Assessment of Users' Satisfaction with Quality of the Healthcare Systems in Delta State, Nigeria: A Mixed-Method Study

The Delta State government strives to improve healthcare and achieve Universal Health Coverage (UHC); however, the impacts are rarely measured from the user’s perspective. This study examines the satisfaction and quality of healthcare systems in Delta State and proposes a broader framework for quality assessments. A mixed-method cross-sectional survey was conducted among 1,191 respondents and 23 participants from randomly selected 6 Local Government Areas (LGAs). The positive rating of the quality of healthcare structure (58.54%), services (43.07%), and outcomes (56.34%), significantly lower than the 78% global benchmark. Residents reported low satisfaction with the healthcare structure (42.49%) and services (42.57%), significantly higher than the 34% global average.  The rating of healthcare structure shared significantly association with annual healthcare expenditure (p < 0.001), LGA (p < 0.001), employment status (p < 0.001), and occupation sector (p = 0.002); the healthcare services rating was associated with frequency of healthcare usage (p = 0.048), employment status (p = 0.001), and occupation sector (p = 0.093); and healthcare outcomes rating was associated with family size (p = 0.023), LGA (p < 0.001), occupational sector (p = 0.031), and gender (p < 0.001). Qualitative interviews also reveal low satisfaction, limited awareness of government programs/projects, a lack of equipment, and low staffing levels. The unified approach proposes a user perspective on the healthcare quality assessment framework. To improve healthcare quality and satisfaction, policymakers should address socio-economic disparities, healthcare infrastructure, and services, aligning with UHC goals of equitable access for all residents.