title: Patient satisfaction with task shifting of antiretroviral services in Ethiopia: implications for universal health coverage.
abstract: Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have largely ignored the patient perspective, focusing on health outcomes and acceptability to health care providers and regulatory bodies, despite studies worldwide that have shown the significance of patient satisfaction as an indicator of quality. This study aimed to measure patient satisfaction with task shifting of antiretroviral services in hospitals and health centres in four regions of Ethiopia. This cross-sectional study used data collected from a time-motion study of patient services paired with 665 patient exit interviews in a stratified random sample of antiretroviral therapy clinics in 21 hospitals and 40 health centres in 2012. Data were analyzed using f-tests across provider types, and multivariate logistic regression to identify determinants of patient satisfaction. Most (528 of 665) patients were satisfied or somewhat satisfied with the services received, but patients who received services from nurses and health officers were significantly more likely to report satisfaction than those who received services from doctors [odds ratio (OR) 0.26, P < 0.01]. Investments in the health facility were associated with higher satisfaction (OR 1.07, P < 0.01), while costs to patients of over 120 birr were associated with lower satisfaction (OR 0.14, P < 0.05). This study showed high levels of patient satisfaction with task shifting in Ethiopia. The evidence generated by this study complements previous biomedical and health care provider/regulatory acceptability studies to support the inclusion of task shifting as a mechanism for scaling-up health services to achieve universal health coverage, particularly for underserved areas facing severe health worker shortages.
authors.affiliation: Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037.
authors.forename: Elias
authors.initials: E
authors.lastname: Asfaw
authors.affiliation: Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037 Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037 sarah_dominis@abtassoc.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dominis
authors.affiliation: Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037.
authors.forename: John G H
authors.initials: JG
authors.lastname: Palen
authors.affiliation: Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037.
authors.forename: Wendy
authors.initials: W
authors.lastname: Wong
authors.affiliation: Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037.
authors.forename: Abebe
authors.initials: A
authors.lastname: Bekele
authors.affiliation: Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037.
authors.forename: Amha
authors.initials: A
authors.lastname: Kebede
authors.affiliation: Ethiopian Health and Nutrition Research Institute (EHNRI), P.O. Box 1242, Addis Ababa, Ethiopia, Abt Associates Inc., 4550 Montgomery Avenue, Bethesda, MD 20814, USA and U.S. State Department, Office of Global AIDS Coordinator, 2100 Pennsylvania Ave NW, Suite 200, Washington, DC 20037.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Johns
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017060:Patient Satisfaction; D019472:Universal Health Insurance; D035862:Vulnerable Populations
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Africa; Ethiopia; HIV; antiretroviral services; attitudes; developing countries; health care utilization; health professionals; health systems research; health workers; health workforce; human resources for health; international health policy; labour market; patient satisfaction; patients; people-centred health systems; task sharing; task shifting; universal health access; universal health coverage; workforce shortages