Patient satisfaction is an important component of healthcare quality reflecting healthcare provider's ability to meet patient's needs and expectations. In many countries assessment and measurement of patient satisfaction with the health care system is recognized as the key indicator of health care quality which is defined as the “the totality of features and characteristics of a service that bear on its ability to satisfy a given need” [1].

Quality healthcare includes characteristics such as availability, accessibility, affordability, acceptability, appropriateness, competency, timeliness, privacy, confidentiality, attentiveness, caring, responsiveness, accountability, accuracy, reliability, comprehensiveness, continuity, equity, amenities and facilities [2]. Quality is an increasingly becoming an important aspect of health care that is given a priority now a days. Patients have become more aware of quality issues and want health care to become safer and of higher quality where the providers have a moral obligation to provide high-quality and safe care [3].

There are a number of factors that have made it difficult for the health-care industry to achieve customer satisfaction and retention in the last two decades. These include increasing patient awareness and knowledge, new research and innovations in the health-care field, the increasing cost of services and continuous competition among healthcare providers. Yet continuously improving quality to make services more efficient, effective and consumer friendly is not an option but a necessity for health-care providers [4].

An understanding of the factors contributing to satisfaction and attempts to foster those attributes of care, have the potential to gain a return to the health service in the form of more effective use of medication and health service resources and to the individual patient in the form of a faster recovery and a better health outcome [5]. Evaluation of clients’ satisfaction can address the reliability of services or the assurance that services are provided in a consistent and dependable manner [6].

Evaluation of clients satisfaction can address the reliability of services or the assurance that services are provided in a consistent and dependable manner; the responsiveness of services or the willingness of providers to meet clients need; the courtesy of providers; and the security of services and records to keep the best level of confidentiality [6].

Measurement of patient satisfaction plays an important role in the growing push toward accountability among health care providers. Studies on patient satisfaction have a significant role in developing and delivering high quality health care in the hospital with the involvement of patients in the management of their problem and treatment [7-9].

A research done in India tertiary care hospital on 450 OPD attend patients regarding waiting area cleanliness 44.45% patients were unsatisfied. On the same study about adequacy of sitting arrangement and examination and explanation received from doctor 51% and 92% patients were satisfied respectively. This study also shows that nearly about 6% respondents were not satisfied with friendliness and helpfulness of registration [10]. A research conducted in Nigeria on 250 patients regard to pharmacy Services 140 (56.0%) were satisfactory patients, while 108 patients (43.3%) were not satisfied. Reasons given for the dissatisfaction were long delay in serving customers (73.1%), unavailability of certain drugs (13.8%), high cost of drugs (11.1%) and rudeness of staff (1.8%) [11].

This study is aimed to determine clients’ satisfaction level and associated factors toward health care service in Addis Ababa.

Institution-based cross-sectional study was conducted. The study was conducted in Addis Ababa; the capital city of Ethiopia. Administratively, the city is divided in to 10 sub cities and 116 Woredas. The total area of the city is 54,000 hectares. At the time of this study, there were a total of 6 public hospitals, 84 functional public health centers and a total of 7563 health professionals working in Addis Ababa health facilities [3,8].

Sample size was determined by single proportion formula by the following assumptions.

n= (Zα/2)² P (1-P)/d2

Where: n=Sample size required, Zα/2=95% confidence level (1.96), P=Proportion of the problem (0.2), d=Desired precision (5%), considering 10% non-response rate, the total sample size was 275 clients.

All six governmental hospitals under Addis Ababa Health bureau were included. Proportional numbers of study subjects were allocated based on the patient flow of the previous month in each health institution. Random sampling technique was employed among admitted patients from each hospital.

A pretested, structured interview based questioner was used. Client satisfaction questions were related to five domains of care: nurse, Doctors and public health officers communication, physical environment, pain management and medication. Items were scored using a 4-point Likert scales, ranging from strongly disagree, disagree, agree and strongly agree.

Data completeness and consistency was checked by the supervisors and data collectors every day before leaving the institution and throughout the data collection, data entry and analysis. Data was coded and entered into a Microsoft Excel spreadsheet and analyzed with SPSS version 20 software. Frequency distribution and percentage was done for selected variables.

Ethical clearance and approval was obtained from academic and review approval committee of Menelik II health Science College. Permission letter from the Addis Ababa health bureau was obtained to the selected health institutions. The consent of the respondents was asked and the right to refuse to respond to any of the questions or refusal of participation was respected.

A total of 275 study participants were recruited in this study. From these, 164 (59.6%) of them were female clients. One hundred twelve (40.7%) of them were 18-29 years old. Nearly similar numbers of clients, from Gandi hospital 51 (18.5%), Rasdesta hospital 50 (18.2%) and Tirunesh Beijing hospital 50 (18.2%) were included. Moreover clients who were included from Minilik II hospital, Yekatit 12 hospital and Zewditu hospital were 46 (16.7%), 49 (17.8%), 29 (10.5%) respectively (Table 1).

Table 1: Background characteristics, Addis Ababa hospitals, 2016.

Among 275 clients 185 (67.3%) of them strongly agree that nurses treat with courtesy and respect whereas 202 (73.5%) strongly agree that doctors/HO treat with courtesy and respect. Clients who can distinguish health care providers were 123 (44.7%).

Clients who were strongly agree that nurses explain things as they could understands were 159 (57.8%) and who were strongly agree doctors/HO explain things as they understand were 74 (63.3%). Few of them strongly agreed that staffs describe the possible side effects of medications before giving a new medication, 40 (14.6%).

Most clients responded that staffs didn’t discuss with clients what sign to look after discharge from the health facility 177 (64.4%) (Table 2).

Table 2: Level of satisfaction of study participants toward client- health care provider’s communication, Addis Ababa city hospitals, 2016.

Among total study participants, 123 (44.3%) of them satisfied with nurse, doctors and HO communications (Figure 1). Clients who strongly agree that the hospital has a clean environment of facility, quit environment and enough space were 190 (69.1%), 192 (69.8%) & 190 (69.1%) respectively. More than half of them responded that services of health facilities are not expensive, 157 (57.1%) (Table 3).

Figure 1: Satisfaction level of clients toward communication of health care providers in selected Addis Ababa Hospitals, 2016.

Table 3: Client satisfaction toward the health facility services and environment, Addis Ababa hospitals, 2016.

Clients participated in Yekatit 12 Hospital, few of them were satisfied for overall services of the facility 11 (22.4%) whereas clients in Minilik II Hospital, most of them were satisfied for the services 31 (67.4%). Clients who were satisfied for overall health services in Gandi Hospital were 33 (64.7%).

Among six hospitals Minilik II Hospitals had higher clients who were satisfied for overall services 31 (67.4%) (Table 4). From total participants more than half of them were satisfied for overall health services 53% (Figure 2).

Table 4: Clients’’ satisfaction level by health facilities, Addis Ababa, 2016.

Figure 2: Overall clients’ satisfaction level in selected Addis Ababa Hospitals, 2017, Addis Ababa.

This study revealed that 67.3% of study participants strongly agree that nurses treat with courtesy and respect where as 73.5% strongly agree that doctors/HO treat with courtesy and respect. Similarly that a study conducted in Nigeria found that 61.5% of clients were satisfied [12-14] but very less clients were satisfied in a study conducted in Jimma (11.8%) [15].

In this study 42.2% clients responded that they were satisfied with laboratory services. Similarly, 33% of study subjects were satisfied in s study conducted in Kenya [13]. This study showed that the overall satisfaction level of the six hospitals was 53% unlikely the finding in a study conducted in Nigeria was 6.5% [12]. In current study 42% of clients said that they got laboratory investigations in the facility which is lesser than the study conducted in Jimma (92.6 %) [15].

On requested laboratory services majority of patients (70%) satisfied with all the requested laboratory services in the institution this result is similar to a result found at Hawassa and Nigeria 71.2% and 73.2% respectively [16].

In this study, 67.3% of clients strongly agree that nurses treat with respect and courtesy where as a study in Nigeria was 34% [14].

This study found that 53% of clients were satisfied for overall health care services where as in Jimma hospital was 77% [15]. Similarly a study conducted in Mozambic was 55% [17,18]. This finding is higher when it is compared to a study done in Gondar hospital (22%) [19] and in Tigray it was found that the overall satisfaction level of clients was 43.6% [20].

Based on the findings of this descriptive cross sectional study, half of the clients (53%) were satisfied for overall health care services. Nearly half of the clients strongly agree that the health care providers do not describes side effects of new medications before prescribing. Most of clients strongly agree that health care providers do not advice/discuss the possible with their clients about the symptoms/danger signs that may face after they discharged. Among six governmental hospitals, Minilik II hospital had higher clients who were satisfied with overall health care services. Clients participated in Yekatit 12 Hospital, few of them were satisfied for overall services of the facility 11 (22.4%) whereas clients in Minilik II Hospital, most of them were satisfied for the services 31 (67.4%). Clients who were satisfied for overall health services in Gandi Hospital were 33 (64.7%).

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