented by 175 respondents indicated that they spent 11-20 min in the Triage

Section. This was followed by the time bracket of 21-30 min that attracted 16% of the

respondents, above 45 min that attracted 6%, 0-10 min that attracted 4.4% and finally the 31-

40 min that attracted 3.6%.On average, it was found that the time stipulated for services in

this section also by the management was 0-10 minutes, although the patients had to wait for

a doubled time length that went to almost over 20 minutes.

According to the patients, they expected to be served in less than 10 minutes as proposed by

the county health sector. This expectation of a minimum contact time for service can be

supported by the information from the county health department indicating that the

government has taken strategic measures like in giving the county health service a new look.

This includes: integrating modern technology, acquiring better medical equipment, increased

the number of employees over time since the health employment and deployment is done at

the county levels unlike the times when it was under the old constitution, etc.

Also, the Kilifi County Government (2015) report indicated that, there has been an

increased number of nurses and medical doctors serving in various hospitals and health

centres in the county since it came to power in 2013 by over 45%, adopted electricity and new



Tana River and Taita Taveta. This has also been shown in its efforts of collaborating with

other bodies like KEMRI, UNICEF, USAID, WHO etc.


0 – 10 min

11 – 20 min

21 – 30 min

31 – 40 min

Above 45 min

11

175

40

9

15

4.4%

70%

16%

3.6%

6%

Total 250 100%

19

When asked to give reasons as to why they felt there were delays at this section than

expected, on average 54% of the patients argued that, some attendants looked disorganized

and relaxed/ not ready to handle their duties at speed. This was pronounced in areas of

Kaloleni and Ganze.

3.2.3 Examination Section (Doctor/Physician)


Examination Section (Doctor/Physician). This is the third section where the

patients visit in the hospital. The questions included the specific time brackets

spent, the expected time and some reason for the time spent at the section.

Table 3.4 Time taken at Examination (Doctor/Physician) Section

From the baseline survey field information, on average over 58% of the respondents

who were represented by 145 respondents indicated that they spent 11-20 min in

the Examination (Doctor/Physician) Section. This was followed by the time bracket of 0-

10 min that attracted 16% of the respondents, 21-30 min that attracted 12%, 31-40min that

attracted 8% and finally over 45 min that attracted 6%.On average, it was found that the time

stipulated for services in this section by the management was 0-10 minutes, although

patients had to wait for almost over 20 minutes. However, there was a fair score in this

section since the stretch towards the over 20 minutes of waiting is on a reducing trend as

compared to other sections.




government has taken strategic measures aimed at giving the county health service a new

look. This includes: integrating modern technology in all sections of operations, acquiring

better medical equipment, increasing the number of employees over time since the health

employment and deployment is done at the county levels unlike the times when it was

under the old constitution, etc.


0 – 10 min

11 – 20 min

21 – 30 min

31 – 40 min

Above 45 min

40

145

30

20

15

16%

58%

12%

8%

6%

Total 250 100%

20

Also, the Kilifi County Government (2015) report indicated that, there has been an

increased number of nurses and medical doctors serving in various hospitals and health

centres in the county since it came to power in 2013 by over 45%, adopted electricity and new



Tana River and Taita Taveta. This has also been shown in its efforts of collaborating with

other bodies like KEMRI, UNICEF, USAID, WHO etc.


expected, on average 58% of the patients surprisingly did not blame it on the doctors/

Physician. Instead, they argued that, most of the patients gave unnecessary detailed

information to the doctors since they felt that if they gave them such historical information

can help them get the effective medication. It was noted that the complications of the patients

also differed and a number of them had different explanation and different problems that

required different checks/attention. For example, a statistical average of 59.01% of the

respondents indicated that they spent quality time with the doctor and felt better than the

fear they had before, without even being subjected to medication.

3.2.4 Laboratory Section


Laboratory Section. This is the fourth section where the patients visit in the

hospital if need be. The questions included the specific time brackets spent, the

expected time and some reason for the time spent at the section.

Table 3.5 Time taken at Laboratory Section


21

From the baseline survey field information, on average over 66% of the respondents

who were represented by 165 respondents indicated that they spent the longest

time in this section of over 45 min as compared to other sections. This can be

attributed to the fact that most of the laboratory tests involve a series of processes

and some could even require some cultured processes that take up to three days.

This was followed by the time bracket of 31-40 min that attracted 16% of the respondents, 21-

30 min that attracted 7.6%, 11-20 min that attracted 6% and finally less than 10 min that

attracted 4.4%. On average, it was found that the time stipulated for services in this section

by the management was nonstandard and the discrepancy differed from one test to another.

For example HIV test, though done in a different section, had a maximum of 40 minutes due

to counseling, the malaria test had an allocated time of 10 minutes, STI like the UTI had a

time frame that went slightly above 40 minutes while others had times that went to over one

day, although patients had to wait for almost over 20 minutes.

However, according to some of the patients, they expected to be served in less than 10

minutes since their problems were not such complicated. This was supported by 37% of the

respondents, but the majority of over 63% seemed to be comfortable with the time spent in

this section. From the county of Kilifi, this expectation of a minimum contact time for service

at the laboratory can be supported by the information from the county health department

indicating that the government has done an integrating modern technology in all sections of

operations, acquired better medical equipment for almost all the laboratories, increased the

number of laboratory attendants/medical laboratory employees and technicians etc.

According to the Kilifi County Government (2015), there has been an increased number of

nurses, laboratory technicians/attendants and medical doctors serving in various hospitals

and health centres in the county since it came to power in 2013 by over 45%, adopted

electricity and new infrastructural facilities like piped water, new buildings, modern

equipment like x-rays and computers by a trending rating of over 51.12%; double than its

neighbouring counties like Tana River and Taita Taveta. This has also been shown in its

efforts of collaborating with other bodies like KEMRI, UNICEF, USAID, WHO, MTCs etc.

0 – 10 min

11 – 20 min

21 – 30 min

31 – 40 min

Above 45 min

11

15

19

40

165

4.4%

6%

7.6%

16%

66%

Total 250 100%

22

When asked to give reasons as to why they felt that there were delays at this section than

expected, on average, over 63% of the patients surprisingly did not blame it on the

technicians or attendants at the laboratories. Instead, they seemed to agree that, there are

different types of diagnosis done for each individual and therefore for a particular disease to

be effectively identified in some patients there need to be proper procedure to testing. This

differs from one disease to another, one hospital to another, one region to another and one

blood in an individual to another.

3.2.5 X-ray Section

The survey sought to establish the time taken for patients to be served in the X-ray

Section. This is the fifth section where the patients visit in the hospital if need be.

The questions included the specific time brackets spent, the expected time and

some reason for the time spent at the section.

Table 3.6 Time taken at X-ray Section

From the baseline survey field information all the questionnaires analyzed had

responses for this section. Therefore, on average over 50% of the respondents who

were represented by 125 respondents indicated that they spent between 31-40

minutes. This was followed by the time bracket of 21-30 min that attracted 22% of the

respondents, 11-20 min that attracted 14%, above 45 min that attracted 10% and finally less

than 10 min that attracted 4 %. On average, it was found that the time stipulated for services

in this section by the management was nonstandard and the discrepancy lied between 20

minutes and over one hour. This can be supported by the idea the machines being used and

not very modern and only 2 hospitals are served with x-ray machines.

However, according to some of the patients, they expected to be served in less than 20

minutes since their problems were not such complicated. This was supported by 48% of the

respondents. From the county of Kilifi, this expectation of a minimum contact time for

service at the x-ray section can be supported by the information from the county health

department indicating that the government has acquired better medical equipment like the


0 – 10 min

11 – 20 min

21 – 30 min

31 – 40 min

Above 45 min

10

35

55

125

25

4%

14%

22%

50%

10%

Total 250 100%

23

x-ray, has improved the x-ray by servicing it and increased the number of attendants/

technicians at the x-ray laboratories. According to the Kilifi County Government (2015),

there has been an increased number of nurses, laboratory technicians/attendants and

medical doctors serving in various hospitals and health centres in the county since it came to

power in 2013 by over 45%, adopted electricity and new infrastructural facilities like piped

water, new buildings, modern equipment like x-rays and computers by a trending rating of

over 51.12%; double than its neighbouring counties like Tana River and Taita Taveta. This

has also been shown in its efforts of collaborating with other bodies like KEMRI, UNICEF,

USAID, WHO, raining institutes and other that have better knowledge of x-ray machines

and knowledge to easy the delivery of services.

When asked to give reasons as to why they felt that there were delays at this section than

expected, on average, over 50% of the patients surprisingly did not blame it on the

technicians or attendants also. Instead, they seemed to agree that, there are different types of

diagnosis done for each individual. Also, the patients blamed it on the government for the

limited numbers of the x-ray machines, the lack of enough attendants for the services and the

unnecessary time wasted in waited for the x-ray picture to be read and interpreted.

3.2.6 Pharmacy Section


Pharmacy Section. This is the sixth section where the patients visit in the hospital.



Table 3.7 Time taken at Pharmacy Section

From the baseline survey, on average, over 49.2% of the respondents who were

represented by 123 respondents indicated that they spent 11-20 min in the

Pharmacy Section. This was followed by the time bracket of 0-10 min that attracted 16% of

the respondents, 31-40 min that attracted 14.8%, 21-30 min that attracted 12% and finally

above 45 min that attracted 8%.On average, it was found that the time stipulated for services


0 – 10 min

11 – 20 min

21 – 30 min

31 – 40 min

Above 45 min

40

123

30

37

20

16%

49.2%

12%

14.8%

8%

Total 250 100%

24

in this section by the management was 0-10 minutes, although the patients had to wait for a

doubled time length that went to almost over 20 minutes.




government has taken strategic measures in giving the county health service a new look.

This includes: integrating modern technology, acquiring better medical equipment, increased

the number of employees over time since the health employment and deployment is done at

the county levels unlike the times when it was under the old constitution, etc.

The Kilifi County Government (2015) report indicates that there has been an increased

number of nurses, pharmacists, laboratory attendants, relevant workers and medical doctors

serving in various hospitals and health centres in the county since it came to power in 2013

by over 45%, adopted electricity and new infrastructural facilities like piped water, new

buildings, modern equipment like x-rays and computers by a trending rating of over 51.12%;

double than its neighbouring counties like Tana River and Taita Taveta. This has also been

shown in its efforts of collaborating with other bodies like KEMRI, UNICEF, USAID, WHO

etc. that have provided modern records management that makes it easy for one to identify

the type of medicine to be given to the patients; limiting the time wasted in waiting for

subscription.


expected, on average 50% of the patients argued that, some attendants were slow in

understanding what was required in the papers maybe due to the fact that there is no proper

link with the medical subscribes, others wasted time in calling some help from other

attendants, or in some occasions the attendants wasted time looking for medicine that was

not in stock; just to realize later and then send the patients to go and buy elsewhere.

3.2.7 Cash Payment Office/Section

The survey sought to establish the time taken for patients to be served in the Cash

Payment Section. This is the last section where the patients visit in the hospital.



Table 3.8 Time taken at Cash Payment Section


25

From the baseline survey, on average, over 80% of the respondents who were

indicated that they spent less than 20 min in the cash payment. General trend in the

hospitals performance indicates that this the best performing section so far; with a higher

percentage (44.4%) of the patients being served in less than 10 minutes. According to the

survey, age between 21-30 minutes attracted 12% of the respondents, 31-40 min that attracted

6 % and finally 45 minutes that attracted 2%.




integration of modern cash payment technology like the use of the M-pesa services has eased

the work of money payments. Also the use of computerized receipts helps the payments

process. Some employees who answered in the favour of delays in payments argued that

they delayed in payments due to the procedures involved and a good number of them did

not know how much they were supposed to pay since the government form time to time has

said that the medication at county levels is free; therefore they did not carry money.

3.2.8 Rating Customer Satisfaction on a Likert Scale

The patients were given a number of questions and the rating done on a scale to show the

magnitude of satisfaction and results discussed as follows:

0 – 10 min

11 – 20 min

21 – 30 min

31 – 40 min

Above 45 min

111

89

30

15

5

44.4%

35.6%

12%

6%

2%

Total 250 100%

26

Table 3.9: Rating Customer Satisfaction

Statement Aver

age

Percen

tage

Equivalency

Valid

Total

250

The Health facility staff treated me with

courtesy and respect.

3.5 70% Agree

The Health facility staff did explain things

to me in a way I could understand.

3.6 72% Agree

I was given ample time to discuss my

medical problem with the doctor/health

officer or the nurse.

3.8 76%

Agree

The Health facility is clean and well

maintained.

2.4 48% Disagree

Total average 3.33 66.6% Weakly

agree

On a rating scale of 1 to 5 where; 1=strongly disagree, 2=disagree, 3= weakly agree, 4=agree

and 5= strongly agree and the results below gotten:

The survey noted that, almost over 66.6% of the respondents were on average in agreement

that the county health sector was doing well and it offered services that satisfied them on an

average basis. This was supported by a computed average of 3.33 that equated to fairly

agree. This translates to a value of 66.6%.

The individual statement scores indicated that: 3.5 score that is equated to agree was scored

by the statement that said, the Health facility staff treated me with courtesy and respect; 3.6

score that was equated to agree was scored by the statement that said, the Health facility

staff did explain things to me in a way I could understand; 3.8 score that was equated to

agree was scored by the statement that said, I was given ample time to discuss my medical

problem with the doctor/health officer or the nurse; and, finally 2.4 score that is equated to

agree was scored by the statement that said, the Health facility is clean and well maintained.

The general trend indicated that the patients were on average satisfied with the services that were offered to them by the Ministry of Health centres, hospitals and dispensaries. However this needs to be improved because the score is a minimal fair score. 3.2.9 Recommendations by the Patients about the Health Facilities Respondents were asked if they would recommend the health facility to their friends and other family members and the response was that, 66% of the respondents argued that they could recommend their close people to the various facilities while the remaining 34% argued that they could recommend their family people or friends to these health facilities.

27

When asked to give reasons, over 60% of the respondents said that, they supported the way in which the health facilities have been improved unlike previous days when they were under the national government. Also, the respondents indicated that the county governments has set up new centres, brought electricity and increased the number of medical attendants; some of who are good and understanding than it was in the previous times. It is clear that this response therefore was dominate d by the respondents of ages between 30’s and 50’s who are considered to be the most beneficiaries of the new constitution. The patients recommended that the drugs should be increase as supported by 78% of the respondents, equipment like the x-rays be increased (56%), time for lunch should be having stand shift employees so that no closing of various offices is done (67%), more medical doctors should be added since the ones serving are few (57%), and at the Pharmacy, the attendants should keep better records of the drugs available and when sending someone to buy elsewhere, they should tell the person the prices/the cost of the drug (80%).

4: 0 CONCLUSIONS AND RECOMMENDATIONS

Based on the findings from the field and the figures indicated, the research concludes

that:

4.1 Conclusions

On average, the survey has indicated that the various sections of the county health

providers have not managed to beat time in serving their customers. As much as the

cash payment section has been rated as one of the best in observing time, still the

patients served in less than 10 minutes are still found to be less that 50%.

It has however been noted that the county government through various partnerships

and strategic operations has managed to increase the number of employees

throughout the various sections in the county hospitals, dispensaries and health

centres. The county government has been on a better rating as compared to

neighbours like Tana Delta by increasing the electricity coverage, the development of

infrastructure like necessary buildings (laboratories/wards/resting points),

acquiring necessary equipment and many more.

Due to its better services than it was previously, a greater percentage of the

respondents argued that they can recommend their close people for services in the

health centres. From the field report, 66% of the respondents argued that they could

recommend their close people to the various facilities while the remaining 34%

argued that they could recommend their family people or friends to these health

facilities.

28

4.2 Recommendations

The survey recommends that;

i. The county hospitals should adopt modern systems of keeping records at the

registry points so that the information about the patients can automatically be

generated and avoid the long queues and manual checking of the records of

the patients.

ii. The county government should come up with equipped laboratories with

various equipment of testing various diseases. The x-rays also should be

extended to other points in the county as opposed to two major hospitals. This

shall help in reducing the congestions and times wasted in scrambling for the

services.

iii. The county government should increase the variety if drugs in its store so that

the poor people of Kilifi can be saved of the trouble of being sent to various

point to buy medicine while they are already drained with life demanding

need food and water. The government should callable with other bodies like

donors to get more medicine for its people. ‘Finally the government should

better the health infrastructure, increase the number of employees and

increase the coverage of dispensaries and health centres across the county.

This shall help reduce congestion and eliminate the challenges of wasted time

and services delivery.

29

References

GOK. (20115). National Nutrition Action Plan 2012-2017. Nairobi: Government Printer.

Kilifi County Government. (2015). The County Treasury. Promoting Economic

Transformation for A Shared Prosperity.www.kilificounty.com.

Unite For Sight. (2015). Innovations in Healthcare for Women and Children. Module 15:

http://www.uniteforsight.org/women-children-course/innovation-women-children.

World Bank. (2015). Bulletin of the World Health Organization. 20 Avenue Appia, 1211

Geneva 27, Switzerland.

World Health Organization. (2015). World Health Report 2015. New York.USA.

http://www.uniteforsight.org/women-children-course/innovation-women-children

30

KIMTUX ENTERPRISES LIMITED, BOX 16669 MOMBASA

Contact: 072 713 4649/0725247351/0721246744

_________________________________________________________________________

CUSTOMER (PATIENTS) SATISFACTION SURVEY QUESTIONNAIRE

Dear customer,

The Kilifi County Government Ministry of Health is conducting a Customer Satisfaction Survey

for the financial year 2016/2017. The purpose of this survey is to collect data to determine the

customer satisfaction levels, general perception about the county health services with regards

to service delivery and propose appropriate action plan for addressing the emerging issues for

recommendations and suggestions for interventions and for further improvement where

appropriate. This survey is administered by: KIMTUX ENTERPRISES LIMITED.

The survey is designed to solicit honest and candid feedback from respondents. The

information obtained will be kept confidential and used for the purpose of the survey only.

Please take a few minutes to complete this questionnaire.

Name of Health

Facility………………………………………………………………………………………………..

Service category: General/Maternal care/Children care

1.0 Personal Details

TOTAL

SOLUTIONS

31

1.1 Gender: Male Female

1.2 Age: 0-10 Years 11 – 20 Years 21 – 30 Years 31 – 40 Years

41 – 50 Years 51 –60 Years Above 60 Years

2.0 How much time did it take you to have the first contact with a health center staff on

your arrival in the following areas

a) Patient Registry Section :

0 – 10 min 11 – 20 min 21 – 30 min

31 – 40 min above 45 min

What was your expected waiting time?

.................................................................

Give a reason

........................................................................................................................................................................................

........................................................................................................................................................................................

..................................

b) Triage Section: 0 – 10 min 11 – 20 min 21 – 30 min



32

.................................................................

Give a reason

.............................................................................................................................................................. ..........................

........................................................................................................................................................................................

..................................

c) Examination (Doctor/Physician): 0 – 10 min 11 – 20 min 21 – 30 min



.................................................................

Give a reason

........................................................................................................................................................................................

........................................................................................................................................................................................

..................................

d) Laboratory : 0 – 10 min 11 – 20 min 21 – 30 min 31 – 40 min

above 45 min


.................................................................

Give a reason

........................................................................................................................................................................................

........................................................................................................................................................................................

..................................

e) X-ray : 0 – 10 min 11 – 20 min 21 – 30 min 31 – 40 min

above 45 min


.................................................................

33

Give a reason

........................................................................................................................................................................................

........................................................................................................................................................................................

..................................

f) Pharmacy: 0 – 10 min 11 – 20 min 21 – 30 min 31 – 40 min

above 45 min


.................................................................

Give a reason

........................................................................................................................................................................................

........................................................................................................................................................................................

..................................

g) Cash Payment Office: 0 – 10 min 11 – 20 min 21 – 30 min 31 – 40 min

above 45 min


.................................................................

Give a reason

........................................................................................................................................................................................

........................................................................................................................................................................................

..................................

3.0 The Health facility staff treated me with courtesy and respect

Strongly Disagree Disagree Weakly Agree Agree Strongly Agree

34

4.0 The Health facility staff did explain things to me in a way I could understand


5.0 I was given ample time to discuss my medical problem with the doctor/health officer

or

the nurse


6.0 The Health facility is clean and well maintained?


7.0 Would you recommend this Health facility to your friends and other family

members?

Yes [ ]

No [ ]

Give reasons to support your response

……………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………

…………………..

8.0 What are your recommendations for health center sections above to improve on

their service delivery to the public and stakeholders in general?

i.

35

ii.

iii.

9.0 Indicate the section within the health facility that you are extremely happy about:

i.

ii.

iii.

10.0 State the section within the health facility that needs to improve on:

i.

ii.

iii.

Thank you for your cooperation.

Code number of Enumerator _______________________________________________

Date of data collection _____________________________________________________

Questionnaire serial number ___________________________________________________

customer satisfaction baseline survey report for kilifi county government ministry of health

Documents