International Digital Organization for Scientific Research IDOSRJES101

Abstract

This study aimed to examine the factors that affect quality of health services in Kakindo Health Center IV in Kakumiro District. The study used a cross-sectional design using a quantitative approach on the population which was under study. Data was collected using questionnaires, processed in excel, and word using SSP software for correlation purposes. The study found a high significant relationship between health-related factors, health worker related factors and quality of health service delivery. Patient related factors had a low significance. The study concluded that the quality of health services depends on the level to which the management of the facility provides the employees with a conducive work environment. appropriate knowledge and skills, and positive attitude of health workers towards patients was emphasized. health workers were argued to carry out daily patient education in order to change their traditional beliefs. Grading the facility to a level of Hospital this would help to build more infrastructure for both patients and staffs, for security of both patients and staff, the facility needs tapped water so that staff can access clean water inwards, especially the paediatric ward, theatre, general ward, outpatient department, A R T Clinic Cold chain unit and a few staff quarters. A proper fence must be put constructed at the facility.

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International Digital Organization for Scientific Research IDOSRJES101.5068.24
IDOSR JOURNAL OF EXPERIMENTAL SCIENCES 10(1): 50-68, 2024.
https://doi.org/10.59298/IDOSR/JES/101.5068.1724
Factors Affecting Quality of Health Care Services in
Government Facilities in Kakindo Health Centre IV in
Kakumiro District
Semambo Nathan
Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus Uganda.
ABSTRACT
This study aimed to examine the factors that affect quality of health services in Kakindo Health Center IV in
Kakumiro District. The study used a cross-sectional design using a quantitative approach on the population which
was under study. Data was collected using questionnaires, processed in excel, and word using SSP software for
correlation purposes. The study found a high significant relationship between health-related factors, health
worker related factors and quality of health service delivery. Patient related factors had a low significance. The
study concluded that the quality of health services depends on the level to which the management of the facility
provides the employees with a conducive work environment. appropriate knowledge and skills, and positive
attitude of health workers towards patients was emphasized. health workers were argued to carry out daily
patient education in order to change their traditional beliefs. Grading the facility to a level of Hospital this would
help to build more infrastructure for both patients and staffs, for security of both patients and staff, the facility
needs tapped water so that staff can access clean water inwards, especially the paediatric ward, theatre, general
ward, outpatient department, A R T Clinic Cold chain unit and a few staff quarters. A proper fence must be put
constructed at the facility.
Keywords: Health service, Health workers, Patients, Delivery, Staff.
INTRODUCTION
The study examined the factors affecting the quality
of health services at Kakindo Health Centre IV in
Kakumiro District. The health facility, health
workers, and patient factors were the independent
variables, while the quality of health services delivery
was the dependent variable of the study. This chapter
describes in detail the background of the study, the
statement of the problem, the general objectives of
the study, the specific objectives, research
questions, t h e research hypothesis, t h e scope of
the study, t h e significance of the study,
justification and the conceptual from work. There is
great concern about the quality of health services in
hospitals across the world. Varying deficiencies in the
quality of health services have been evident in both
developed and developing countries, especially in
Africa. The quality of health services is still low in
terms of the doctor-patient ratio, supply of drugs,
medical tools and equipment for diagnosis services
and access to health services in terms of long-
distance move by patients to the hospitals [1, 2, 3].
Quality of health service delivery determines the
level of utilization of the hospital facility by patient’s
treatment. Governments in both developed and
developing countries have become interested in the
need to improve the quality of health services. There
is also a very minimal participation of the community
in health services because of limited resources [4].
The funding for health services in African countries
is mostly dependent on donor funds from developed
countries. Over 50% of health sector funds are from
developed countries. This is also reflected in the
Poverty Eradication Action Plan (PEAP 2004-2005)
[5]. As a result, the health sector in Uganda still has
a challenge of achieving the global health objective of
ensuring high-quality health service which can
indicate a high recovery rate after treatment [6, 7, 8].
Thus, there is a need to monitor and evaluate the
quality of health service delivery for quality
assurance and put in place supportive actions through
supervision of health services in health centers.
Kakindo Health Centre IV was started in 1945
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initially at the dispensary level. It used to provide a
minimum of health services such as immunization of
children for the six killer diseases, and first aid
treatment for malaria, cough and flu. In 1986 the
facility was upgraded from a dispensary to Health
Centre Three with additional services including
antenatal and, maternity, and finally, it became
Health Centre IV in the year 2000 with the
construction of the theatre which led to major
operations like caesarian section to be done there.
Construction of the mother's waiting shade was done
in 2013 by I D I and S M G L, Construction of the
pediatric ward was also completed in the year 2014
with a total bed capacity of sixteen beds, by World
Vision Uganda. Other services offered include dental
services, nutritional services, R C T, O P D, In-
patient, and laboratory services. The health centre
serves a collection area with an estimated population
of more than one hundred thousand (100,000) people
with only 49 health providers currently and yet there
is a great concern about the low quality of health
services this facility provides to the community in
terms of long waiting hours before getting the
service, inadequate medicines, unavailability of
essential medicines among others. The study used
Herzberg’s motivation–hygiene theory to
analyze the factors affecting t h e quality of
health service at Kakindo Health IV. The
theory assumes that human beings operate at
two levels, the physical and psychological
levels. The psychological level which includes the
inmate motivation aspect of man influenced by
several factors among which include achievement,
recognition, work itself,
responsibility,
advancement and growth. This theory further
considered the hygiene factors that were physical to
human beings such as institutional policy and
supervision, relationship with supervisors, working
conditions, relationship with subordinates, status in
society and security of the job and personal property
[9]. At the psychological level, motivation to
improve performance is linked to a feeling of self-
fulfillment, achievement and recognition. These
feelings can be influenced by providing quality
services. The quality of service involves customer
care to clients, teamwork and a conducive working
environment to ensure that staff are motivated to
satisfy patient’s needs. At a large socio- cultural level,
motivation factors can include Relationships between
co-workers, and clients, support from community
leaders and perception of community members
concerning services [10].
Statement of the problem
The provision of quality health service is vital and a
matter of great concern to the whole world. The
perception of the community towards quality health
services is aligned on the availability, sustainable,
timely, patient oriented of affordable health services in
health facility. Kakindo Health Centre IV handles
complicated medical and surgical cases including
those from the community around it and referrals
from other health Centers such as Nyarweyo Health
centre three, Kisiita Health Centre three, Kasambya
Health Centre three, Birembo Health Centre three,
Kasenyi Health Centre three, Kigando health Centre
three, Igayaza and masaka health Centre three and
many others from private health facilities. While
efforts were made to ensure supply of drugs and
some medical equipment to use in the facility,
employment of skilled medical and nonmedical
workers as well as improved remunerations, the
quality-of-service delivery was still low. The
community was concerned about the long waiting
period by the patient before access to health services,
unfriendly interpersonal relations between health
workers and patients and the shortage of drugs in the
facility, failure to get treatment or patients being told
to go and buy certain drugs, others being referred to
other facilities due to lack of certain treatment and
others dying due to lack of proper management.
There is no study done at kakindo health Centre iv to
find out factors affecting quality of health care but it’s
believed that the quality of health services is still
lacking. It was against this back ground the
researcher set to the field in order to find out what
were factors affecting the quality of health service
delivery at Kakindo Health Centre IV.
METHODOLOGY
Study Design
A cross sectional descriptive study [11] using
quantitative methods was used to assess the factors
that were affecting the quality of health service
delivery at kakindo health Centre IV. The factors in
question were, environmental factors, attitude,
knowledge and practices, of health workers at
Kakindo Health Centre IV. This design was used
because it was easy for the researcher to be able to
quantify data from health workers by use of
structured interviewed questionnaire.
Area of Study
The study was conducted at Kakindo Health Centre
IV Kakumiro District which is a government Health
Facility. It is approximately 50 kilometres from the
District Headquarters and 340 Kilometers from
Kampala Capital City of Uganda located in South
Western of Uganda Bunyoro Region. The area has
relatively flat Land with gentle slopes with fertile
soils with the majority of the population being

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peasant farmers, who are also Banyoro, Bakiga,
Basoga, Banyankole, Banyalwanda tribes there. The
facility currently serves a population of 500 patients
per day and with the total number of staff equaling
49 these include medical officers, clinical officers,
Nursing officers, Laboratory technicians and
technologists, Lab Assistants, Theatre Assistants,
among others.
Study Population
The study was conducted among all the staffs
working at Kakindo Health Centre IV.
Sample Size Determination
Estimation of the sample size was determined
statistically using [12] statistical method below
n = X2NP (1-P)
d2 (N-1) + X2P (1-P)
Where;
n= desired sample size,
X2 = the table value of chi-square for 1 degree of
freedom at the desired confidence level 1.962.
N = the population size,
P = the population proportion (assumed to be 48 since
this would provide the maximum sample size) and
d = the degree of accuracy expressed as a proportion
(0.5).
n= (1.96)2 X 50 X 0.5 X (1-0.5)
(0.05)2 X (50-1) + (1.96)2 X 0.5 X (1-0.5)
Where;
n = 44 participants were selected.
Sampling Procedure and Rationale
A Convenience sampling technical is a type of non –
probability or non–random sampling where members
of the target population that meet certain practical
criteria, such as easy accessibility, geographical
proximity, availability at a given time, or the
willingness to participate were included for the
purpose of the study. It was important in this study
because it gave time for the participants to carry out
with their normal duty hence good results were
generated as both interviewer and interviewee were
not under tension.
Inclusion Criteria
The study included all health workers at Kakindo
Health Centre IV who were available and consented.
Exclusion Criteria
The supporting staff of Kakindo health, all health
workers who were from Kakindo health Centre iv,
and all staff of Kakindo health centre iv who did not
consent, were excluded from the study.
Definition of Variables
Independent variables were the health facility
environmental factors, attitude, knowledge and
practices of health workers. The dependent variable
was the quality of health service delivery.
Research instruments
These included structured questionnaires.
Data collection procedure
A Questionnaire was issued to each respondent after a
thorough explanation of all the steps to follow. All
completed questionnaires were collected by the
researcher from the participants.
Data management
Data was managed to maintain the maximum level of
confidentiality of information collected from each
participant. Un Authorized Personnel were not
allowed to access data. Data was collected during the
day to ensure safety.
Data Processing and Analysis
The filled questionnaires were checked at the end of
each day by the researcher to ensure completeness
and accuracy. Data collected was processed and
analyzed using Microsoft word 2010, Microsoft
Excel, and calculators and presented in a descriptive
form of pie charts, and tables using the SPSS system.
Ethical Considerations
The researcher obtained an introductory letter from
Kampala International University western compass,
faculty of clinical medicine and dentistry, introducing
him to the in charge of Kakindo Health Centre IV as a
fifth-year medical student, requesting for permission
to conduct his research. The researcher obtained
permission from the facility in charge which made
him to reach the respondents for data collection. All
participants were given a consent form and signed
before the process of data collection. All participants
were assured of confidentiality. In case one wanted to
stop from participating for any reason, he or she was
not stopped [13].

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Key
45.50
%
54.50
%
Male
Female
RESULTS
Biodemographic Data
Figure 1: Age of respondents
Results represented from the figure above show that
the majority (34.1%) of respondents were aged
between 18-30, followed by the age group 41-50
(29.5%), then followed by the age group 31-40
(25.0%), and the minority of the respondents (11.4%)
belonged to 51 years and above. These results indicate
that the health facility consists of young and
energetic health workers, with the highest proportion
falling within the age group of 18-30. Younger health
workers often bring fresh perspectives, up-to-date
knowledge, and enthusiasm for their roles, which can
positively impact the quality of health care service
delivery at Kakindo Health Centre IV, Kakumiro
District.
Figure 2: Respondent’s gender
40.00%
35.00%
34.10%
30.00%
29.50%
25.00%
25.00%
20.00%
15.00%
11.40%
10.00%
5.00%
0.00%
18-30
31-40
41-50
51 and above
Age of respondents
Percentage

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Results represented from the figure above show that
the gender distribution of respondents was such that
45.5% of them were male and 54.5% were female.
These results indicate that the study had a relatively
balanced representation of both genders. This gender
balance suggests that the study considered
perspectives from both males and females,
contributing to a more comprehensive understanding
of the healthcare service delivery dynamics.
Figure 3: Marital status of the respondents
The figure above shows the marital status
distribution of the respondents in the study. Among
the participants, 45.5% were married, 34.1% were
single, 11.4% were divorced, and 9.1% were widowed.
The results demonstrate a diverse representation of
marital statuses among the respondents, which
allows for a comprehensive analysis of factors
affecting the quality of health care service delivery at
Kakindo Health Centre IV, Kakumiro District,
considering the perspectives of individuals in different
marital situations.
15.00%
Marital status
Widowed
Divorced
Single
Married
0.00%
5.00%
9.10%
10.00%
11.40%
20.00%
25.00%
30.00%
34.10%
35.00%
40.00%
45.00%
45.50%
50.00%
Percentage

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22.70%
36.40%
Key
Catholic
Anglican
Muslim
Born again
18.20%
22.70%
Figure 4: Religion of the respondents
The figure above presents the distribution of
respondents' religious affiliations in the study. Among
the participants, 36.4% identified as Catholic, 22.7%
as Anglican, 18.2% as Muslim, and another 22.7%
identified as "Born again." The results highlight the
religious diversity among the respondents, which is
essential for understanding the impact of religious
beliefs and practices on factors affecting the quality of
health care service delivery at Kakindo Health Centre
IV, Kakumiro District.
Figure 5: Education level of the respondents
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
36.40%
38.60%
15.90%
9.10%
Certificate Diploma
Bachelors
Education level
Masters
Percentage of respondents

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The figure above illustrates the education level
distribution of the respondents in the study. Among
the participants, the majority (38.6%) held a Diploma,
followed closely by those with a Certificate (36.4%).
In comparison, a smaller proportion had a Bachelor's
degree (15.9%), and the minority of the respondents
(9.1%) held a Master's degree. The results reveal a
diverse range of educational backgrounds among the
participants, with the majority having completed a
Diploma, which is crucial for understanding how
different levels of education may influence the
perception and utilization of health care services at
Kakindo Health Centre IV, Kakumiro District.
Health Facility Related Factors Affecting Quality Health Care Service Delivery
Table 1: Health-facility related factors affecting quality health care service delivery
Statement
Strongly
Agree
Agree
Disagree
Strongly
Disagree
The health center has enough buildings to
accommodate patients
and staff.
Freq
9
14
19
2
(%)
20.5
31.8
43.2
4.5
There are enough seats and waiting areas for
patients at the health center.
Freq
6
17
20
1
(%)
13.6
38.6
45.5
2.3
The health center has enough beds and
mattresses for patient care.
Freq
9
12
22
1
(%)
20.5
27.3
50.0
2.3
There are enough wards to provide
appropriate patient isolation and care.
Freq
5
24
13
2
(%)
11.4
54.5
29.5
4.5
The health center provides accommodation
for its staff, if
necessary.
Freq
14
19
10
1
(%)
31.8
43.2
22.7
2.3
The noise level at the health center is
controlled and conducive to healing.
Freq
2
24
15
3
(%)
4.5
54.5
34.1
6.8
The health center has a reliable source
of water for various purposes.
Freq
1
21
18
4
(%)
2.3
47.7
40.9
9.
Freq
8
14
19
3
The health center premises are properly
fenced for security and
privacy.
(%)
18.2
31.8
43.2
6.8
The health centre is accessible to people with
disabilities.
Freq
7
24
12
1
(%)
15.9
54.5
27.3
2.3
The health centre maintains a clean and
hygienic environment.
Freq
4
20
19
1
(%)
9.1
45.5
43.2
2.3

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The majority of the respondents (43.2%) disagreed
that the health centre has enough buildings to
accommodate patients and staff. This might be
because the health centre is facing increased demand,
and the current infrastructure may not be sufficient to
meet the growing patient population. On the other
hand, 20.5% of respondents strongly agreed,
indicating that while some recognize the limitations
in the existing infrastructure, they still acknowledge
that the health centre is making efforts to manage the
available buildings. The highest number of
respondents (38.6%) agreed that there are enough
seats and waiting areas for patients at the health
centre. This positive response may indicate that the
health centre has adequate facilities to accommodate
patients while they wait, leading to a more
comfortable experience. Conversely, the lowest
percentage of respondents (2.3%) strongly disagreed,
suggesting that there is at least a small portion of
respondents who feel strongly dissatisfied with the
seating and waiting arrangements, possibly due to
overcrowding or poor seating conditions. The
highest number of respondents (50.0%) strongly
disagreed that the health centre has enough beds and
mattresses for patient care. This indicates a critical
issue with the availability of beds, which could lead
to compromised patient care and comfort. On
the other hand, 27.3% of respondents agreed,
suggesting that some recognize that there might be a
shortage, but the health centre still manages to
accommodate patients to some extent. The majority
of the respondents (54.5%) agreed that there are
enough wards to provide appropriate patient isolation
and care. This suggests that the health center is
making efforts to maintain proper isolation facilities,
especially during contagious disease outbreaks. In
contrast, the lowest percentage of respondents
(11.4%) strongly disagreed, indicating that a
minority of respondents perceive that the health
center does have adequate wards for patient isolation,
possibly due to real issues with insufficient isolation
wards or a lack of awareness among some
respondents about the availability of such facilities.
The highest number of respondents (43.2%) agreed
that the health centre provides accommodation for its
staff if necessary. This positive response suggests
that the health centre takes care of its staff's
accommodation needs, which can be beneficial in
attracting and retaining healthcare professionals.
Conversely, the lowest percentage of respondents
(2.3%) strongly disagreed, indicating that only a
small portion of respondents believe that the health
centre does not provide staff accommodation when
necessary. The reasons for this response could be
limited availability of staff accommodation or
dissatisfaction among some staff members. The
majority of the respondents (54.5%) agreed that the
noise level at the health centre is controlled and
conducive to healing. This suggests that the health
centre has implemented measures to maintain a
peaceful environment for the patient's well-being and
recovery. However, only a small minority (4.5%)
strongly agreed, indicating that some respondents
feel there is still room for improvement in providing
an optimal noise-free environment for healing. The
highest number of respondents (47.7%) agreed that
the health centre has a reliable source of water for
various purposes. This positive response suggests
that the health centre ensures a consistent water
supply, which is crucial for maintaining hygiene and
patient care. On the other hand, the lowest
percentage of respondents (2.3%) strongly disagreed,
indicating that only a small minority believe that the
health centre lacks a reliable source of water, which
could be due to isolated incidents or specific periods
of water supply disruption. The majority of the
respondents (43.2%) disagreed that the health centre
premises are properly fenced for security and privacy.
This suggests that many respondents believe that the
health centre needs to improve its security measures
to ensure the safety and privacy of patients and staff.
Conversely, 18.2% of respondents agreed, indicating
that while the health centre has taken some security
measures, there are still areas for improvement. The
majority of the respondents (54.5%) agreed that the
health centre is accessible to people with disabilities.
This indicates that the health centre has made efforts
to ensure it is inclusive and accessible for all patients,
regardless of their disabilities. On the other hand,
only a very small minority (2.3%) strongly disagreed,
suggesting that there might be specific instances of
difficulty faced by individuals with disabilities, but
overall, the majority of respondents acknowledge the
centre's efforts towards accessibility. The highest
number of respondents (45.5%) agreed that the
health centre maintains a clean and hygienic
environment. This suggests that the majority of
respondents are satisfied with the cleanliness
standards at the health centre. However, only 9.1% of
respondents strongly agreed, indicating that there
might be some room for improvement in the health
center's cleanliness and hygiene practices. Overall,
the agreement shows that the health center is making
efforts to provide a clean environment for patients.

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Health-Worker Factors Affecting Quality Health Care Service Delivery
Table 2: Health worker-related factors affecting Quality health care service delivery
Statement
Strongly
Agree
Agree
Disagree
Strongly
Disagree
The health workers at the facility
demonstrate sufficient medical
knowledge and expertise.
Freq
4
17
21
2
(%)
9.1
38.6
47.7
4.5
The health workers show empathy
and respect towards patients' concerns and
needs.
Freq
8
14
14
8
(%)
18.2
31.8
31.8
18.2
The health workers actively involve
patients in the decision-making
process.
Freq
3
18
22
1
(%)
6.8
40.9
50.0
2.3
The health workers communicate
clearly and effectively with patients.
Freq
10
16
17
1
(%)
22.7
36.4
38.6
2.3
The health workers maintain a
professional attitude and behavior at all
times.
Freq
17
9
15
3
(%)
38.6
20.5
34.1
6.8
Freq
10
13
14
6
The health workers are skilled in accurately
diagnosing medical
conditions.
(%)
22.7
29.5
31.8
13.6
The health workers provide clear
explanations of medical conditions
and treatment options.
Freq
11
13
12
8
(%)
25.0
29.5
27.3
18.2
The health workers maintain
confidentiality and privacy in
patient interactions.
Freq
8
26
10
0
(%)
18.2
59.1
22.7
0.0
The health workers regularly update their
medical knowledge and skills.
Freq
2
21
12
9
(%)
4.5
47.7
27.3
20.5
The health workers ensure continuity of
care and provide adequate follow-up.
Freq
5
23
13
3
(%)
11.4
52.3
29.5
6.8

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The majority of the respondents (47.7%) disagreed
that the health workers at the facility demonstrate
sufficient medical knowledge and expertise. This
suggests that a significant number of respondents
have concerns about the level of knowledge and
expertise displayed by the health workers.
Conversely, 38.6% of respondents agreed, indicating
that some respondents are satisfied with the medical
knowledge and expertise demonstrated by the health
workers. The highest number of respondents (31.8%)
agreed that the health workers show empathy and
respect towards patients' concerns and needs. This
indicates that a considerable portion of respondents
perceive that the health workers treat patients with
empathy and respect. However, the same percentage
of respondents (31.8%) disagreed, suggesting an equal
number of respondents have a different experience,
possibly feeling that the health workers lack empathy
and respect. The majority of the respondents (50.0%)
disagreed that the health workers actively involve
patients in the decision-making process. This
indicates that many respondents feel that patients are
not adequately involved in their treatment decisions.
On the other hand, 40.9% of respondents agreed,
suggesting that some patients do experience active
involvement in the decision-making process. The
highest number of respondents (38.6%) disagreed that
the health workers communicate clearly and
effectively with patients. This suggests that a
significant portion of respondents feel that the health
workers' communication is lacking. On the other
hand, 36.4% of respondents agreed, indicating that
some patients do experience clear and effective
communication with health workers. The majority of
the respondents (38.6%) strongly agreed that health
workers maintain a professional attitude and
behaviour at all times. This indicates that a
significant number of respondents perceive the health
workers as consistently displaying professionalism.
Conversely, 20.5% of respondents disagreed,
suggesting that some respondents have observed
unprofessional behaviour among health workers. The
highest number of respondents (31.8%) disagreed
that the health workers are skilled in accurately
diagnosing medical conditions. This suggests that a
considerable portion of respondents doubt the
diagnostic skills of the health workers. On the other
hand, 29.5% of respondents agreed, indicating that
some believe the health workers possess adequate
diagnostic skills. The highest number of respondents
(29.5%) disagreed that the health workers provide
clear explanations of medical conditions and
treatment options. This indicates that many
respondents perceive that the health workers'
explanations are not clear enough. Conversely, 25.0%
of respondents agreed, suggesting that some patients
do receive clear explanations from health workers.
The majority of the respondents (59.1%) agreed that
health workers maintain confidentiality and privacy
in patient interactions. This positive response
suggests that the health workers are generally
perceived as respecting patient privacy. However,
22.7% of respondents disagreed, indicating that there
are some concerns about confidentiality and privacy
breaches. The highest number of respondents (47.7%)
agreed that health workers regularly update their
medical knowledge and skills. This indicates that
many respondents believe that health workers make
efforts to stay updated. On the other hand, 20.5% of
respondents strongly disagreed, suggesting that
some believe that health workers do not prioritize
continuous improvement of their knowledge and
skills. The majority of the respondents (52.3%)
agreed that the health workers ensure continuity of
care and provide adequate follow-up. This indicates
that many respondents perceive that the health
workers make efforts to provide ongoing care and
follow-up. Conversely, 11.4% of respondents
disagreed, suggesting that a minority believe there
are shortcomings in the continuity of care and follow-
up provided by health workers.

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Patient-Related Factors Affecting Quality Health Care Service Delivery
Table 3: Patient-related factors affecting quality healthcare care service delivery
Statement
Strongly
Agree
Agree
Disagree
Strongly
Disagree
Patients maintaining good personal hygiene
positively influence the quality of care they
receive from
health workers.
Freq
17
9
16
2
(%)
38.6
20.5
36.4
4.5
Patients' adherence to treatment plans
enhances the effectiveness of care provided by
health workers.
Freq
14
15
14
1
(%)
31.8
34.1
31.8
2.3
Patients’ Religion
freq
17
10
10
7
%
38.6
22.7
22.7
15.9
Patients’ cultures
freq
9
16
2
17
%
20.5
36.4
4.5
38.6
Addiction to drugs
Freq
5
16
15
8
(%)
11.4
36.4
34.1
18.2
Patients' financial cooperation allows health
workers to offer comprehensive care without
constraints.
Freq
7
17
16
4
(%)
15.9
38.6
36.4
9.1
Patients being proactive in sharing their
medical history helps health
workers make accurate diagnoses.
Freq
7
17
10
10
(%)
15.9
38.6
22.7
22.7
Patients actively engaging in discussions
with health workers leads to more informed
and personalized
care.
Freq
2
21
9
12
(%)
4.5
47.7
20.5
27.3
Patient's willingness to follow health
workers' advice and instructions contribute
to better health outcomes.
Freq
6
17
15
6
(%)
13.6
38.6
34.1
34.1
Patients having a support system or
caregiver assists health workers in ensuring
continuity of care.
Freq
4
20
16
4
(%)
9.1
45.5
36.4
9.1
Patient's commitment to lifestyle changes
positively impacts the overall effectiveness of
healthcare interventions provided by health
workers
Freq
5
16
15
8
(%)
11.4
36.4
34.1
18.2

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The majority of the respondents (36.4%) disagreed
that patients maintaining good personal hygiene
positively influence the quality of care they receive
from health workers. This suggests that a significant
portion of respondents do not believe that personal
hygiene directly impacts the quality of care. On the
other hand, 38.6% of respondents strongly
agreed, indicating that a considerable number of
respondents recognize the importance of personal
hygiene in influencing the care they receive. The
highest number of respondents (34.1%) agreed that
patients' adherence to treatment plans enhances the
effectiveness of care provided by health workers. This
indicates that a considerable portion of respondents
acknowledge the importance of patient compliance in
achieving better health outcomes. However, 31.8% of
respondents disagreed, suggesting that some
respondents may not perceive a direct correlation
between treatment adherence and the effectiveness of
care. The majority of the respondents (38.6%) agreed
that patients' religion influences health service
delivery. This suggests that many respondents
believe that religion plays a role in shaping the
healthcare experience. Similarly, 22.7% of
respondents disagreed, indicating that a significant
number of respondents do not consider religion as a
significant factor in healthcare. There is also a
sizeable proportion of respondents (15.9%) who were
neutral on this aspect. The highest number of
respondents (38.6%) agreed that patients' cultures
impact health service delivery. This indicates that
many respondents perceive culture as an influential
factor in the healthcare context. On the other hand,
36.4% of respondents disagreed, suggesting that a
significant proportion of respondents do not view
culture as a major determinant of healthcare
outcomes. A smaller percentage (20.5%) of
respondents were neutral on this matter. The
majority of the respondents (36.4%) agreed that
addiction to drugs affects health service delivery.
This suggests that many respondents believe drug
addiction plays a role in influencing healthcare
outcomes. Additionally, 34.1% of respondents
disagreed, indicating that a significant number of
respondents do not consider drug addiction to have a
strong impact on health service delivery. A smaller
percentage (18.2%) of respondents were neutral on
this issue. The majority of the respondents (38.6%)
agreed that patients' financial cooperation allows
health workers to offer comprehensive care without
constraints. This suggests that many respondents
recognize the significance of financial cooperation in
facilitating better access to healthcare services.
Conversely, 15.9% of respondents disagreed,
indicating that some believe financial cooperation
might not directly impact the quality of care
provided. The highest number of respondents
(38.6%) agreed that patients being proactive in
sharing their medical history helps health workers
make accurate diagnoses. This indicates that a
significant portion of respondents perceive patient
involvement in providing medical history as essential
for effective diagnosis. On the other hand, 22.7% of
respondents disagreed, suggesting that some do not
consider patient participation in medical history
sharing as crucial for accurate diagnoses. The
majority of the respondents (47.7%) agreed that
patients actively engaging in discussions with health
workers lead to more informed and personalized care.
This suggests that many respondents recognize the
value of patient engagement in discussions as a
means to better understand their healthcare needs.
Conversely, 4.5% of respondents strongly agreed,
indicating that only a small minority strongly
believes in the impact of patient engagement on care
personalization. The highest number of respondents
(34.1%) disagreed that patients' willingness to follow
health workers' advice and instructions contributes to
better health outcomes. This suggests that a
considerable portion of respondents might not
perceive a direct relationship between patient
compliance with advice and improved health
outcomes. Conversely, 13.6% of respondents strongly
agreed, indicating that only a small minority strongly
believe in the importance of patient compliance for
better health outcomes. The majority of the
respondents (45.5%) agreed that patients having a
support system or caregiver assists health workers in
ensuring continuity of care. This suggests that many
respondents recognize the significance of patient
support systems in maintaining continuous care.
Conversely, 9.1% of respondents disagreed,
indicating that some do not consider patient support
systems as crucial for care continuity. The highest
number of respondents (36.4%) disagreed that
patients' commitment to lifestyle changes positively
impacts the overall effectiveness of healthcare
interventions provided by health workers. This
suggests that a significant portion of respondents
may not perceive a direct correlation between patient
lifestyle changes and the overall effectiveness of
healthcare interventions. Conversely, 11.4% of
respondents strongly agreed, indicating that only a
small minority strongly believe in the impact of
patient lifestyle changes on healthcare interventions'
effectiveness.

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Table 4: Relationship between Health worker related factors and patient-related factors
Health-worker related factors
Patient-related factors
Health-worker related factors
Pearson Correlation Sig. (2-tailed)
1.297**
N
125
125
Patient related factors
Pearson Correlation Sig. (2-tailed)
.297**
1.000
N
44
44
The table above presents the results of the
correlation analysis between Health-worker-related
factors and Patient-related factors. The Pearson
correlation coefficient between these two sets of
factors is 0.297 with a two-tailed significance level of
p = 0.000 (expressed as 0.000 in scientific notation).
The positive correlation coefficient (r = 0.297)
indicates a moderate positive association between
Health-facility related factors and Patient-related
factors. The statistically significant p-value (p <
0.001) suggests that this correlation is unlikely to
have occurred by chance, providing strong evidence
to reject the null hypothesis. Thus, the relationship
between Health-worker-related factors and Patient-
related factors is positive and statistically significant.
Table 5: Relationship between Health worker related factors and Health facility related factors
Health worker related factors
Health facility-related factors
Pearson Correlation
Sig. (2-tailed)
1.184**
.032
N
44
44
The table above presents the results of the
correlation analysis between Health worker-related
factors and Health facility-related factors. The
Pearson correlation coefficient between these two
sets of factors is 0.184 with a two-tailed significance
level of p = 0.032. The positive correlation coefficient
(r = 0.184) indicates a weak positive association
between Health worker-related factors and Health
facility-related factors. The statistically significant p-
value (p = 0.032) suggests that this correlation is
unlikely to have occurred by chance, providing
evidence to reject the null hypothesis. Thus, the
relationship between Health worker-related factors
and Health facility-related factors is positive and
statistically significant.
DISCUSSIONS
Facility-related factors affecting the quality of
health service delivery
The facility did not have enough infrastructure in
terms of patient ward, O P D, which resulted in the
congestion of the facility, leading to poor health
service delivery. Patients were found sleeping on the
floor while receiving treatment because the facility
did not have enough beds and mattresses. The result
of a similar study was reported by [14] in his study in
Entebe Hospital where he found out that poor,
unrenovated wards were the factor affecting health
service delivery. In addition, the facility was found to
have very small wards, with many patients. The
space within the wards was quite inadequate. The (U
R N, 20170) revealed the same results in the Kagadi
General Hospital Kagadi district that expectant
mothers struggle to find space and beds. The hospital
receives about 20 expectant mothers daily, and the
available space and beds in the facility are not enough
for the expectant mothers, exposing newborn babies
to infections. In addition to the above, a study from
Palisa General Hospital palisa district revealed that
due to lack of space in the hospital patient with
diabetes are reviewed once in a month. In adequate
protective gears for the staffs like gloves, boots,
aprons were not available most of the times, 52% of
respondents reported. This implied that most health
workers do not put on gloves while doing some
procedure on patients. Leading to the contraction of
diseases, and contamination. In line with the above,
lack of essential medicines was another surrounding
factor affecting healthcare delivery at kakindo Health
Centre IV. This was because the facility receives very
little medicine from the government, causing patients
to go home without medications, and developing
complications. This finding concurred with Studies
done in South Africa on the Experience of Nurses in a
critical shortage of medical equipment in a rural
District revealed that Nurses expressed concern
about inadequate and irrelevant equipment for
demonstrating Nursing procedures to students’ e.g.
incomplete delivery parks and lack of valval
swabbing packs after delivery [15]. In South Africa,
a study was carried out to find out the effects and
determinants of stock outs of Anti TB Drugs and

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found out that health workers were substituting Anti
TB drugs with other Medicines hence causing poor
treatment outcomes [16]. The study found that the
facility had only a borehole as the source of water.
This borehole supplies water to all departments
where a cleaner has to pump water in a jerrycan, then
carry it and pour it into buckets to various
departments. Alternatively, the facility uses rain as a
second source of water. This is only applicable during
the rainy season. This was in line with the [17]
report which indicated that one in four healthcare
facilities lacks basic water supply services worldwide.
This impacts 1.5 billion people majority being in less
developed countries. This has resulted in the spread
of infections, and sepsis among others The study
further added that 17 million people give birth in
health centres with in adequate water supply,
sanitation, and hygiene. The fact the facility is located
along the highway to Hoima near the stage of
Boboda, and also within the town council there was
noise in the facility though it was reported by the
minority 38% of the respondents. This affected the
mental well-being of patients who receive patients
and, destruction of health workers while on duty.
This study finding concurs with [18] report where it
was stated that an estimated one million healthy life
years were lost from traffic-related noise in the
western part of Europe only. The report further
mentioned the causes of noise in health facilities such
as exposure are road, railway and air traffic, or
building sites. The report it was also added that noise
exposure can also occur through other sources such as
wind turbines, and leisure activities such as listening
to loud music or other audio content including
participation in e-sports (video and computer game
competitions). Excessive noise can cause annoyance;
in addition, research shows it increases the risk for
IHD and hypertension, sleep disturbance, hearing
impairment, tinnitus and cognitive impairment, with
increasing evidence for other health impacts such as
adverse birth outcomes and mental health problems.
The study further found out that there was a lot of
insecurity within the facility. This was so because
ever since the facility was constructed it has never
been fenced. This puts the lives of patients staff, and
the government at high risk of being stolen by
thieves.
The health worker's related factors affecting the
quality of health service delivery.
They further established that more than half of the
respondents 54% of the respondents were unable to
manage patients properly on their own. The
majority could not take a proper history of the
patients, could not ask for correct investigations,
and hence made a wrong diagnosis. This is because
the majority were certificate holders, yet they are
the ones most employed in big numbers as
compared to other higher carders. They spend most
of the time consulting other than the management of
the patients, hence causing the delay. Further
studies in Masindi District in which the primary care
health workers were asked about how comfortable
they were in diagnosing and managing respiratory
diseases, only 8% indicated that they were very
comfortable in doing so. More than half (52%) of the
respondents indicated that they were not
comfortable with diagnosing and managing
respiratory diseases [6]. In Nigeria, a study
conducted on the knowledge and attitude of health
workers towards TB patients under direct
observation treatment found that of the 76
respondents, 41 (53.9%) were females, 39.9% were
community health workers, and 26.3% were Nurses
and Midwives. 30.3% lacked training on the
management of TB patients. Only 43.4% knew
when to take action on patients who missed their
dose in the intensive phase, and 30.3% and 35.5%
knew defaults among category one and category
two in the continuation phase of treatment [19]. In
Nepal, a study was done about knowledge and
practice on prevention and control of TB among
Nurses working in Regional Hospital found that
majority of the Nurses had an inadequate level of
knowledge and poor practice of prevention and
control of Tuberculosis. Regarding practice, none of
them reported the use of N95 masks or respirators
during the care of TB patients [20]. Studies
conducted in Uganda by the World Bank found that
there was a knowledge gap between Teachers and
Healthy workers in both private and Government
facilities. Only a third of the public health workers
could correctly diagnose four out of five common
conditions such as Diarrhea, or Malaria with
Anemia [6]. [21], in her study found that 8% of the
clinicians were comfortable with the diagnosis of
lung diseases and 52% were not comfortable. Due to
the Lack of enough trained health workers, triaging
of patients was mostly done by a V H T who is less
knowledgeable about patient conditions, the study
revealed. Similar findings were reported by [22] in
their study of northern Uganda Hospitals. He stated
that “Lack of training variation of triage protocol
from hospital to hospital, shortage of staff on duty
were among the factors hindering this medical
practice” In Kenya knowledge gap among health
workers has been worsened by the use of
Community health workers to supply information to
the end users (patients) and then back to the
professionals hence affecting the quality of health
service delivery. This information conquers with the

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study done in Uganda which found out that VHTs
are still doing the same work of giving treatment at
village levels [23]. A study done into hospitals of
Uganda to assess medical error reporting among
physicians and nurses found that nurses and
physicians make a lot of medical errors that were
not reported. This harmed patient lives. About 33
(42.9%) respondents reported the occurrence of
overdoses in two hospitals followed by prescription
errors 27 (35.1%). Other errors that were identified
included near misses (11.7%), Adverse drug reaction
6 (7.8%) and careless handling of patients (2.6%)
[24]. A study done in Tanzania to Assess the anti-
microbial dispensing practice among ADDO
dispensers for children revealed that appropriate
dispensing and use of anti-microbial in children
were influenced by multiple factors for example
patients and dispenser’s knowledge, attitude, finance
and product-related factors. Only 8% (62 out of 773)
of the dispensers asked for a prescription before
dispensing medicine while 90% of them did not ask
for them prescription. In most of the dispensers 83%
(436 out of 513 supplied incomplete doses of anti-
microbial, 60.5% (345 out of 370) gave incorrect
instruction over 75% of the ADDOS displayed poor
practice in taking patient history [25]. In Ethiopia,
a study conducted on medication administration
errors and contributing factors among nurses
showed that 298 (98.3%) of Nurses completed the
survey questionnaire of these 203 (68.1%) reported
committing medication Administration errors [26].
Whereas in Malawi studies showed that about 65%
of clinicians were not adhering to hygiene and this
led to hospital-acquired infections [27]. Studies
done in Northern Uganda in 6 hospitals showed
that 33 participants consented and participated.
Only one hospital (16.7%) of six hospitals had a
formal best adult protocol. Only two hospitals
(33.5%) had un allocated emergency department the
rest received emergency patients/ performed triage
from OPD and Wards. In News land a study
conducted by Hellen on factors why don’t Nurses
consistently take patients reparatory rate found out
that majority of the Nurses were overloaded by the
ward activities and end up forgetting vitals such as
respiratory rate [28]. The study also found out that
67% of the respondents had never attended any
quality improvement training. Majority attributed
this to the fact that they were new in the system and
they had not been called upon to attend such
training. Knowledge and skills in guiding and
counselling patients was another factor that was
found to affect health service delivery at Kakindo
Health Centre IV. This leads to many of them
remaining unsatisfied with service delivery since
patients need to be prepared differently because
they suffer from different conditions. This finding
concurred with a [29] study where it was found that
Counselling children was reported to be a difficult
exercise due to some children being unable to
express themselves, being dependent on adults for
their care, being fearful, and requiring more time to
open up during counselling. This was compounded
by some caretakers' unwillingness and difficulty to
disclose the HIV status of their children. Other
issues about the caretakers were: lack of consistency
in caretakers; old age; sickness; and poverty. Health
workers mentioned the following as some of the
challenges they face in the delivery of HIV
counselling and testing services for children: lack of
counselling skills; failure to cope with the
knowledge demand; difficulty to facilitate disclosure;
heavy workload; and lack of other support services.
Institutions were found to be constrained by limited
space and lack of antiretroviral for children.
Attitudes refers to Manner, disposition, feeling,
position, etc., with regard to a person or thing;
tendency or orientation, especially of the mind: or
Attitude can be defined as the way in which a person
views and evaluates something or someone, a
predisposition or a tendency to respond. In Uganda,
poor attitude ranks first in affecting quality health
care in both private and public health facilities [31].
A study done in mulago national referral hospital
about infection control knowledge, attitudes and
practices among health care workers, revealed that
nursing and support staff were likely to perceive
that HCWs hands can be a vector of disease
transmission. Sinks were not readily accessible, and
soap at sinks were not uncommon throughout the
medicine and the obstetric wards [32]. Stigmatized
attitudes towards patients especially those with
chronic conditions patients were reported by half of
the respondents 53%. This has caused a delay for
such patients to access health services. A group of
patients in particular is the mentally ill patients, and
malnourished children under five years. Similarly,
the same percentage of respondents expressed fear
attitudes during treatment of infectious patients.
This was because they fear to contract the disease,
and most of the time the facility is in crisis of
protective gears for the health workers. Studies
done from Shiraz University of Medical Workers
found out that most of the health workers had a
stigmatized attitude towards care of patients of
HIV. 42% of health workers feared to treat HIV
positive patients because they fear to be affected by
the same illness [33]. Where as in Qatar a study
was done on health care professional attitudes
towards patients with mental illness 406 nurses

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and 92 Doctors were interviewed. The study
revealed that nurses and Doctors had a stigmatized
attitude towards people with mental illness. The
prevalence being more on nurses than Doctors
[34]. The abusive behaviours among health
workers were reported by 61% of the respondents.
This implies that there is disrespect for patients
since health workers feel they are in control of the
patient’s life. This was found to affect quality of care
because over time patients became annoyed and also
started abusing the health workers. In a related
development majority of the participants had
problems with communication skills. This was
attributed to burn out syndrome that occurs due to
over working hours of seeing many patients by a
few health workers. These health workers become
very much tired, loss their temper and start
communicating in un appropriate way to patients.
Corruption practice among respondents was
reported by 10% of them. This was in terms of
extorting money from patients before getting
service. [35] noted that Uganda faces considerable
challenges related to corruption and that healthcare
is among the most affected public sector services.
This study highlighted bribery, absenteeism and
ghost workers' impact on public service delivery as
the major forms. These practices constrained access
to essential health services, affecting people’s
everyday health, well-being and life chances. Data
available further suggests that the problem is
growing, an increasing share of Ugandans report
that they pay bribes and state that corruption has
worsened. Despite being a clear challenge to
Uganda’s sustainable development, comprehensive
estimates of the extent and cost of corruption in the
healthcare sector are lacking.
The patient-related factors affecting the quality
of health service delivery
From the study, it was established that Patients with
a support system from relatives and other caregivers
were well managed because these would assist health
workers in ensuring continuity of care as compared to
those who had no support system. The recent study
done in Morocco, confirms the role of the parents or
guardians is crucial in caring for children and seeing
to it that their requirements for food, clothes,
education, shelter, and protection are addressed,
particularly in times of crisis. In addition to these
responsibilities, if the children suffer chronic
psychological disorders or mental illness, this requires
additional work and duties. The presence of the family
thus becomes vital in ensuring that these children
receive social assistance, particularly since researchers
have confirmed that mothers of mentally ill children
have a two to three times higher risk of developing
depression than mothers of healthy children [36].
The study further established the significance of
patient cultures on the quality of health service
delivery. Half of the respondents. The study findings
concurred with [37], who found out that culture
influences health and illness from how people
conceptualize the illness, seek medical care, perceive
healthcare providers, and accept medical care. The
study found that religious beliefs among patients
were more likely to impact the quality of health
service delivery at Kakindo Health Centre iv. This
was because some patient’s religion prohibits them
from receiving drugs and other health products for a
better life. [38], cited religions such as Jehovah’s
Witnesses – which follow several Old and New
Testament scriptures that were used by Jehovah's
Witnesses to explain why their religion refuses to
accept blood transfusions. This is a religious issue
rather than a personal one. We avoid taking blood not
only in obedience to God but also out of respect for
him as the Giver of life.’ Followers are quick to point
out that other than accepting blood, Jehovah's
Witnesses are told to seek and receive the best
medical care available” The Amish – “The Amish will
not allow heart transplants and, in some cases, heart
surgery because they view the heart as ‘the soul of the
body.’ Children who have not been baptized are
exempt from that restriction. Though the religion
does not forbid its members from seeking medical
attention, many Amish are reluctant to do so unless
necessary. They believe that God is the ultimate
healer, and they are likely to turn to folk remedies,
herbal teas and other more "'natural' antidotes. They
do not practice birth control, often lack prenatal care
and avoid preventative screenings” [38]. Hindus –
“Vaishnavism, the major branch of the Hindu faith,
considers the killing of animals, especially cows, to be
sinful. Therefore, the religion does not condone the
use of any drugs, implants, skin grafts or medical
dressings that contain parts of pigs or bovines” [38].
Muslims – “Both Sunni and Shiite Muslims also do
not approve of any drugs, medical dressings or
implants that contain porcine ingredients. But they
too allow exceptions for emergencies and when no
alternative drugs or materials are available” [38].
The examples above demonstrate just how important
an understanding of individual spiritual beliefs can be
to successful healthcare outcomes. We live in a world
where healthcare and religious freedom must be
taken into account when care is being provided.
When providers take the time to understand the faith
of a patient, as well as how religion may affect the
ability to receive care, everyone benefits.

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CONCLUSIONS
From the findings, one can conclude that the
environmental factors, knowledge and practices of
health workers, and their attitudes have a strong
positive relationship if health service delivery must be
of better quality in Kakindo Health Centre IV.
Recommendations
Based on the findings of the study, the researcher
would like to suggest to the management of Kakindo
Health Centre IV and policymakers in public health
management the following for each of the factors
under the study as follows.
Facility-related factors
Upgrading the facility to the level of a hospital will
help to build more infrastructure for both patients
and staff and for security purposes of both patients
and staff, the facility needs to be enclosed in a
concrete fence. The facility needs tap water so that
staff can access clean water inwards, especially in the
pediatric ward, theatre, general ward, outpatient
department, ART Clinic Cold chain unit and a few
staff quarters. The government needs to supply
enough drugs and other medical supplies that are
always inadequate, yet they are very important for
both health workers and patients so that health
workers have what to use for treating patients.
Health worker-related factors
Emphasis should be put on continuous medical
education related more on quality improvement. Staff
should go for further studies to improve their skills
and knowledge. There is a need for health workers to
follow ethical codes of conduct while executing their
work There needs to be teamwork for all staff. The
staff should avoid reporting late on duty. Should be
non-discriminative while giving care. Staff should be
motivated equally by the top management. Qualified
staff should be the ones to do the work of triaging
patients, not the V H TS. The same study should be
carried out in other health facilities within Kakumiro
District. This will lead to the accumulation of data on
issues surrounding factors affecting health service
delivery in the district and it will help and guide in
proper planning. Patient-related factors. Patients
should ensure that they are clean before coming to
the facility. Continuous community sensitization
about the causes, prevention and management of
diseases. Family therapy should be conducted by a
trained therapist.
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CITE AS: Semambo, Nathan (2024). Factors Affecting Quality of Health Care Services in Government
Facilities in Kakindo Health Centre IV in Kakumiro District. IDOSR JOURNAL OF
EXPERIMENTAL SCIENCES, 10(1): 50-68. https://doi.org/10.59298/IDOSR/JES/101.5068.1724