Health System Responsiveness and Its Associated Factors Among Outpatients in Primary Health Care Facilities, Asagirt District, NorthShewa Zone, Ethiopia, 2021: Cross Sectional Study Design

Abstract Background: Health system responsiveness is defined as the outcome of designing health facility relationships in such a way that they are familiar and respond appropriately to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only scanty evidence exists in Sub-Saharan Africa. In Ethiopia information about the level of health system responsiveness among outpatients is scant. Assessing responsiveness could help facilities in improving service delivery based on patient expectations. Objective: The study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, North Shewa Zone, Ethiopia, 2021. Methods: Facility-based cross-sectional quantitative study was implemented between 30th March and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using a structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors that have an association with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare statistical significance in this study. Results: The overall health system responsiveness was 66.2% (95% CI: 61.4% - 70.7%). Confidentiality and dignity domains were the highest responsiveness score. Health system responsiveness was higher among satisfied outpatients (AOR: 9.9, 95% CI: 5.11-19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32-18.25), and no transport cost (AOR: 1.7, 95% CI: 1.03-2.92) in the study setting. Conclusion: Overall health system responsiveness was higher as compared to other case-specific study in Ethiopia. The domains of Autonomy, Waiting time, Basic amenities, and Choice were identified as vital areas needing the effort to raise responsiveness of health care service in the District. HSR was higher in private than public healthcare facilities, among satisfied clients and those who didn’t pay for transport on their way to the health facility than their counterparts. Thus, enhancing patient satisfaction, using input from service users, Collaboration, and experience exchange between public and private facilities will be important interventions to improve HSR.