In total, 21 one-on-one semi-structured interviews with different health services users were performed between April and July 2019. A total of 21 key informants (10 academics, 7 students, 2 administration staff, and 2 student services staff took part in the study. Majority (14/21, 67%) of the participants were female compared with 7 male participants with an average age ranging from 20 - 79 years old. Several key themes related to effective health services planning and management emerged from this study.
Theme 1: General perceptions towards effective health services
Participants viewed accessibility to health basic health services as an important concept of effective health services delivery. The semi-structured interviews with key informants indicated that the lack of accessibility to health services is a barrier to good health outcome. They argue that the absence of health services such as basic laboratory facilities at the clinic is stressful and affected their health seeking behaviour.
“I suggest that the pathology section to check for Malaria parasites be available here at the clinic instead having patients walk all the way to Paramed for check-up then back to the clinic to get medication” (Participant 001).
The availability of health services for those in need is an indication of effective health services. Participants point out that health services are effective when essential health services are available at the health facility and are able to access their services when they are sick. All (100%, 21/21) the participants complained that availability of health services after hours, from 5pm to 7am, weekends and public holiday is actually difficult. About 81% (17/21) of the participants suggested that it is necessary to consider putting some form of information about who to consult during these times. About three (3,14%) participants reported that even students find it easy to use the services. Despite these setbacks, they all concur that the health services provided are of high quality.
“A doctor must be available on site 5 days a week and must be available after hours and during weekends for emergency services. “Not all of our families and us have vehicles to move. Going to Pharamed campus for tests is not as easy as what many think. Total inconvenience” (Participant 004), “There is not even any form of notice who to contact during emergencies” (Participant 004, 011).
Theme 2: Health Workers conduct and attitude towards patients
Findings from the semi-structured interviews reveal that health care workers’ (HCWs) professionalism and attitude was influential on their health seeking behaviour. Nineteen (19, 99%) health services users highly commended the health workers for their positive attitudes, and actions while seeking treatment at the clinic. They maintained that the health workers are easily approachable and relate well to patients when they are at the clinic. Majority (99%) of the interviewees showed much more positive attitudes towards HCWs. About 10% (2/21) of the interviewees perceived that HCWs positive attitudes’ and friendly towards patients has developed trust and motivated them to seek medical help at the clinic. They maintained that the trust between the health staff and patients play an important role to accessing health services. The interviewees emphasise that because of the staff positive attitude, they are open to provide their full medical problems without fear of stigma and discrimination.
“Services provided is superb! Staff are very helpful” (Participant 001). “I trust the nurses so I want to tell them about all my health problems, because I know they will help me” Participant 0020). “The clinic is convenient for me to access and also it has excellent team of clinical staff. The clinic has a friendly receptionist who is also very helpful. Most of the times, I book in to see medical doctors who are polite, professional and provide the best care and advice. On few times, I had appointment with the nursing staff. In addition, nursing staff are knowledgeable and provide best care. I have no negative comments but praises” (Participant 006).
Theme 3: Health workers’ skills and expertise
The participants in this study viewed health workers’ skills and expertise as animportant element of effective health services. The health workers’ expertise and skills are key to proper diagnosis of medical conditions and prescribing appropriate treatment. About 19% (4/21) of the participants reported that the nurses are very knowledgeable and make accurate diagnosis and prescribed right treatment.
Participants’ experiences reveal that healthcare practitioners’ knowledge, experiences and skills are also an important aspect of good health services management. The participants highly commended the health workers for their expertise in the clinical management of health problems. Adequate training and education of health workers’ problem a key role and may lead to improved health outcomes of those in need. The results from the participants’ experiences affirm that right diagnosis and treatment are results for adequate training and education of health professionals. Three participants said this about HCWs knowledge and skills:
“On few times, I had appointment with the nursing staff. Also, nursing staff are knowledgeable and provide best care. I have no negative comments but praises” (Participant 006). “…she is very knowledgeable and well inform of and her diagnosis is accurate” (Participant 007). “…treatment given also is effective, meaning you get healed once the staff start you on treatment for whatever condition you present to them” (Participant 008).
In contrast, they argue that the absence of specialist nurses and doctors is a barrier to effective health services. They contended that they needed technical information to manage certain health problems. They cited the absence of a pediatrician as limitation to quality health services. One participant said this about the unavailability of specialist medical officers: “We have specialist doctors on campus except a Pediatrician – we have so many children especially babies on campus and if we had a Pediatrician, it would be very good for us. Babies need special care and special attention and it is vital we have a specialist for children on campus. When my baby gets sick, I do not work and this affects my students, especially those of us who are teaching. With advice from a pediatrician we will feel that our babies are okay and that we can go to work otherwise, we stake sick leave and nurse them at home or go somewhere else to look for help” (participant 002).
Theme 4: Level of care
The quality of healthcare is an important indicator of effective health services. Different users can define quality in the healthcare systems. However, from the users’ perspective in this study, quality healthcare means best, timely, fast and good staff behaviour. About 81% (17/21) of the participants reported that the general level of care given at the clinic are outstanding compared to other public health facilities.
Furthermore, 76% (15/21) participants reported that they have no major problems accessing health services and consulting health workers to seek medical treatment. Additionally, they feel comfortable talking to staff, as they are responsive to their needs. The participants stated that the quality of health services they receive is of a high standard. They said that they are given medical treatment on time and do not wait longer at the clinic. The healthcare workers are caring as this is reflected in the level of care given to patients and high rate of recovery after taking the prescribed treatment. One participant said that:
“Services provided at clinic are the best by any standard as far as PNG’s public health care system is concerned. Best in the sense that service are provided on time, patients do not wait on long queues, staff are friendly and polite and they talk to you nicely. Treatment given also is effective, meaning you get healed once the staff start you on treatment for whatever condition you present to them” (Participant, 008).
Theme 5: Health systems challenges affecting the delivery of health services
The information below outlines challenges affecting the delivery of health services based on the survey and interview data collected from the key informants.
Sub-Theme 5.1 Lack of continuity of health services
The survey of semi-structured interview results show that majority of the participants perceived access to health services from 5pm to 7am, weekends and public holidays is problematic. As shown in graph 2, about 67% (14/21) of the interviewees strongly agree while 19% (4/21) also agree that access to health services is difficult during these times. Others, about 56% (12/21) even reported that there is no contact information about who to consult during emergencies. HCWs affirmed that there is no formal arrangement with the university management/administration for them to work after the normal working hours, for instance, 5pm – 7am, weekends and public holidays. As such, they affirm that they do not work shift and overtime and no contact information is posted for patients to access health workers. They explain that their employment contract allow them to work from 8am to 5pm daily during weekdays and not on weekends and public holidays. They iterated that when either sick patients staff from the university or students approached them, they make a decision to attend or not to attend. Another health worker maintains that developing good public relations with a health worker may make is possible to contact him/her on weekends. Additionally, another HCW noted that employment of a medical officer at the clinic to provide the strategic directions of the health services might address the lack of accessibility of health services.
“Only if you happen to know one of the staff it is easy to call upon them in the weekend” (HCW 001),
“It need a part-time medical officer and leader who will plan strategic development of services” (HCWs 002).
“I sign the contract to work from 8 o’clock am to 5 o’clock pm from Monday to Friday. I am not allowed to work after hours, weekend and on public holidays. But I do help patients when they come to my house as part of my community services since I started work here” (HCW 001)
“Sadly, we do not have an emergency number that we can call in emergency. And we also do not know if a clinic staff/ or doctor available for assistance in emergency after hours and on weekends” (Participant 008).
Sub-Theme 5.2: Inadequate health services infrastructures’
Inadequate health services infrastructure is another important factor affecting the delivery of health services. The survey found that the lack of laboratory services at the clinic has affected the effectiveness of health services management. About 52% (14/21) strongly agree that the lack of access to laboratory services is a major barrier to effective health service. In addition, employment and availability of specialist medical doctors also contribute to effective health services delivery. About 45% (9/21) of the participants perceived inadequate specialist doctors as a barrier to quality health services. A further 35% (7/21) of the participants reported that lack of appropriate health services is an obstacle. Interviews with the key informants indicated that patients are frustrated due to lack of laboratory services. The participants noted that it is time-consuming travelling to the pathology for simple blood examinations. The perceptions of key informants were based on their personal experiences of trying to access health services at the clinic and expressed disappointed over the absence of basic health services. My interview with healthcare providers agree with the patients and suggested that the clinic should start with some basic blood examination.
Furthermore, one participant perceived that there is an increased number of referral to the pathology due to the absences of laboratory services.
“In terms of laboratory services, start with malaria microscopy. As this is the most common lab investigation ordered by officers at the clinic and clients have to go all the way to Paramed to do the test and bring the results back down to the clinic. It is a very time consuming exercise” (HCW 005).
“I suggest that the pathology section to check for Malaria parasites be available here at the clinic instead having patients walk all the way to Paramed for check-up then back to the clinic to get medication” (Participant 001).