Conceptualising quality in health care as perceived and experienced by households : a case study of privatising Zambia Consolidated Copper Mines, Luanshya Division.

摘要

Donabedian’s framework, based on the structure, processes and outcomes is widely used to assess quality in health care studies. This study argued the relevance of Donabedian’s framework in exploring changes of quality in health care as perceived and experienced by households.udThe study was conducted in three mining townships in Luanshya town. Six focus group discussions composed of 8 – 12 respondents were conducted within the households. In addition, interviews were conducted with the District Director of Health in Luanshya town and the Manager Human Resources at Luanshya Copper Mines Plc. In addition, documents such as newspapers and reports from the Zambia Privatisation Agency were analysed.udThe study revealed that quality in health care had declined based on thirteen areas of concern. In response, households have adopted coping strategies in their access to health care. Households who incur high costs in their access to health care have reduced access to formal care while those that incur low costs have maintained their access. These findings presented a major limitation in Donabedian’s framework. Whereas the framework focuses only on the micro process of users seeking health, it omits important factors described in the blueprint, which affect access to health care.udBased on the findings from households and limitations of Donabedian’s framework a blueprint to conceptualise quality in health care within Zambia was proposed. The blueprint recognises the macro context, which considers the economic and social contexts that affect access to health care and, therefore, influence household’s perceptions of quality.udWithin the macro context, the economic context, which is privatisation, affected household incomes and the cost of travel. Additionally, the social context reflected by services provided by other health systems, has also affected household utilisation of mine facilities. Both factors have helped form households’ negative perceptions of quality in health care.