Characteristics of the respondents
Table 2 summarized the respondents’ demographic characteristics. A total of 21 in-depth interviews were conducted with the health services users (5 males and 16 females). Participants were grouped based on their basic demographic variables, e.g., age, sex, education, religion, experience, and marital status. The majority (n=16/21) of the participants were female compared with 5 male participants with an average age ranging from 20 - 79 years old. Respondents were asked if they were frequent users of the health facility. This data was important, as personal experience of the phenomenon under study was significant to provide an in-depth rich subjective experience of the effectiveness of the health services and problems that may impede the planning and delivery of healthcare services. Five key themes emerged from this study: availability, accessibility, acceptability, quality, and health systems challenges.
Most of the respondents are concerned over the availability of healthcare providers at the health facility to provide the required services. They were concerned that the few health workers at the facility have affected the utilization of basic health services. The responses and the meaning the participants talked about in terms of their perceptions of effective planning and delivery of health services when they were asked the question are presented here with the supporting quotes. Respondents said that the availability of health workers and specific healthcare services were the key interpretation of the respondents’ perceptions of effective planning and health services delivery. The majority of the respondents identified the presence of health workers as an effective element of health services delivery system:
“I suggest that at least two more nurses and a doctor should be employed to provide adequate health services. At the moment, there is no fulltime doctor and that complicated health conditions are referred to the provincial hospital. There are more patients at the hospital and we have to wait for many hours to consult a doctor” (Participant 004).
“An additional nurse should also be recruited to increase the current staff strength. Currently, only one nurse lives inside the campus and takes all emergency cases and when she is absent, there is no-one else to report to particularly during the weekends” (Participant 007)
Some respondents noted that ensuring the availability of adequately trained and competent PHC providers at the health institution is a significant element of health service planning. The respondents’ perceptions of effective healthcare are that the presence of an appropriate number of healthcare providers is of limited benefits if providers are absent from their planned duties or if health services delivery is structured in such a way that patients are unable to access skilled healthcare provider at convenient times.
“I think that the current health workers are very experienced in their work. They do right diagnosis and prescribe correct treatment and you get better. It is good to recruit additional staff but they should also consider their skills and experience like a midwife to provide mothers clinic or Paediatric nurse to attend to our children when they are sick (Participant 007).
Respondents feel that patients can only receive high quality healthcare from competent health workers if those health workers are present in facilities and trained in relevant healthcare. Others shared similar views that even with the availability of large numbers of health workers, inadequately trained and skilled providers will unlikely contribute to individual or community health outcomes.
Findings from the semi-structured interviews revealed that HCWs’ skills and attitudes were influential on their health-seeking behavior. The majority of the respondents’ view accessibility as an indicator of effective health services planning and delivery. Nineteen health services users highly commended the health workers for their positive attitudes, and actions while seeking treatment at the clinic. This approach has established a positive environment for open communication and dialogue between health providers and users. As a result, respondents stressed that they were not ashamed to provide specific details of their medical conditions. On the other hand, the participants are concerned about the cost of healthcare. Respondents highlighted that the high cost of healthcare is a barrier to accessing healthcare for residents of lower socioeconomic status. Participants are concerned that patients coming from disadvantaged settings may not afford the cost of healthcare. Besides, the majority of the participants expressed concerned over the lack of information regarding the operating hours. They emphasized that effective communication to end-users about health services is an element of good management. Participants are concerned that there is no information from the HCWs about how to access clinical services during medical emergencies.
“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).
The cost of some services are expensive, I feel for those that are unemployed and come from squatter settlements” (Participant 016).
“There is not even any form of notice who to contact during emergencies” (Participant 004, 011).
The respondents’ claims indicated that access to comprehensive, quality healthcare services are important for promoting and maintaining disease, reducing unwanted disabilities, and premature death. The healthcare industry is one of the key domains that influence the local population. This study reveals the important role of health professionals and socioeconomic status as narrated by the study respondents. As healthcare expenditure increases and the sector continues to grow, accessibility remains a major concern in many countries, particularly populations with lower socioeconomic status (LSES).
Acceptability of health services
Respondents emphasized the significance of providing health services according to end-users needs and expectations. The design and organization of health care services should be done according to current health and demographic information. In that way, healthcare providers are confident that health services are relevant to the needs of patients. Health services are provided to different segments of the population including men, women, and children. The respondents stressed that health services should be tailored to meet such groups. However, respondents stressed that due to lack of consideration of end-users needs, some vital services such as mother and child health, emergency services, and microscopy are not provided. As a result, some female respondents stressed that their work is affected because they had to care for their sick child at the nearby general hospital.
“We have specialist doctors working part-time 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 take sick leave and nurse them at home or go somewhere else to look for help. The services provide by the public health system is very inefficient” (participant 002).
This situation was largely inefficient, especially from the users’ perspectives. Indeed, the users spend a lot of time travelling to other health settings, had to suffer a great deal of stress queuing at the health facility to get the treatment or see the physicians. Very often the public health facility is overcrowded with patients and they have to wait long hours.
Quality of healthcare
The quality of healthcare is an important indicator of effective health services. The participants in this study associated quality of healthcare with expressions such as best, timely, fast, and good staff behavior. About 17 participants reported that the general level of care given at the clinic is outstanding compared to other public health facilities. Furthermore, another 15 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 stressed that the quality of health services they receive is of a high standard. They are given medical treatment on time with low waiting time at the clinic. The healthcare workers are caring as this is reflected in the level of care given to patients and the 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 is 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).
The above respondents’ narratives generally reflected the core attributes of quality healthcare that is measured by six domains: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability. Healthcare quality remains an important discussion topic for both clinicians and patients36.
Health systems challenges affecting the delivery of health services
Lack of continuity of health services
Most respondents reported that disruptions to health services due to the closure of the clinic were seen as a major barrier to accessing clinical services. Furthermore, the closure has affected the continuity of treatment for the health problems. The majority of the participants consider access to health services from 5pm to 7am, weekends, and public holidays as problematic. Most of the respondents agree that access to health services is difficult during these times. Others, about twelve respondents even reported that there is no contact information on who to consult during emergencies. Interviews with health care providers affirmed that there is no formal arrangement with the university administration for overtime work during these hours as highlighted by the users. As such, they affirm that they don’t work shifts and overtime and no contact information is posted for patients to access health workers. They explain that they are allowed to work from 8 am to 5 pm daily during weekdays and not on weekends and public holidays. Additionally, another HCW noted that employment of a permanent medical officer at the clinic would address the accessibility issues raised by the users.
“Only if you happen to know one of the staff it is easy to call upon them during the weekend” (HCW 001),
“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).
“It need a fulltime medical officer and leader who will plan strategic development of services” (HCWs 002).)
“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).
Continuity of healthcare services has always been a core pillar of PHC services. Health users who receive continuity of care have improved health outcomes, higher satisfaction rates, and the healthcare they receive is more cost-effective36
Inadequate health services infrastructures’
The health services users responded that inadequate health services infrastructure such as a laboratory facility was an impediment to access and using of health services. The participants suffered additional challenges traveling to the pathology for simple blood examinations. The participants expressed disappointment over the absence of other health services. Both healthcare providers and service users expressed a need to start minor blood examinations at the health center. My interview with healthcare providers agree with the patients of setting laboratory facilities to resolve the problem.
“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).
Although a strong infrastructure depends on many institutions, PHC providers are considered key players of essential health services. PHC facilities provide opportunities for health service users to prevent disease, promote health, and respond to both acute and chronic health threats. Infrastructures is the basis for planning, delivering, evaluating, and improving community health5.
Table 2 Summary of generated themes and codes/nodes
Presence of a trained worker
Healthcare services availability
Adequate supply of health workers
Economic accessibility or affordability
Barriers & challenges
Health systems barriers
Planning and management