ST.

MARY’S UNIVERSITY

DEPARTMENT OF SOCIAL WORK

AN ASSESSEMENT OF QUALITY HEALTH CARE DELIVERY

SERVICE AND CUSTOMER SATISFACTION IN ALERT
GENERAL HOSPITAL,

ADDIS ABABA

BY: ASHIA EBRO BEKETA

JUNE, 2021

ADDIS ABABA, ETHIOPIA

I
AN ASSESSNT OF SERVICE QUALITY HEALTH CARE DELIVERY
AND

CUSTOMER SATISFACTIONS IN ALERT GENERAL HOSPITAL

BY:

ASHIA EBRO BEKETA

ADVISOR

DR. HABTAMU (PHD)

ATHESIS SUBMITTED TO [Link]‟S UNIVERSITY SCHOOL OF

GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK

JUNE, 2021

ADDIS ABABA, ETHIOPIA

II
 [Link]’S UNIVERSITY

SCHOOL OF GRADUATE STUDIES

FACULTY OF HUMANITY

AN ASSESSEMENT OF QUALITY HEALTH CARE DELIVERY SERVICE AND

CUSTOMER SATISFACTION IN ALERT GENERAL HOSPITAL,ADDIS ABABA
ETHIOPI

BY:

ASHIA EBRO BEKETA

APPROVED BY BOARD OF EXAMINERS

Advisor

Signature Date

Internal examiner

Signature Date

External examiner

Signature Date

Dean graduate students

Signature Date

III
ENDORSEMENT

This thesis has been submitted to [Link]‟s University, School of Graduate Studies for the
examinations with my approval as a University advisor.

Dr. Habtamu (PHD)

Advisor Signature

St. Mary‟s University, Addis Ababa

JUNE, 2021

IV
DECLARATION

I the under signed, declare that this thesis is my original work, prepared under the guidance of
Habtamu (PHD).For all guidance of thesis has been dully acknowledge. I further confirm that the
thesis has not been submitted either in part or in full to any other higher learning institution for
the purpose of earning any degree.

Ashia Ebro Signature

[Link]‟s University, Addis Ababa JUNE, 2021

V
 ACKNOWLEDGMENTS
I would like to take this opportunity to thanks the Almighty Allah, the people who help me and
involved in assisting and guiding to me the completion of this Thesis. First I would like to thank
my University; [Link]‟s University School of graduate studies for support throughout my study
thesis like this depends greatly.

On the research material available and I am particularly grate full to the center for student
support service, I spent May pleasant day wandering through its in comparable collections. I
would also like to express my sincere gratitude to my Advisor, Dr. Habtamu (PHD). For his
dedication time and effort in supervising me and whose invaluable insights played a critical role
in the shape and content of this research.

i
 Table of content

Contents Pages
ACKNOWLEDGMENTS ............................................................................................................... i

List of Table .................................................................................................................................... v

List of Figure................................................................................................................................... v

LIST OF ABBREVIATIONS ........................................................................................................ vi

ABSTRACT.................................................................................................................................... vii

CHAPTER ONE ............................................................................................................................. 1

1. INTRODUCTION ...................................................................................................................... 1

1.1 BACK GROUND OF THE STUDY .................................................................................... 1

1.2. STATEMENTS OF THE PROBLEM ................................................................................. 4

1.3 RESEARCH QUESTIONS ................................................................................................... 6

1.4. OBJECTIVE OF THE STUDY ........................................................................................... 6

1.4.1 General objective ............................................................................................................ 6

1.4.2 Specific objective. .......................................................................................................... 6

1.5. SIGNIFICANCE OF THE STUDY ..................................................................................... 6

1.6. SCOPE OF THE STUDY .................................................................................................... 7

1.7 LIMITATION OF THE STUDY .......................................................................................... 7

1.8. Definition of Key Terms ...................................................................................................... 8

CHAPTER TWO .......................................................................................................................... 10

2. LITERATURE REVIEW ......................................................................................................... 10

2.1 INTRODUCTION ............................................................................................................... 10

2.2 Services Quality Concepts .................................................................................................. 10

2.3 CUSTOMER SATISFACTION .......................................................................................... 11

2.4 Theoretical Analysis ............................................................................................................ 11

ii
 2.4.1 Service Quality Model .................................................................................................. 11

2.4.2 Factors that Affect Customer Satisfaction .................................................................... 13

2.4.3 Relationship between Service Quality and Customer Satisfaction .............................. 13

2.5 CORE CONCEPTS OF HEALTH CARE QUALITY ....................................................... 13

2.5.1 Quality Values in Health Care ...................................................................................... 13

2.5.2 Definition of Health Care Quality ................................................................................ 14

2.5.3 Quality Dimension in Medical Care ............................................................................. 15

2.5.4 The Meaning of Quality ............................................................................................... 16

2.5.5 Voice of the Customer .................................................................................................. 17

2.6 CUSTOMER SATISFACTIONS AS QUALITY INDICATOR........................................ 17

2.7. DELIVERY SERVICE QUALITY IN THE WESTERN CONTECXT ........................... 19

2.8. THEORETICAL FRAMEWORK FOR THE STUDY ..................................................... 19

2.9 CONCEPTUAL FRAMEWORK ....................................................................................... 20

CHAPTER THREE ...................................................................................................................... 22

3. METHODOLGY ...................................................................................................................... 22

3.1 RESEARCH DESIGN ........................................................................................................ 22

3.2 THE STUDY AREA AND POPULATION OF THE STUDY. ......................................... 22

3.3 STUDY POPULATION ..................................................................................................... 23

3. 4 SAMPLE SIZE ................................................................................................................... 23

3.5. SAMPLING TECHNIQUES ............................................................................................. 24

3.6. TOOLS/INSTRUMENTS OF DATA COLLECTION ..................................................... 24

3.7 DATA COLLECTION PROCEDURES ............................................................................. 25

3.8. METHOD OF DATA ANALYSIS .................................................................................... 25

3.9. ETHICAL CONSIDERATION ......................................................................................... 25

iii
CHAPTER FOUR ......................................................................................................................... 27

4. RESULTS AND DISCUSSIONS ............................................................................................ 27

4.1 Descriptive analysis of socio-demographic......................................................................... 27

4.1. 1. Demographic characteristics of the Respondents ....................................................... 28

4.1.2. Expectation and perception towards quality of health care services provided by
customers ............................................................................................................................... 29

CHAPTER FIVE .......................................................................................................................... 34

5. SUMMARY, CONCLUSIONAND RECOMMENDATIONS ................................................ 34

5.1 Summary of the Finding...................................................................................................... 34

5.2 CONCLUSION ................................................................................................................... 35

5.3 RECOMMENDATION ...................................................................................................... 36

REFERENCES ............................................................................................................................. 37

ANNEXES .................................................................................................................................... 40

iv
List of Table

Table 1: Demography characteristics of the Respondents ............................................................ 28

[Link] of facility usage ............................................................................................... 29

Table 3: mean scores for each SERVQUAL Statement. .............................................................. 30

Table 4: Five Highest and Lowest Means SERVQUAL statements, ........................................... 32

Table 6: Coefficient Of predictive variable .................................................................................. 33

Table 5:Customer satisfaction on service provided(%) ................................................................ 32

List of Figure

Figure 1. Customer perceptions of quality and customer satisfaction Wilson et al. …………..21

v
LIST OF ABBREVIATIONS

WHO -------------World Health Organization

SERVQUAL ----Service Quality Model

SPSS -------------Statistical Packages for Social Sciences

NPS---------------National Health Service

CI-----------------Confidence Interval

AGH-------------Alert General Hospital

WB--------------World Bank

OPD-------------Out Patient Department

AHWO----------Africa Health Workforce Observation

UDHR ---------Universal Declaration of Human Rights

vi
 ABSTRACT
This study was conducted to assess the health service delivery and customer satisfaction of
service offered to outpatient in Alert Hospital in Addis Ababa. The study was conducted on a
sample of 221 services users. In order to assess the quality and effectiveness of service provided
by the Government in Hospitals, a quantitative study was conducted among the out-patients to
find out the association between patients expectations and perceptions towards health services
quality provided in the hospital by Doctors, nurse/medical assistant and available
infrastructures. Data were collected through as self-administered questionnaire distributed to
outpatients in the Alert General Hospitals. To analyses the collected data, SPSS version20 for
windows used. From the result findings, here was a significantly difference between expectations
& perceptions was found in the urgency dimension specifically in patient room comfort ability
and the lowest difference was in tangibility domain specifically Doctor’s\nurses service quality.
This study demonstrated that patient expectations were higher than their perception in there five
out of five dimensions in the Hospital service quality. The Logistic regression showed that
Tangibility, Reliability and Assurance are the domains that have significant relation with
satisfaction.

Key Words: Quality health care delivery service and customer satisfaction.

vii
 CHAPTER ONE

1. INTRODUCTION

1.1 BACK GROUND OF THE STUDY

Customer satisfaction has been a subject of great interests to organization and researchers alike.
The principal objective of organization is to maximize profits and to minimize cost. Profit
maximization can be achieved through increase in sales with lesser costs. One of the factors that
can help to increase sales is customer satisfaction, because satisfaction leads to customer loyalty
(Wilson et al., 2008) recommendation and repeat purchase. Customer satisfaction is the main
concern of business section of today; their researchers are always conducting research about the
customer especially on what relates to satisfaction.
In the globalization and liberalized business environment, service sector encountering stiff
competition to meet the requirements of the profitable ways business.

Quality can be defined as the comprising to which health services for individuals and population
increase the likelihood of desired health outcomes and are consistent with current professional
knowledge. Quality can also refer to services evaluated at the individual or population level of
analysis and focus on improvement of health care outcomes.
Quality health care delivery service and customer satisfaction was originally used during the
landmark reports of the Institute of Medicine starting with Lohr (1990).
There is no doubt that the greatest asset of every country is its citizens. „This is because their
general wellbeing determines the overall progress and development of national economy as an
enhanced quality of life means higher productivity. Any country that has unhealthy population is
bound to suffer the implementation of development programs to improve the quality of life of the
people. This had necessitated the adoption of various human rights provision at the national and
international level to protect and enhance the basic needs of human kinds including the right to
adequate and quality health care during sickness (Howard, 2000).
[Link]. (1985) also describes a frame work describing the quality delivery service gap
model indentifies five gaps of prevalent imperfects information in „patient‟ health care provider
interaction. The most important gaps has been identified as gaps which patients to the expected

1
versus perceived quality of services delivery from the health care delivery from the health care
provider to the patient. Within this framework, the use of measurement toll called the
SERVQUAL questionnaire is implemented (Parasuman) Berry and Zenithal, (1988). The
SERVQUAL tool enables researchers to identify not only the gaps in perceptions and
expectations in service quality from patients, but also identify which factors or dimensions under
lie the quality construct.
Although the SERVQUAL tool has under gone criticism, it has continues to be widely used as a
reliable and valid tool for service quality assessment. Parasuraman, Berry and Zenithal (1991)
identified five dimension which under lie service quality. These dimensions (Tangibles,
Reliabilities, Responsiveness, Assurance and Empathy) have been used in subsequent studies as
theoretical fact (Tanner and Antony, 2006).How ever due to criticism of the validity of
transposing these dimensions to different population (Buttle, 1994).
Service quality has shown to have close relationship with patients‟ satisfaction. Quality of
service has been indicated in number of studies tobe an antecedent to satisfaction (Cronin and
Taylor; 1992; Fornell, Bryant,Chan and Johnson,1996).
After attaining recognition ,the next important things is to make it work for the benefit of its
target group –the patients and to achieve this well definitely demand the involvement of the
patients in quality health care delivery service to make the whole treatment process holistic. One
cannot deny the fact that the health care industry is undergoing a rapid transformation to meet the
ever-increasing needs and demands of the patient‟s population. Hospitals are shifting from
viewing patients as undereducated and passive individuals with little quality health care choices
and to recognizing that the educated consumer has many service demands and health care
choices available (Howard,2000). To move towards higher quality health care delivery services,
more and better information is commonly required on existing provision, on the intervention
offered and on major constraints on service implantation.
Consumers need information about what is good and bad about their health. Why not all their
expectations would be satisfied, and that they have rights, which all providers should respect
(WHO, 2000).
This scenario had created the growing interest in improving the performance of quality of health
systems in many countries .It is now a major pre-occupation, reflecting common pressures for
cost commitment on one hand and the rising consumer expectation on the other .This is led to a

2
number of recent initiatives by many countries to measure and improve performance against
quality, efficiency, and equality goals in health care delivery services (WHO, 2000).
As “Brundt land” rightly put it:
The good health of nations is key to human development and economic growth and it is
important to analyze health system performance and to share what we knew with governmental
and international community (Brundtland G.H.2001).
Despite differences in the levels and methods of quality health care delivery services, the
challenges and solutions in quality are remarkably similar between countries. The common
national concern over quality that cut across all nations are; unsafe health systems ,unequal
access to health service ,dissatisfaction on the part of users and the wider public ,unacceptable
level of variations in performance, practices and outcomes ;overuse, misuse or under-use of
health care technologies; unaffordable waste from poor quality and unaffordable costs to society
(Shaw,2002) .

Issues of responsiveness in quality health care delivery systems are many and varied. One basic
distinction is between elements related to respect for human beings as persons, who are largely
subjective and judged primarily by the patients and objective elements related to how a system
meets common expressed concerns of patients and their families as clients of health system.

All people are consumers of health services and it is important to know their expectations on
quality health care services .Users of health services want safe, appropriate interventions,
treatment, and care that consider their dignity and respect. They want information that is
accurate, timely and relevant. Consumers believe that if this is to happen, then consumers of
health services must be involved and consulted, not only in relation to their own health care, but
also about the service planning and delivery, health evaluation and research (Graham, 2001).
Patient satisfaction measures therefore provide healthcare managers with useful information
about the structure, process, and outcomes of care. They alert administrators of the positive and
negative aspects of their institutions. Patients satisfactions assessments help maximize an
organization‟s quality and the value of the care it provides (Bell et al., 1997, Kelsey, 2001). To
the patients ,the appearance of the environment and employees ,reliability ,dependability of the
service delivery ,responsiveness ,competence ,understanding of the patients ,access ,courtesy
,communication ,credibility ,and

3
Security, all indicate quality care. Patient‟s satisfaction also hinges on whether the service
experiences meet consumer expectation. This has created the need for a system of continuous
quality improvement aimed at providing valued services to consumer. This is vital for improving
the quality of care in the health delivery services system in the country. The literature pertaining
to patient satisfaction in the inpatients setting may be extensive there is a paucity of data on
patient satisfaction pertaining to outpatients clinical services (Belletal., 1997, Kesley, 2001).

1.2. STATEMENTS OF THE PROBLEM

The health care service industry historically has paid limited attention to customer perspective
(Howard,2000).The main challenge is to create health systems which fairly improve health
outcomes, satisfy clients ‟expectations and to render the services at fair price (Blazevska et
al.,2004). Health care systems in most developing countries suffer from serious deficiencies in
financing, efficiency, equity and quality; poorly prepared to meet these challenges (Fekedu and
Yohannes, 2011).

In Ethiopia, health services are inadequate and poor quality and the country has extremely poor
health status relative to other low income countries (Habtamu and Abebe, 2016).According to
WHO (2010) limited availability of health resources, overreliance on direct payments at the time
of people need care and inefficient and inequitable use of resources identified as the main
interrelated problems that limit universal health coverage.

Client satisfaction rate is generally believed to be low due to different reason such as a limited
skilled man power, infrastructure and other basic health resources. The factor that affect the
service satisfaction level among customer of health service utilizes are not well assessed taking
into all five integral components of services quality models including tangibles ,reliability,
responsiveness ,assurance and empathy. They tend to take parts of these service quality
measurements to measure customer level of satisfaction. In most case studies focused on health
service providers circumstances. In addition, when these previous researches are well reviewed
they focused on urban hospital. But, there are high disparities between accessibilities, quality of
health services delivery between urban and rural areas (World Bank, 2005).

4
The public sector paved the for the development by sensitizing the population to the need for
advanced care and creating more demand for health care delivery service. The most important
problems faced by providers are lack of sufficient number of trained professional, especially
doctors in specialty areas of Africa Health Workforce Observatory (AHWO) 2010. The
employment of trained and qualified personnel and retain them in the facilities is critical to
ensure good quality care. A wide spread shortage of trained professionals, especially in the
certain area of specialties since the such highly specialized and sub specialized medical trainings
are not widely provide in the country. Based on the above reviewed the study and other variety
of client satisfaction studies in Ethiopia, the majority of study focused on hospital. These studies
and others conducted in Ethiopia also failure to assess internal facilities ,shortage and challenges
of basic health resource ,absence or inappropriate service units and minimum service delivery
standards of hospital which has significant contribution for quality health services associated
customer satisfaction.

Government and professional bodies needs to make concerted effort to address this issue in
holistic manner and develop appropriate strategies‟. Ethiopia will achieve better health sooner
and more efficiently in public sector. Ministry of Health can play strategic role in setting the
stage through policies and program interventions that influence the public sector to achieve the
health care goal. The hospitals are therefore making the effort to determine what health care
customers need their services to meet those needs and then attracting patients to continue use
their services.

Quality of delivery service and patient satisfaction had been extensively studied and considerable
effort has gone into developing survey instrument to measure it. However, most reviews have
critical of its use since there is rarely any theoretical or conceptual development of the patient
satisfaction concept. This study points out that there is urgent need to it measure the difference
between the expected and perceived the quality of health care delivery service and evaluate its
satisfaction level in order to better understand patient‟s needs.

Therefore, in response to the above research problems and so fact studied and indicated research
gaps, this study conducted to assessment of quality health care delivery service and customer
satisfaction in Addis Ababa, at Alert General Hospital.

5
1.3 RESEARCH QUESTIONS
In view of this revelation, the study seeks to find answers to the following fundamental
question:-

 To what extent are customers satisfied or dissatisfied with services they receive at Alert
General Hospital?
 What are customer perspectives about quality health care delivery services?

1.4. OBJECTIVE OF THE STUDY

1.4.1 General objective
The general objective of this study is assessment of quality health care delivery services and
satisfaction of Alert General Hospital.

1.4.2 Specific objective.

 To identify level of quality care and treatment are out patients receiving from the health
care accessible.
 To identify areas of improvement to improve customer satisfaction and quality of the
service

1.5. SIGNIFICANCE OF THE STUDY

The significance of this study included the development of lessons to serve as guiding principles
for the improvement of the health care delivery systems at the Alert General Hospital and the
findings to serve as one of the scientific basis on which researchers could use to assess health
care delivery and customer satisfaction.

- Patients stand to gain if their concerns are factored into the daily administration and
running of health care facilities for improvement ,
- To the government ,it will measure the performance of one sector (health) to the
development of nation
- To the health sector ,it will make them improve upon their services for patients‟
satisfaction and confidence and for the dignity of the institutions and their workers ,

6
 - It will also assist the health sector in determining what patients‟ value in any quality of
health care delivery services and hence their assessment of quality in health care‟s
delivery,
- It will create awareness among hospital staff on the need to see patients not just as
recipients of health care but have rights that must be protected.

1.6. SCOPE OF THE STUDY

Research study the customer‟s expectations, perception and quality delivery service and
customer satisfaction level on service from Alert hospital in Addis Ababa. There are limitations
as predicted for conducting this research. First of all the, respondents in this study are limited to
only out-patients from the Alert hospital in Addis Ababa. The number of patient which is in-
patient is not including in this population and sampling.
Beside, as any study based on consumer survey through a predesigned questionnaire study faced
the basic limitation the possibility of difference between what is recorded and what is true, no
matter how carefully the questionnaires has been designed and field has been conducted .The
customer may not deliberately report their preference and even they wish to do so there are
bound to be differences owing to problems filters of communication process.
Furthermore, it was difficult to get feedback from seriously ill patients where they are sick and
unable to cooperate in answering the questionnaire. Taking into consideration uncomfortable
feelings.

1.7 LIMITATION OF THE STUDY

- One of the limitations of this study, is that it does not take into consideration
demographical impact on perception it would be expected that differences in perceptions,
- The study will primarily focusing in Alert General Hospital ,where there are relatively
better health facilities and where the sector has relatively better capacity and organized
.Thus, the finding of the study might not be solid enough to generalize the reality at the
country.

The financial resources and availability relevant reference documents, time and information
sources could be other bottlenecks. Similarly getting the right key informants and getting their
willingness to provide information could be potentially demanding bodies.
7
1.8. Definition of Key Terms
In order to avoid misunderstanding and individual interpretation and usage of certain concepts in
this study, the research defined those concepts used in this study; based on the contexts within
the study below.

Customer expectation and perception

Customer expectation is defined as what the customer wants from the product service they have
purchased, Customer perception quality is explained as the customer‟s judgment about a
product/service‟s overall excellence or superiority, based on perceptions of what is received and
what is given (Zenithal, 1988).
The evaluation is done by comparing the expectation with the perceived performance of product
or services.
Customer satisfaction:
Customer satisfaction is a parson‟s feeling of pleasure or disappointment resulting from
comparing a product or services perceived performance or outcome in. relation to her or his
expectations (Nair, 2004).
Assessment: is the process by which the characteristics and needs of clients, groups and
situations are evaluated or determined to address the actual needs or desires, expectations or
situations.

Dissatisfaction: Unpleased feeling about the services or product as mismatching with

expectations or desires.

Health care: the functional and non-technical aspect of health services delivery which emphasis
on the human aspects of interactions between services provides and customers.

Neutral: those customer who are neither satisfied nor dissatisfied but falls between two as
medium ;not interested to say much more than does not matter or medium.

Patient: any person who has visited the health facilities for the sake of health care services. The
term used interchangeably with client and customer in this study.

8
Satisfaction: pleased experience of customer after using the services or products because of
attaining match services with expectations or desires.

Very dissatisfied: higher failure of the product or services below one‟s expectations

Very satisfied: exceeding of the product or services above one‟s expectations

9
 CHAPTER TWO

2. LITERATURE REVIEW
2.1 INTRODUCTION
Quality health care delivery services affects all sectors of the economy because of every
economy relies on a healthy working population to offer skill and unskilled labor for increased
productivity and growth of the national income. Hence, the structural connectivity between
quality health care delivery services and other sectors of the economy .This had necessitated the
need for a system of continuous quality improvement committed to providing better medical
services as a surest way of ensuring quality health care delivery services. Despite the modern
scientific development and technological advancement in health care delivery, issues of patients
centered health care delivery still needs improvement. Even in the best systems, mistakes and
lapses occur during treatment leading to injuries and dissatisfaction in services delivery. More
importantly, health personnel could also undervalue the psychosocial aspect of treatment during
the course of executing their duties. It is no wonder that, states, international organizations,
corporate bodies, and even individuals are working tirelessly to promote quality health care and
patient‟s protection and safety. Relevant literature on quality services, healthcare, customer
satisfaction and patient‟s rights were undertaken. The research issues arising from these reviews
guided the formulation of the research objectives.

2.2 Services Quality Concepts

Service quality is defined as the overall assessment of a service by customer (Eshghi et
al.,2008,p.121).Ghylin et al.,(2008,p.76)points out that ,y defining service quality ,companies
will be able to delivery services with higher quality level presumably resulting in increased
customer satisfaction .Understanding service quality must involve acknowledging the
characteristics of service which are intangibility, heterogeneity and inseparability,(Parasuraman
et al.,1985,p.42);(Ladhari,2008,p.172).In that way ,service quality would be easily measured .

In this study, service quality can be defined as the difference between customer‟s expectation for
service performance prior to the service encounter and their perception of service received.
Customer‟s expectation serves as a foundation for evaluating service quality because, quality is

10
high when performance exceeds expectation and quality is low when performance does not meet
their expectation (Asubonteng et al.,(1996,p.64).Expectation is viewed in service quality
literature as desires or wants of customer i.e., what they feel a service provider should offer
rather than would offer(Parasuman et al.,1988,p.17).Perceived service is the outcome of the
customer‟s view of service dimensions, which are both technical and functional in
nature(Gronroos,1984,p.39).

2.3 CUSTOMER SATISFACTION

Customer satisfaction is conceptualized as been transaction specific meaning it is based on the
customer‟s experience on a particular service encounter,(Cronin and Taylor,1992)and also some
think satisfaction is cumulative based on the overall evaluation of service experience(Jones and
Suh,2000).These highlight the fact that customer satisfaction is based on experience with service
provider and also the outcome of service. Customer satisfaction is considered as an attitude, Yi,
(1990).

2.4 Theoretical Analysis

2.4.1 Service Quality Model
As stated earlier service quality has been defined differently by different people and there is no
consensus as to what the actual definition is. We adopted the definition by Parasuman et al,
(1988,p.5)which defines service quality as the discrepancy between a customer‟s „expectation of
the service and the customers perception of the offering. Measuring service quality has been one
of the most recurrent topics in management literature ,Parasuman et
al.,1988),Gronroos,(1984),Cronin et al.,(1992).This is because of the need to develop valid
instruments for the systematic evaluation of firms „performance from the customer point of view;
and the association between perceived service quality and other key organizational outcomes
,Cronin et al.,(2010,p.93),which has led to the development of models for measuring service
[Link] et al .,(2004,p.372-273) reviewed the various way service quality can be
measured.

11
SERVPERF model developed by Cronin and Taylor, (1992), was derived from the SERVQUAL
model by dropping the expectations and measuring service quality perception just by evaluating
the customer‟s the overall feeling towards the service.

SERVQUAL=Performance-Expectations

Weighted SERVQUAL=importance (performance-expectations)

SERVPERF=Performance

Weight SERVFPERF=Importance x(performance).

There are five dimensions:-

Tangibility: physical facilities, equipment, and appearance of personal, employees and

management team. Further, it is also defined as the ease in visibility of resources necessary for
providing the service to customers, well groomed employees and ease in accessing written
materials like pamphlets, brochures, folders, information books etc will have a favorable
consequence on the level of customer satisfaction parasuraman et al(1985).

Reliability: ability to perform the promised service dependably and accurately.

Responsiveness: defined responsiveness as the interests in providing prompt service to

customers when required, further, it is research that willingness or readiness of employees to
provide the required customer service without any in convenience at any time will strongly
influence the level of customer satisfaction parasuraman et al(1988) customers get satisfied when
organization provide individual attention and employees are paying attention to problem
experienced by customers Willingness to help customers and provide service.

Assurance: Knowledge and courtesy of employees and their ability to inspire trust and
confidence will strongly strike the level of customer satisfaction parasuraman et al(1988).

Empathy: Caring individualized attention the firm provides to its customers. The better
understanding of customer‟s specific needs, enhanced communication between management and
customers will have appositive out come on customer satisfaction.

12
Assessment: is the process by which the characteristics and needs clients, groups, and situations
are evaluated or determined to address the actual needs or desires, expectation and situatiation.

2.4.2 Factors that Affect Customer Satisfaction

Matzler et al.,(2002),classify factors that affect customers‟ satisfaction in three factor structure.

1. Basic factor: these are minimum requirements that are required in a product to prevent
the customer from being dissatisfied. They do not necessarily cause satisfaction but lead
to dissatisfaction if absent.
2. Performance factors: these are factors that lead to satisfaction if fulfilled and can lead to
dissatisfaction if not fulfilled. These include reliability and friendliness.
3. Excitement factors: these are factor that increase customers‟ satisfaction if fulfilled but
does not cause dissatisfaction if not fulfilled which include project management.

2.4.3 Relationship between Service Quality and Customer Satisfaction

According to Sureshchandarm et al.,(2002,p.363),customer satisfaction should be seen as multi-
dimensional construct just as service quality meaning it can occur at multi-level in an
organization and that it should be operational zed along the same factor on which service quality
is operational [Link] et al.,(1985) suggested that when perceived service quality is high
,then it will lead to increase in customer satisfaction. He supports that service quality leads to
customer satisfaction and this is in line with Saravana and Rao,(2007,p.436)and Lee et
al.,(2000,p.226)who acknowledge that customer satisfaction is based upon the level of service
quality provided by the service provider.
Fen and Lian ,(2005,p.59-60)found that both service quality and customer satisfaction have a
positive effect on customer‟s re-patronage intentions showing that both service quality and
customer satisfaction have a crucial role play in the success and survival of any health care.

2.5 CORE CONCEPTS OF HEALTH CARE QUALITY

2.5.1 Quality Values in Health Care
One cannot deny the fact that openness, confidence, motivation, and commitment are the
foundation of any quality cultures. However, traditional practices and attitudes towards authority,

13
mutual support, and individual responsibility actively resist improvement. This creates cultures
of low expectations and quality (from public and professional), vertical command structures,
restricted information, and a 6negative view of accountability and responsibility. This is still a
major problem in the whole of Africa.

Quality design involves providers, clients and managers in structured process to explicitly
identify client‟s needs and design services processes with the key feature to meet those needs. In
the context of quality design, the features are concrete, practical expressions of client‟s needs,
desires, and expectation. Quality design is use to develop an entirely new process or redesign an
existing process for improved service delivery.

2.5.2 Definition of Health Care Quality

The most comprehensive and perhaps the simplest definition of quality is that used by advocates
of total quality management (Deming, 1982):” Doing the right things right, right away.” Almost
as universal is the view by “Ovretveit, (1992”) who almost a decade later, recognized the three
“stakeholders” components of quality namely clients, professional, and management quality.
Client’s quality address what the client‟s wants from services,

Professional quality Indicates whether the services meets the needs as defined by professional
providers and referrers and whether it correctly carries out techniques and procedures which are
believed to necessary to meet the client‟s needs,

The management quality aspect is concerned with the most efficient and productive use of the
resources within limits and directives set by higher authorities and purchasers. As integrated
definition of health care quality therefore combines these elements .A” quality health services
/system gives patients what they want and need at the lowest cost”(Ovretveit, 1992)”.

Another clients- focused definition of quality comes from “Donabedian (1980)” and Morgan and
“Murgatroyd (1994)” Client satisfaction is of fundamental importance as measure of quality of
care, because, it gives more information on the provider‟s success at meeting those client values
and expectations on which the client has authority “Donabedian”.Also saw health care as
consisting of two parties: a technical task and an interpersonal exchange where by doctors and

14
patients discussed and agreed on treatment .Donabedian suggested that quality of care is made of
structures, processes and outcome.

Structure refers to the attributes of the setting in which care occurs. These includes the attributes
of materials resources (such as facilities, equipment and money), of human resources (such as the
number and qualification of personnel), and of organizational structures (such as medical staff
organization, method of peer review and method of reimbursement).

Process denotes procedures in giving and receiving care. It includes the patient‟s actives in
seeking care and caring it out as well as the practitioner‟s actives in making a diagnosis and
recommending or implementing treatment.

Outcome denotes the effects of care on the health status of the patients and population.
Improvement in the patient‟s knowledge salutary changes and patient‟s behaviors are included
under abroad definition of health status, and so is the degree of patient‟s satisfaction with care.

Patient‟s satisfaction is increasingly being recognized as an important measure of outcome and

quality of care. Whether Patient‟s will seek medical advice or comply with treatment will depend
on the level of satisfaction .These Quality health care concerns have led health care organizations
to use patient satisfaction data to identify facts about the processes of work and the root causes of
failures in those processes .This leads to improved standards of work leading to best clinical
practices.

2.5.3 Quality Dimension in Medical Care

Diversity is a rises when examining the meaning of quality in medical care. Medical quality
consist of a mixture of hard technical elements such as correct diagnosis ,appropriate
intervention and effective treatment as well as soft element such as good communication
,patient‟s satisfaction and consideration for the patient‟s preferences(Gill,1993).It is therefore not
sufficient to consider only the technical competence of those providing care ,but also care
provider more effectively ,efficiently and humanly . Ovretveit,(1990) stated that” professional
quality has two parts;(1)whether the service meet professionally assisted needs of its clients
and(2)whether the services correctly select and cares out the techniques and procedures which
professional believe meet the needs of clients .

15
 2.5.4 The Meaning of Quality
The definition and dimensions outlined above constitute a broad conceptual framework that
includes almost every aspect of the health system performance. These entire dimensions come
into play as clients, health providers, and health care managers try to define quality of care from
their unique perspectives. Quality health care is one, which meets their needs, and delivered
courteously and on time (Brown, et, al 1990).The dimension of quality that relates to clients
satisfaction also affect the health and well-being of the community. Hence, patients and
communities often focus on effectiveness, accessibility, interpersonal relations, continuity, and
amenities as the most important dimensions off quality. From the provider‟s perspective, quality
are implies that he or she or she has the skills, resources, and conditions necessary to improve the
health status of the patients and community according to current technical standards and
available resources .The provider commitment and motivation depends on the ability to care out
his or her duties in an ideal or optimal way. Providers tend to focus on the technical competence,
effectiveness, and safety.

Quality care requires that managers are rarely involved in delivering patient care although the
quality of patients care is central to everything they do. The varied demand of supervision,
financial and logistics management present many an expected challenges. This can level a
manager without a clear sense of priorities or purpose. Focusing on the various dimension of
quality can help to set administrative priorities. Health care managers must provide for the needs
and demands of both providers and patients, to be responsible set wards of the resource entrusted
to them by the government, private entities, and the community.

Health care managers must consider the needs of the multiple clients in addressing questions
about resources allocations, fee schedules, staffing patterns and management practices. In this
way, there will be no trade-off between increasing patient satisfaction, improving professional
outcomes, and reducing cost” (Ovretveit J, 2001)”.Despite the different perspective on quality
health by various players, a definition of quality needs to guide towards what is measured. It
should resonate with professional‟s values, while increasing efficiency to satisfy the client.

16
 2.5.5 Voice of the Customer
One cannot talk about quality issues without factoring in the concerns of customers. Increased
contact with external and internal customer provides managers with new ideas for improvement
and ultimately assists a manager to measure and adjust his or her performance against the all-
important barometer of the customer satisfaction “(Longeneceker and Neubert, 2003)”.There is
variety of methods for finding out what customers think about a service (Ovretveit, 1993);
talking-to staff or clients about what clients like and dislike about the service. It also involves
routine customer group meeting; letter sent to a sample of clients; comments cards ;free
telephones lines for comments and complaints; observation against check-list ;objective
indicators of customer satisfaction, example client-cancelled appointments ,demand and waiting
times. Each measures different things and used for different purpose in different situation. The
combining data collection methods give reach insights in to client‟s perspective on services
quality.

2.6 CUSTOMER SATISFACTIONS AS QUALITY INDICATOR

Customer satisfaction is the personal feelings, meanings and interpretation a consumer makes of
a product and/or services following its usage (Solomon 1996, Wells and Prensky 1996 cited in
Metewa and Almossiawi, 1998). Customer satisfaction is now the essence of success in today‟s
highly competitive world of business‟ (Kohl and Gasworks, 1990 cited in Jamal and Nasser
2002:146).

Customers or consumers of health care services therefore play a variety of roles in health care
quality assessment and monitoring. By expressing their preference, they supply the valuations
needed to choose among alternative strategies of care (Donabedian, 1987). They help define the
meaning of quality in the technical sense. Moreover; their preferences are the paramount
consideration in defining the quality of the interpersonal process and of the amenities of care.
Consumers are also valuable sources of information in judging the quality of care and non-
technical aspect of treatment.

This is because consumer can and do, through expressing satisfaction or dissatisfaction, pass a
judgment about many aspects of the process of care and its outcomes. Consumers, if properly
informed, could differently to regulate the quality of care by means of their choice. No wonder

17
that, health care is now entering an age of accountability where patients are demanding services
excellence. Some studies view patient‟s expectations as probabilities judgment about the
likelihood that a set of events will occur (McKinley, 2002; Conway, Will cocks, 1997). Others
view expectations on quality care as perceived needs, wants, importance, standards, or
entitlement (Kravitz, 1996). These expectations may pertain to health care in general or to a
specific health care encounter such as a clinic visits or hospitalization. Whether patient‟s
expectation or probabilities or values, an understanding of a patient expectation is important
because meeting these expectations may lead to greater satisfaction with care. As the patients is
becoming widely recognized as reliable and importance source of information about quality
medical practice(Lawathers,oRozanski,Nizakovski and Rys,1999),important steps towards
making performance transparent come with the publication of concrete figures on the quality of
outcomes relevant to patients. Patient‟s services are an important part of this. Advantages of
patients surveys to measure specific domains of experiences and satisfactions. However to reach
the valid and reliable results remain a challenge for the health care organizations (Sitzia, 1999).
If the questioner and process are scrutinized using scientific method, it can guarantee a useful
and comparative data .Health care organization using performance indicators to differentiate
themselves and demonstrate customer focus reap considerable advantages, especially if they
have a quality management system to underpin the development of performance. That is the
benefit of both patients and staff (Kolking, 2003, Dolan, 1998).

According to Jenkins on et al, (2002), patient‟s experiences of health and medical care are at the
very core of the purpose of clinical medicine. If medical treatment succeeds only in a limited,
technical sense, without any benefit to those receiving them, then such intervention would have
failed. Health care providers must consider whether and how patient expectations of their
services can be managed (McKinley et al, 2002). Dissatisfaction with the provision of heal care
services could be contained know what they can expect and then receives.

The above analysis of customer satisfaction is as a quality indicator, point to the fact that quality
health service delivery should have the customer or patients concerns as central to the overall
treatment process.

18
2.7. DELIVERY SERVICE QUALITY IN THE WESTERN CONTECXT
In Tomes and Ng (1995) study on delivery service quality in hospital care of National Health
Service (NHS) in England, they mentioned that healthcare professionals and managers must the
issues of improving the quality of service they provided.

2.8. THEORETICAL FRAMEWORK FOR THE STUDY

The main theoretical framework underlying this study is the use of the system theory of
management, regarded as one of the total quality management approaches espoused by quality
management writer such Dobbins and Crawford-Mason, [Link] system theory views
organizations as a unified and purposeful system interrelated parts. This approach expects
management to look at the organizations as a whole and as part of a larger, external environment.
As” Ludwig von Bertalantly et al 1956” pointed out; the system theory tells us that the activity of
any part or segments of the organization affects, in varying degrees, the activity of every other
segments. This pre-supposes that every part of the system including the work force must work to
support each other. When the sub-systems of an organization do not support each other, then the
organization cannot focus on quality management. The theory therefore emphasized that every
organization interacts with internal and external system by taking resources from the
environment and providing output.

According to the system theory, every organization has two major inputs:-

a. Human Resources- come from people who worked in the organization by contributing
their time, energy, value systems to the organization in exchange for wages and other
tangible and intangible resources.
b. Non-Human Resource- consists of raw materials and information, technology, physical
infrastructure .The human and material resources are inputs into the system and are
transforming into final products and services to satisfy consumers.
The human and materials resource are inputs into the system and are transforming into final
products and service to satisfy consumes. For instance, the hospital inputs are its staff, supplies,
and patients. The patients go through the application of medical knowledge and treatment, and
the inherent organizational culture and values system. The output is patients restored to a level of

19
psychological and physical consistent with severity of the disease. The system receives the
feedbacks from the external environment for assessment in term of quality of service.

2.9 CONCEPTUAL FRAMEWORK

The conceptual frame work (Figure1) explains the underlying process which is applied to guide
this study. As discussed above, the SERVQUAL model is suitable for measuring service quality
and customer satisfaction in hospital offering adequate services using the service quality
dimensions. SERVQUAL model are modified to measure the perceived health care delivery
service and customer satisfaction in Alert general hospital The research want to find out the
overall service quality perceived by customers with pre _medical service and medical services
that on which dimensions customers satisfied. According the two most important variables of
study were quality health care service (Independent variable) and customer satisfaction
(Independent variable). The independent variable has effect on customers satisfaction while the
independent variable could be conditioned based on the status of the independent variables was
tested in correlation in the analysis part of the study.

Quality health care service was measured in terms its Five dimension of Quality service:
reliability, responsiveness, empathy, assurance and tangibility of o the services. But this Quality
healthy cares services was affected by different factors that can hamper or enhance the process of
service provision .In addition, the way an organization receives feedback (complaints) and makes
services recovery affect the satisfaction level .Effective system of handling in place the most
likely result was customer satisfaction and the reverse was occurred in the service delivery
(exchange) process. It was also obvious that the customers‟ attributes like word of mouth,
personal needs and past experiences affect the customers‟ expectations‟ and that lastly result
either in satisfaction and dissatisfaction.

20
Figure 1. Customer perceptions of quality and customer satisfaction Wilson et al.

Reliability, ability to perform the promised service dependently and accurately

Responsiveness, as the interest in providing prompt service to customer when required, further
its research that willingness or redlines of employees to provide the required customer service
without any in convince at any time will strongly influence the level of customer satisfaction
parasurament et al 1988 customer get satisfied when organization provide individual attention
and employees are paying attention to problem experienced by customers willingness to help
customer and provide service.

Assurance, knowledge and courtesy of employees and their ability to inspire trust and
confidence will strongly strive the level of customer parasuraman et al, 1988.

Empathy, caring individualized attention the firm provides to its customers. The better
understanding of customer‟s specific needs enhanced communication between management and
customers will have appositive out come on customer satisfaction.

Tangibility, physically facilitates, equipment and appearance of personal, employees and

management team will have a favorable consequence on the level of customer satisfaction
parasuraman et 1988.

21
 CHAPTER THREE

3. METHODOLGY

3.1 RESEARCH DESIGN

A research design is defined as the arrangement of conditions for collection and analysis of data
in a manner that aim to combine relevance to the research purpose with aimed procedure. In
other words, the research design is a conceptual structure within which research is conducted; it
constitutes the blueprint for the collection, measurement, and analysis data. Accordingly, the
design incorporates a framework of what the researcher is going to do from the basic questions
and their operational implications to the final analysis of data (Sauder‟s et al., 2007).

Therefore, this is a quantitative research that adopted the survey strategy through convenience
samples of non-probability sampling technique. Surveys allow the collection of large amount of
data from sizeable population in a highly economical way (Sauder‟s et al., 2007;The data often
obtained by using a self- administered questionnaire the standardized and structured
questionnaires‟ that allowing easy comparison

3.2 THE STUDY AREA AND POPULATION OF THE STUDY.

The study conducted at Alert General Hospital in Addis Ababa the capital city of Ethiopia. Alert
hospital was found in Zenebawork, KolfeKeranyo, and Addis Ababa Ethiopia. The hospital lies
between latitude 8.9856⁰ and 8⁰ 59‟8.2‟‟north .Longitude 38.7104⁰ or 38⁰ 42‟ 37.4‟‟ east, and
elevation 2303 meters or 7556 feet. Alert is originally built by ”Dr Thomas Lambie in 1992,”
which was later named the Princess Zenaba Work Hospital. A memorandum to found ALERT
was signed Dec.11,1965 by representative of the Ministry of Health, Addis Ababa University,
the international Society for the Rehabilitation of the Disabled ,The Leprosy Mission, and
“[Link] Kellersberger” of the American Leprosy Mission ,who had had the vision for
establishing such a multifaceted center and had been the main promoter of the project. The
hospital provides curative, preventive and rehabilitative service. Furthermore, the hospital
function as pre service training center for the medical student from the different medical and
health science teaching institutes in the capital city for practicum attachment and it‟s also has

22
been also providing in service training for leprosy patients over the world on rehabilitation
activities. As to the infrastructure the hospital has 24 hours water and electricity supply.

3.3 STUDY POPULATION

All patient visited Alert hospital for medical services during working days(Monday to Friday)of
the week in the study period. All adult patients visited outpatient department (OPD) units of
Alert hospital on working days of the week during the study period. It is a general hospital for
primary hospital. All outpatients visiting the hospital for health services from Monday to Friday
during working hours were the study population. Therefore, the researcher was expected to get
about 221 service seekers of outpatients who were come to Alert General Hospital from Monday
to Friday during working hours. This was served as a population from which is a representative
sample was drawn with convenience sampling and into incorporated into customer study.
ALERT‟s activities focus on its hospital, rehabilitation of leprosy patients, training programs for
leprosy personnel from around the world, and leprosy control (administration of Ethiopian
Ministry of Health‟s regional leprosy control program).From the beginning, ALERT provided
leprosy training for medical students from Addis Ababa University.

3. 4 SAMPLE SIZE
One of the important reasons for the researcher to determine sample size for this study was, it is
very difficult to include the entire population to study due time, finance and manpower
constraints. Taking all these in to account the investigator tried to estimate the reasonable sample
size using the single population to proportion formula used by Yamane (1967:886) with the
following assumption. These include 95% confidence interval, 0.1 expected margin of error
and.05 proportion.

The equation is:- n=

Where n is the sample size, N is the population size, and e is the level of precision. When this
formula is applied to the above sample equation will get

n= =68

Therefore the researcher used 221 respondents with 10% of contingency for non-respondents.

23
Comparing with other previous similar study done by Peng (2006), the investigator deems that
this computed sample size will be adequate to infer the findings to general population of the
study area. It was adequate sample size for this study. Because, Peng (2006) that verified the
minimum sample size of 200 respondents is needed for any type of quantitative research to reach
a significant result.

3.5. SAMPLING TECHNIQUES

The researcher used a non-probably sampling technique. Non probability sampling provides a
range of alternative techniques to select samples based on your subjective judgment to answer
research question and meet the objectives. Sampling technique is available to the researcher by
virtue of its accessibility (Bryman and Bell, 2003:105) the researcher was interested in customer
satisfaction and service delivery. Non-probability sampling techniques also provide researcher
with the opportunity to select the sample purposively and to reach difficult to identify members
of the population. It was impossible to select all members of the population to take part in the
research. Because; a non-probably sample is simply one in the researcher uses any subjects that
are available to participate in the research study.

3.6. TOOLS/INSTRUMENTS OF DATA COLLECTION

Preliminary observation and assessment were made by going to the study area to know about the
organizational set up of service delivery system and the concern and views of the customer
satisfaction to develop useful tools for the study. Different related articles(Kent, 2007).and
(Saunders et al, 2009:256) were reviewed to get more insight on both dependent and independent
variables to be including data collaction. Then after the study tool was adapted from similar
studies by English and then translated from English to Amharic and back to English for
consistency. Self- administration and face to face interview methods were used for those who
able to write and read and not able read and write respectively for data collection using
structured questionnaires. The collected information entailed socio-demographic characteristics
of respondents and their satisfaction level with different components of hospital‟s health care
services provided, perception of customers towards waiting time and cleanliness of waiting
areas, perception of customers toward receptiveness and services provided by health service
providers when patients visited hospital with medical problem, and perception on the availability
of diagnostic facilities at hospital.

24
3.7 DATA COLLECTION PROCEDURES
Preliminary observation and assessment were made by going to the study area to know about the
organizational set up of service delivery system and the concern and views of the customer
satisfaction to develop useful tools for the study. The primary data was collected through
carefully prepared and organized questionnaire with convenience selected respondents of Alert
General Hospital. There are 215 respondents were self-administered and 6 of them are
respondents were face to face interview. The information was collected through a structured
questionnaire with five Likert scale types (having a scale of range 1 strongly disagree to 5
strongly agree).The PI checked each question for completeness and constituency on daily basis
after each data collection day taking 10 to 15% of the completed questionnaires. Data were
coded and entered into computer using SPSS version 2020 software. In the analysis of client
satisfaction, each variable is scored on a 5 point Likert –like scale, ranging from 1(strongly
disagree) to 5(strongly agree).Frequency distribution and percentages are calculated for selected
variables. Hierarchical binary logistic regression analysis was conducted to predict the factors
which influence the level of customer satisfaction with health service deliveries with a 95%
Confidence Interval (CI). P-values less than 0.05 were taken as statistically significant.

3.8. METHOD OF DATA ANALYSIS

Data were coded and entered into computer using SPSS version 20.0 software. Data double
entered. In the analysis of client satisfaction, each variable is scored on a 5 point Likert –like
scale, ranging from 1(strongly disagree) to 5(strongly agree).Frequency distribution and
percentages are calculated for selected variables. Tables, graphs, pie chart and central tendency
measure like mean, mode, and percentages were used to display in important information.
Hierarchical binary logistic regression analysis was conducted to predict the factors which
influence the level of customer satisfaction with health service deliveries with a 95% Confidence
Interval (CI). P-values less than 0.05 were taken as statistically significant.

3.9. ETHICAL CONSIDERATION

Before the study was carried out, the research sough the consent of respondents by explaining the
purpose of the study to them and assuring them of their confidentiality. The respondents were
also informed about their right to refuse the participation from the beginning and/or in between
whenever they want and told as has no effect on their right to get any health care services at the

25
hospital further, customer were informed on time it took complete either self-administered
questions or face to face interview.

26
 CHAPTER FOUR

4. RESULTS AND DISCUSSIONS

4.1 Descriptive analysis of socio-demographic.

This chapter was about result and discusses findings of the data from the field on assessing
perceived quality health care delivery service and customer satisfactions using SERVQUAL
model at Alert Hospital. The study was aimed to determine overall quality of health services
perceived by customer and quality health care delivery service dimensions that bring customer
satisfactions. Primary and main analyses were done. The preliminary analysis mainly focused on
quantitative statistics to summarize data. Whereas, the main analyses involved the gap score
analysis where by quantitative statistics were applied to summarize means of perceptions and
expectations of customers. The perception minus expectation scores was done for each item and
dimension in order to identify the quality of health care delivery service gaps at outpatient
department of study hospital.

27
4.1. 1. Demographic characteristics of the Respondents

Table 1: Demography characteristics of the Respondents

Numbers Percent (%)

Sex Male 92 41.6
Female 129 58.4
Total 221 100
Age 20-25 28 12.7
26-40 101 45.7
41-65 65 29.4
>65 27 12.2
Total 221 100
Religious Muslims 91 41.2
Christens 94 42.5
Others 36 16.3
Total 221 100
Marital status Married 158 71.5
Single 45 20.4
Divorce 10 4.5
Widowed 8 3.6
Total 221 100
Education Uneducated 4 1.81
Level
Primary 14 6.33
school
Secondary 35 15.84
School
Tertiary 168 76.02
education
Total 221 100
Sources: field survey of 2020

Table 1 shows the distribution of the sample which was 58.4%female and 41.6% male and the
largest proportion of the age dropped to age group 26-40, which account about 45.70% and while
the least proportion was went to age category above>65 years (12.12%).Out of 221 respondents a
proportion of Christian is higher than Muslim respondents (42.5% and 41.2%).The proportion of
married respondents were a little less than three quarter of the respondents (71.5%).Likewise, the
proportion of the respondent who were literate(with primary and above education)account about
98.2% of which the respondent with tertiary level of education were above 76.02%.Seventy-one
percent (71%) (157) of the respondents were from urban areas and while the remaining 29 %(

28
64) were from rural areas .A little above half (56.6%) of the respondents were government
employee and the rest 43.4 %( 96) of respondents were private employee by employment status.

4.1.2. Expectation and perception towards quality of health care services provided by
customers

[Link] Preference of facility

[Link] of facility usage

Types of health care Number percent

Mostly public 71 32.1
Public 127 57.5
Mostly private 2 0.9
Private 21 9.5
Total 221 100
Source: field surveyof2020

From table 2,more than three- quarter(89.6%)of the respondent responded as their preference for
seeking care curative care were predominantly public facility than private facility out of these
about one –third(32%) of the participants mostly seek medical care from the public facility.

29
 [Link] Analysis of score difference between perceived and expected quality of healthcare in
Alert Hospital outpatient department

Table 3: mean scores for each SERVQUAL Statement.

Statement Perceived(Mea Expected(mean) SERVQUAL

Number Statements n) Score difference
cleanliness and hygiene in hospital should be 4.15 5.10 -0.95
1 excellent
2 the patient room should be comfortable enough 4.15 5.10 -0.95
hospital should provide treatment ,diagnostic test and 4.07 5.05 -0.98
3 other services in acceptable time period
when patient has a problem the hospital should show 4.24 5.20 -0.96
4 sincere interest to solve it
doctor should explain health condition diagnostic and 4.10 5.15 -1.05
5 treatment in an understandable way
nurse should explain to patients exactly when what 4.11 5.10 -0.99
6 they are going to do
if you are admitted ,doctors should monitors your 3.19 5.15 -1.96
7 health status at daily
doctors/nurses should response immediately when 4.12 5.10 -0.98
8 called patients
9 doctors/nurses should be willing to help patients 4.05 5.01 -0.96
Waiting time for admission 3.92 5.00 -1.08
10 shouldn‟t be longer than 7days/week
waiting time for daily service shouldn‟t be longer than 4.04 5.00 -0.96
11 30 minutes
12 Doctor should be competent 4.00 5.01 -1.01
13 nurses should be skilful 3.91 5.01 -1.1
14 Patients should feel receiving medical treatment 3.78 5.05 -1.27
15 hospital should provide privacy during treatment 3.95 5.00 -1.05
doctors/nurses should be respectful towards patients 3.90 5.01
16 -1.11
17 doctors should spend enough time with each patients 3.94 5.00 -1.06
18 hospital should open on time for patient 3.57 5.01 -1.44
doctors/nurses in hospital should be listen to you 3.81 5.05 -1.24
19 attentively
20 nurse in hospital should be care 3.80 5.01 -1.21
hospital provide treatment diagnostic tests and other 4.19 5.10 -0.91
21 services within an acceptable time period
when, I have a problem hospital workers show 4.14 5.06 -0.92
22 willingness to solve it
doctors explain health conditions ,diagnosis and 3.93 5.00 -1.07
23 understandable way
Before giving you any drug, did the hospital staff 3.83 5.04 -1.21
24 explain to you the usage and side effect of the drug?
How satisfied are you with the quality health care 3.90 5.00 -1.10
25 delivery at Alert hospital services?

Source field survey, 2020

30
From table 3,the largest SERVQUAL score difference between participation and expectation
was registered for hospital should open on time for patient (-1.44)while the lowest was for
SERVQUAL means score difference between perception and expectation for when, have a
problem hospital workers show willingness to solve it(-0.92). The perceived and expected means
score for cleanliness of the hospital and size room were equal from SERVQUAL statement for
both variables 4.15 and 5.10respectively with -0.95 SERVQUAL mean score.

This depict that the perceived quality of health care provided is lower than the expected quality
of care provided at outpatient department of Alert hospital. As to the difference on mean score of
perceived and expected convey the right health education on the diagnosis and treatment
provided was -1.05 and -0.99 for doctors and nurses which shows nurse are at better position to
communicate with patient than Doctors. The SERVQUAL score difference for perception and
expectation for hospital provide treatment, diagnosis test and other services within an acceptable
time period is -0.91 but, this was much lower than recorded SERVQUAL score difference for
perception and expectation for waiting time for daily service shouldn‟t be greater than 30
minutes (-0.96).Likewise, the SERVWUAL score difference on perception and expectation of
respondent on companionate (sincere interest) to solve the problem revealed -0.96 and was
much better than mean score difference observed between perception and expectation for
respectful care for patient (-1.1)and worst of score difference for patient feel receiving medical
treatment in hospital (-1.27).As the to the competency of services providers to provide quality
service ,the SERVQUAL score difference between perception and expectation for doctors is
better (-1.01 compared to Nurses(-1.1).

The recorded SERVQUAL means score difference between perception and expectation for
privacy and spent adequate time with patient was comparable(-1.05 and -1.06).As to one of the
important variable for this study,-1.10 SERVQUAL mean score difference was recorded
between perception and expectation for how satisfied are you with the quality health care
delivery at Alert hospital services. Finally, the SERVQUAL statement on observed difference
on mean score between perception and expectation for all parameters found negative which
clearly pin pointed the existence gaps on perceived and expected quality of health care services
provided in the Alert hospital outpatient department.

31
 Table 4: Five Highest and Lowest Means SERVQUAL statements,

Alert Hospital, 2020

Five highest perceptions Five lowest perception

Statement Mean Statement Mean
4 4.24 7 3.19
21 4.19 18 3.57
1 4.15 14 3.78
2 4.15 20 3.80
22 4.14 19 3.81
Five highest expectation Five lowest expectation
Statement Mean Statement Mean
4 5.20 10 5.00
5 5.15 11 5.00
7 5.15 15 5.00
1 5.10 17 5.00
Five largest Five smallest
difference(SERVQUAL)score difference(SERVQUAL)score
Statement Mean Statement Mean
6 0.99 7 1.96
3 0.98 14 1.27
4 0.96 18 1.44
1 0.95 19 1.24
21 0.91 20 1.21

Source: field survey of, 2020

Table 5:Customer satisfaction on service provided(%)

Statement Number Percent

Very satisfied 133 60

Satisfied 77 35

Neutral 11 5

Total 221 100

Source: field survey, 2020

32
Almost all (96%) patients are satisfied with the service provided and there is no patient
responded they were dissatisfied by the service provided see (Table 5 above).The showed the
highest satisfaction (60%)and very satisfied(35%) and only(5%) were neutral.

4.2.2 Regression of variables

Regression analysis was conducted assess how the five dimension of quality product satisfaction
ratings. The regression used the overall satisfaction rating as the dependent variables against the
five dimension of service quality.

Table 6: Coefficient Of predictive variable

Satisfaction B Std. Exp(B) T Sig 95% confidence

grouped Error interval for
Exp(B)
Lower Upper
Bound Bound
2.550 1.400 1.822 .070 -.211 5.311
Dissatisfied
Intercept
.076 .130 .042 .584 .560 -.181 .333
Tangibility
.092 .170 .038 .544 .587 -.243 .427
Reliability
.190 .079 .175 2.417 .017 .035 .345
Responsiveness

Assurance -.014 .093 -.011 -.154 .878 -.199 .170

Empathy -.010 .073 -.009 -.132 .895 -.154 .135

The model shows that, Responsiveness, Reliability and Tangibility are significantly related to
dependant variable at 95% confidence interval.

Customers‟ satisfaction= 0.175(responsiveness) +0.038(reliability) +0.042(tangibility

This implies that if responsiveness increases by2.42 then customer satisfaction will increase
17.5% other variables are increase. Similarly, if Reliability and Tangibility increase by 3.8% and
4.2%, customer satisfactions increase by 58.7% and 56%respectively.

33
 CHAPTER FIVE

5. SUMMARY, CONCLUSIONAND RECOMMENDATIONS

5.1 Summary of the Finding
This chapter was about the summary, conclusion and recommendation from the field on
assessing perceived quality of health care delivery service and customer satisfaction. As a result
and based on the findings of the study at Alert hospital, the overall level of customers
satisfaction for premedical health services. Patient evaluation of care is important to provide
opportunity for improvement such as strategic framing of health plans, which sometimes exceed
patient‟s expectations and perception. The advantages of patient satisfaction survey rely heavily
on using standardized, tools needs to be the further developed and refined in order to reflect
positively on the main goals of patient‟s satisfaction survey. There was a common salient
determining factor between the studies which was interpersonal skills in terms of courtesy,
respect by healthcare providers in addition to communication skills, explanation and clear
information, which are more essential and influential than other technical skills.

The elements of service quality models such as willingness to help a customer, respectful
communication, and nurse/doctor should explain to patients exactly when and what they are
going to do, adequate consultancy and able to express compassion at time of service provisions
are among factors influencing customer level of satisfaction. From experience point of view and
observed from studied subjects, those customers who satisfied with a health services were more
likely to come for fore visits and follow the recommendations of their service providers; provides
thanks and use good words of mouth for service providers .

Finally, this review of various elements of patient‟s satisfaction ranging from its measurement
,predictors for improving overall patient satisfaction and impact of collecting patient information
to build up strategic quality improvement plans and initiatives has shed light on the magnitude
of the subject. It thus provides the opportunity for organization managers and policy makers to
yield a better understanding of patient view and perceptions, and the extent of their involvement
in improving the quality of care and services.

34
 5.2 CONCLUSION
Service delivery is the systematic arrangement of activities in service giving in situations with
the aim of fulfilling the perceived and expectations of customers. Quality of health care delivery
service particular designed for multi-dimensions of activities performed and provided by
especially trained health workers and some supportive staff at different levels of the community
aimed to ensure persistent burdens and satisfying the needs, desires and expectations of
customers.

The main objective of this study is to assess the level of customer satisfaction on the health care
services provided at the hospital and identifies potential to customer satisfaction at Alert hospital
in Addis Ababa. There are sufficient justifications for studying health service delivery system
customer satisfaction in hospital. Firstly, despite the perception towards waiting time and
cleanliness of waiting areas, perception of customer towards receptiveness and services
provided by health service providers when patients visited hospital with medical problem and
perception on the availability of diagnostic facilities at hospital. Customer satisfaction is about
relationships between the customer, product or service. Customer satisfaction is highly personal
assessment that is greatly influenced by individual expectations. It is highly associated with
service quality dimensions. The quality of health service delivery system has significant impact
on quality health services ;in such a way unless the basic health service delivery system be
improved or changed with its internal institutional capacity ,quality health service and related
customer satisfaction could not be ensured or enhanced. Measurement of patients/customer
satisfaction plays an important role in the growing push towards accountability among health
services providers. Studies on patient‟s satisfaction have significant role developing and
delivering highly quality health care in hospital.

The variables of factors which occasionally affect level of customer satisfaction from preventive
and curative health services mostly also related to service provision standards of the health which
was seen in parts organizational structure, facilities, infrastructures, opening of hospital on time
and cleanliness of waiting [Link],these service quality and customer satisfaction influencing
factors are generally found burying in service quality, models as integral components of
tangibles, reliability, responsiveness, assurance and empathy. The elements of service quality
models such as willingness to help a customer, respectful communication, and nurse/doctor
35
should explain to patients exactly when and what they are going to do, adequate consultancy and
able to express compassion at time of service provisions are among factors influencing customer
level of satisfaction. From experience point of view and observed from studied subjects, those
customers who satisfied with a health services were more likely to come for fore visits and
follow the recommendations of their service providers; provides thanks and use good words of
mouth for service providers .

5.3 RECOMMENDATION
This study attempted to recommend on some findings obtained during the study. To make
accessible quality health service deliveries for health, policy review, reformulations and
researches are required in addition to the different gaps in allocation of health resources. Periodic
patients‟ satisfaction survey should be institutionalized to provide feedback for continuous
quality service improvement. Policy makers and administrators of health care facilities need to
give much attention for making rooms comfortable for patients.

The hospitals administration and responsible body in each service level should work together in
improving the rate of patients‟ satisfaction with health care deliveries. The researcher also strive
to recommend the major factors affecting level of customer satisfaction at pre- medical health
service, diagnosis treatments, opening of hospital on time, long waiting of time, inadequacy of
information where customers want to going. In case of different components of health service
deliveries: Inadequacy of health information provisions, explanation procedures, consultancy
about health care and services, courtesy and respect, confidentiality and privacy concerning
health problems and services provided, client health question and problems prompt answering
capacity, cleanliness of services rooms and areas of waiting are factors customers level of
satisfaction and needs appropriate intervention and further improvements.

36
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INTERNET WEBSITES

Universal Declaration of Human Rights (1948-1998):

[Link]/overview/[Link](accessed 20/05/07

39
 ANNEXES
Annex one: Questionnaire (English)

AN ASSESMENT OF QUALITY HEALTH CARE DELIVERY SERVICE AND

CUSTOMER SATISFACTION

(ALERT GENERAL HOSPITAL AT ADDIS ABABA)

The aim of this research is to assess the Addis Ababa population‟s perception of the quality
health care delivery service and customer satisfaction in ALERT hospital as well as the most
influential factors of patient satisfaction within the SEVRVAUAL framework. The questionnaire
has three parts. Demography, Expectation and perception.

PARTONE: Demography

1. Residence
a. Urban b. Rural
2. Marital Status

a. Married c. Divorced

b. Single d. Widowed

3. Religious

a. Muslims c. Others

b. Christian

4. Occupations

a. Private

b. Government

5. Educational Level

40
 a. Uneducated c. Secondary School

b. Primary School d. Tertiary education

6. Age

a. 20-25 C.41-65

b. 26-40 d. 65

7. Gender

a. Male b. Female

8. Which healthcare facilitate do you use?

a. Public
b. Mostly public
c. Private
d. Mostly private
9. What is your perception Alert hospital healthcare?

a. Secondary source (friends and family experience)

b. Personnel experience

41
PARTTWO

Expectation: This part is deals with your opinion of the hospitals

Q10

Strongly Disagree Neutral Agree Strongly

disagree agree

The nurses & doctors should be clean

&well groomed ,

Cleanliness and hygiene in hospital

should be excellent

The patient room should be

comfortable enough

Q11.

Strongly Disagree Neutral Agree Strongly

Disagree Agree
Hospital should provide treatment, diagnostic
test and other services in acceptable time period
When patient has a problem ,the hospital should
show sincere interest to solve it
Doctors should explain health condition
,diagnostic and treatment in an understandable
way
Nurse should explain to patients exactly when
and what they are going to do
If you are admitted, doctors should monitor your
health status at daily

Q12.

Strongly Disagree Neutral Agree Strongly

Disagree Agree
Doctors/nurses should respond immediately when
called patients
Doctors/nurses should be willing to help patients
Waiting time for admission shouldn‟t be longer
than 7 days/a week
Waiting time for daily service shouldn‟t be longer
than 30 minute

42
Q13

Strongly Disagree Neutral Agree Strongly

Disagree Agree
Doctor should be competent
Nurses should be skilful
Patients should feel receiving
medical treatment
Hospital should provide
privacy during treatment
Doctors or nurses should be
respectful towards patients

PART THREE

Perception: The following statements deal with the perceptions of quality health care delivery
service and customer satisfaction in hospital.

Q14

Strongly Disagree Neutral Agree Strongly Agree

Disagree
Doctors should spend enough
time with each patient
Hospital should be open on time
for patient
Doctors/nurses in hospital should
be listen to you attentively
Nurse hospital should be care

Q15

Strongly Disagree neutral Agree Strongly Agree

disagree
Hospital provide treatment,
diagnostic tests and other services
within an acceptable time period
When I have a problem, hospital
workers show willingness to solve it
Doctors explain health conditions
,diagnosis and understandable way

43
16. Before giving you any drug, did the hospital staff explain to you the usage and side effects of
the drug?

A. Never

B. Sometimes

C. Usually

D .Always

17. How satisfied are you with the quality health care delivery at Alert hospital services?

a. Very dissatisfied d. Satisfied

b. Dissatisfied e. very satisfied

c. Neutral

Thank you for participating and completing the questionnaire in this study. This survey forms
part of a research study under the supervision of the [Link]’S UNIVERSITY SCHOOL
OF GRADUATE STUDIES FACULTY OF HUMANITY.

By ASHIA EBRO

44
ANNEX TWO: _ QUESTIONARIE (AMHARIC)
በ አ ሇ ር ትሆስ ፒታሌየ ሚሰ ጥየ ጤና አ ገ ሌግልትጥረ ትእ ና የ ዯነ በ ኞችእ ር ካ ታጥና ት
የ ዚህ ጥና ትአ ሊ ማአ ዲስ አ በ ባ ውስ ጥየ ሚገ ኝአ ሇ ር ትሆስ ፒታሇ የ አ ገ ሌግልትአ ቅር ቦ ትን በ ሚመሇ ከ ትእ
ን ዲሁምበ አ ገ ሌግልትጥራትማእ ቀፍውስ ጥያ ውን የ ተካ ሚዎችእ ር ካ ታን በ ተመከ ከ ተህ ዝቡያ ሇ ውን አ መሇ
ካ ከ ትሇ ማወቅነ ው፡ ፡

ይህ መጠይቅየ ሚከ ተለትን ጉዳዮችይዳስ ሳ ሌ፡ -

ማስ ታወሻ ፡ -

እ ር ስ ዎበ አ ሇ ር ትሆስ ፒታሇ ውስ ጥመሰ ጠትአ ሇ በ ትብሇ ውከ ሚጠብቁትአ ገ ሌግልትጋር ሲነ ፃ ፀ ር በ ዚህ መ

ጠይቅሊ ይያ ዯረ ጉትተሳ ትፎበ ሚስ ጥራዊነ ትእ ን ዯሚያ ዝዘ ረ ግጥሌዎሇ ታሇ ሁ፡ ፡

ክ ፍሌአ ን ድ
1. እ ድሜስ ን ትነ ው

ሀ . ከ 20-25 ዓ መትመ. ከ 41-65 ዓ መት

ሇ . ከ 25-40 ዓ መት ሐ. ከ 65 ዓ መትበ ሊ ይ

2.ፆ ታ ሀ . ወን ድ ሇ . ሴት

3. የ መኖራቦ ት
ሀ . ከ ተማ ሇ . ገ ጠር

4. የ ገ ብቻሁኔ ታ
ሀ. ያገ ባ ሐ. የ ፋታሀ

ሇ. ያሇገ ባ መ. የ ሞተቦ ት

5. ሀ ይማኖት
ሀ . ሙሰ ሌም ሇ . ክ ር ስ ታን ሐ. ላሊ

6. ስ ራ

ሀ . የ ግሌ ሇ . የ ማን ግስ ት

7. የ ትምህ ር ትዯራጃ

45
 ሀ . የ ሌተመፇ ሇ . አ ን ዯኛዯራጃ ሐ. ሁሇ ተኛዯራጃ መ. ከ ዛ በ ሊ ይ

8. እ ር ሶ የ ሚጠቀሙትበ የ ትኛውየ ጤና አ ገ ሌግልልተቋምነ ው

ሀ . የ ህ ዝብ

ሇ . በ አ ብዛ ኛውበ መን ግስ ትባ ሇ ቤትነ ትየ ተያ ዘ

ሐ. በ አ ብዛ ኛውበ ግሌባ ሇ ቤትነ ትየ ተያ ዘ

ክ ፍሌሁሇ ት
9.ከ ዚህ በ ታችየ ተዘ ረ ዘ ሩትበ ሆስ ፒታሇ ውስ ጥመስ ጠት

የ ሚገ ባ ቸውን አ ገ ሌግልትየ ሚያ ሳ ዩ ነ ቸው፡ ፡

በ ጣምአ ሌሰ ማማም አ ሌሰ ማም ገ ሇ ሌተኛ እ ስ ማማሇ ሁ በ ጣም

አ ሰ ማማሇ ሁ
ሆስ ፒታለዘ መና ዊና
በ ግባ ቡየ ተዯራጀመሳ ር ያ ሇ ኖራቸውይገ ባ ሌ
ሆስ ፒታሌውሰ ጥየ ሇ ው
ን ፅ ህ ና ፅ ዳትየ ሊ ቀዯረ ጃሉኖረ ውይገ ባ ሌ
ነ ር ሶ ችና ዶክ ተሮችን ፅ ህ ና
በ አ ገ ባ ቡየ ሇ በ ሱመሆን አ ሇ ባ ቸው
የ ታካ ሚዎችክ ፍሌምቾት
የ ሇ በ ትመሆን ይኖር ባ ታሌ

10.በ ጣምአ ሌስ ማማም /ወሳ ኝያ ሌሆነ ሁኔ ትበ ጣምእ ስ ማማሇ ሁ/ወሳ ኝየ ሆነ ሁኔ ት

በ ጣምአ ሌሰ ማማም አ ሌሰ ማም ገ ሇ ሌተኛ እ ስ ማማሇ ሁ በ ጣምአ ሰ ማማሇ ሁ
ዶክ ተሮች(ነ ር ሶ ች) ከ ታሚዎችጥሪ
በ ሚቅብሊ ቸውጊ ዜምሊ ሽመሇ ጠትአ ሇ ባ ቸው
ዶክ ተሮች(ነ ር ሶ ች)ታከ ሚወችን
ሇ መር ዳትፍቃዯኛመሆን አ ሇ ባ ቸው
ሆሰ ፒታሌተኝቶሇ መታከ ምየ ሚያ ስ ጠብቀው
ጊ ዜከ አ ን ድሳ ምን ትመብሇ ጥየ ሇ በ ትም
በ የ ቀኑ የ ሚያ ድግየ አ ገ ሌግልትጊ ዜ ከ 30
ዯቂቃበ ሊ ይየ ሚያ ስ ጠብቅመሆን የ ሇ በ ትም

46
 11.ከ ዚህ በ ታችየ ተዘ ረ ዘ ሩትከ ሆስ ፒታሌውስ ጥመሰ ጠትየ ሚገ ባ ቸውአ ገ ሌግልቶቸየ ሚመሇ ከ ቱና ቸው፡
፡
በ ጣምአ ሌሰ ማማም አ ሌሰ ማም ገ ሇ ሌተኛ እ ስ ማማሇ ሁ በ ጣምአ ሰ ማማሇ ሁ
ዶክ ተሮችበ ቀትያ ሊ ቸውመሆን አ ሇ ባ ቸው
ነ ር ሶ ችአ ስ ፇሊ ጊ ክ ህ ልትሲኖራቸውይይባ ሌ
ዶክ ተሮች (ነ ር ሶ ች)ጥሪ በ ሚቀር ብሊ ቸውግዜ
ምሊ ሽመስ ጠትአ ሰ ባ ቸው
ዶክ ክ ሮቸ(ነ ር ሶ ች)የ ተካ ሚዎችን ጥጣቄ
ሇ መመሇ ስ
የ ሚያ ስ ችሌበ ቂእ ዉቀትሲኖራቸውይገ ባ ሌ
ዶክ ተሮችበ ትኩረ ተማዯመጥአ ሇ ባ ቸው
ዶክ ተሮችከ አ ን ዳን ድታካ ሚዎችጋር በ ቂ
ጊ ዜመሳ ሇ ፍአ ሳ ባ ቸው
ሆስ ፐታለዘ መና ዊና በ አ ግባ ቡየ ተዯራጀ
መሳ ሪ ያ አ ሊ ቸው

ክ ፍሌሶ ስ ት

12. ከ ዚህ በ ታችየ ተዘ ረ ዘ ሩትነ ጥቦ ችሆስ ፐታለን የ ሚመሇ ከ ቱና ቸው፡ ፡

በ ጣምአ ሌሰ ማማም አ ሌሰ ማም ገ ሇ ሌተኛ እ ስ ማማሇ ሁ በ ጣም
አ ሰ ማማሇ ሁ
ሆስ ፒታለያ ሇ ውን ፅ ህ ና እ ና
ፅ ዯጽበ ቂነ ው
ነ ር ሶ ቸና ዶከ ተሮችን ፁህ ና የ ዯን ብሌብስ
አ ግባ ቡየ ሇ በ ሱና ቸው
የ ታካ ሚዎችክ ፍሌ ምየ ሇ ውነ ው

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 13.በ ጣምአ ሌስ ማማም/ወሳ ኝያ ሌሆነ ሁኔ ታእ ን ዲሁምበ ጣምአ ስ ማማሇ ሁ /ወሳ ኝየ ሆነ ሁኔ ታ
በ ጣም አ ሌሰ ማም ገ ሇ ሌተኛ እ ስ ማማሇ ሁ በ ጣም
አ ሌሰ ማማም አ ሰ ማማሇ ሁ
ሆስ ፐታሌተቀባ ይነ ትባ ሇ ውጊ ዜገ ዯብውስ ጥየ ህ ክ ምና
የ ምረ መራና ላልችመሰ ሌአ ገ ሌግልቶችን ያ ቀር ባ ሌ
አ ን ድታካ ሚችግር በ ሚገ ጥመውጊ ዜሆስ ፒታለሇ
ችግሩመፍትኔ በ ስ ጠትሌባ ዊፍሊ ጎ ትያ ሳ ያ ሌ
ዶክ ተሮችየ ጤን ነ ትሁኔ ታዎችን ምር መራነ የ ህ ክ ምና
አ ሰ ጣጥበ ሚመሇ ከ ትሇ ሰ ዎች በ
ሚገ ባ መን ገ ድያ ሇ ረ ዳለ
ነ ር ሶ ችምን አ ይነ ትአ ገ ሌግልትእ ን ዯሚሰ ጥና
አ ገ ሌግሇ ቱመቼእ ን ዯሚጥያ ስ ረ ዯለ
አ ን ድሰ ውተኝቶበ ሚታከ ምበ ትጊ ዜዶክ ተሮች
የ ጤን ነ ቱን ሁኔ ታበ መዯበ ኛነ ተይኪታታtሊ ለ

14. የ አ ሇ ር ትሆስ ፒታሌጤና አ ገ ሌግልትተቋማትበ ሚሰ ጡትአ ገ ሌግልትምን ያ ህ ሌረ ክ ተዋሌ

ሀ . በ ጣምአ ሌረ ካ ሁም

ሇ . አ ሌረ ከ ም

መ. ገ ሇ ሌተኛ

ሐ. ረ ክ ቻሇ ሁ

ጨ. በ ጣምረ ክ ቻሇ ሁ

15. ማን ኛውምመድኃ ኒ ትከ ማዘ ዛ ቸውበ ፊት ፣ የ ሆስ ፒታለሐኪሞችመድኃኒ ትጥቅምና ጉዳትያ ብረ ራለ

ሀ .ፍፁም ሐ. አ ብዛ ኛውን ጊ ዜ

ሇ . እ ን ዳን ድጊ ዜ መ. ሁሌጊ ዜ

በ ቅድስ ትማሪ ያ ምዩ ኒ ቨ ር ሲቲየ ስ ነ ሰ ብትምህ ር ትክ ፍሌስ ር የ ሚከ ና ወን ጥና ትሊ ይተሳ ታፍስ ሇ ሆኑ እ ና መጠይቁን ሰ ሇ ሞለ

እ ና መሰ ግና ሇ ን ፡ ፡

አ ይሻ ኢብሮ

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