Health system responsiveness and associated factors among outpatients in primary healthcare units in Southern Ethiopia: a facility-based cross-sectional study.

Abstract

To assess the level of health system responsiveness (HSR) and its associated factors among outpatients attending primary healthcare units (PHCU) in Arba Minch, South Ethiopia. Facility-based cross-sectional study. Three PHCUs (one primary hospital and two health centres) in Arba Minch town, Southern Ethiopia. A total of 379 outpatients aged 18 years and above were selected using a systematic random sampling. <i>Primary outcome</i>: level of HSR, measured across seven domains (communication, confidentiality, basic amenities, dignity, choice, prompt attention and autonomy) using a 28-item tool adapted from the WHO HSR framework. <i>Secondary outcome</i>: factors associated with HSR, identified via bivariate and multivariable linear regression. The overall HSR was 59.4%. The highest-performing domains were confidentiality (73.9%) and dignity (70.7%), while the choice of healthcare provider was rated lowest (34.6%). In multivariable linear regression analysis, factors significantly associated with HSR score were travel time to reach the health facility on foot (β = -0.26, 95% CI -0.37 to -0.14); out-of-pocket payment for transport (β = -6.51, 95% CI -8.33 to -4.70); patient satisfaction score (β=1.57, 95% CI 1.27 to 1.88) and perceived quality of healthcare score (β=0.32, 95% CI 0.14 to 0.49). HSR among outpatients in PHCU was moderate, with several individual and service-related factors associated with patient experiences. These findings suggest the need for focused interventions to improve responsiveness domains, although more research is required to demonstrate causal relationships.