Magazine article Journal of Services Research

Service Quality Perception and Satisfaction: A Study over Sub-Urban Public Hospitals in Bangladesh

Magazine article Journal of Services Research

Service Quality Perception and Satisfaction: A Study over Sub-Urban Public Hospitals in Bangladesh

Article excerpt


Services are deeds, processes and performances (Zeithaml and Bitner, 2003). Broadly, services include all economic activities whose output is not a physical product or construction is generally consumed at the time it is produced and provides added value in forms (convenience, amusement, timeliness, comfort or health) that are essentially intangible concerns of its first purchaser (Quinn, Baruch and Paquette, 1987). The Service sector consists of different dimensions and among them we have picked 'health care' which deals with different services such as, hospital services, diagnosis services, physicians' consultancies and some other emerging fields. In this study, we are specially focusing on 'diagnosis services in Bangladesh' as it is one of the parts of integrated health care system.

The public provision of health services to the poor country at no charge (or nominal cost) is common in low-income countries. Policy makers, providers and clients alike tend to agree that the quality of these highly subsidized services is inadequate. And because free services and health commodities are often under-funded, and therefore insufficient to meet demand, they are vulnerable to informal gatekeepers who collect unofficial charges (Saha and Bartleman 1998: 160).

The public health system of Bangladesh is subdivided into four different levels according to their capacity of resolution and the internal organization. The range of services offered, staffing pattern, furnishing of equipment, etc. is relatively homogeneous at each level: i) Union health and family welfare centers (no. Of UHFWC 3375) for primary health care and family planning; ii) Thana or upazila health complexes (no. Of UHC 397) for primary health care and simple hospitalization cases, iii) 4 District hospitals for primary and secondary care (no. of DH 80), and IV) Medical college hospitals mainly for tertiary care (no. of MCH 13). Generally, all public hospitals offer outpatient services. According to the Development Gateway: Doctor to population ratio - 1:4, Nurse to population ratio - 1:8, Total hospital beds - 40,773 (over 29000 in GOB). (USAID Country health Statistic report, WHO, WB Bangladesh development series).

The problem of access to health care is particularly acute in Bangladesh. According to the Global Equity Gauge Alliance, 'only 48% of the population has access to primary health services in Bangladesh. The poor performance of the health care sector was attributed to the following: critical staff are absent, essential supplies are generally unavailable, facilities are inadequate, and the quality of staffing is poor. The problems of supervision and accountability exacerbate the problems. According to the Transparency International, Bangladesh: 28.1% of the HHs had patients who sought treatment at public hospitals through out the country during the last one year. Approximately two-fifths (39.4%) of the HHs reported payment higher than normal registration fees at the outpatient department. payment of extra money to the hospital staff reported by 18% of HHs, through hospital staff reported by 9% and through influential persons reported by 9% of HHs. The other 41 % did not receive medicines from the hospital. About one-fourth (26%) were advised to get medicines from designated stores. 21% of these HHs had these tests done at the public hospitals and the remaining 79% had their tests performed at private clinics. The reasons for having the test done in private clinic were attributed to poor service in public hospitals (50%) and advice by the doctor (50%).

The health care delivery system in Bangladesh faces three major challenges improving quality, increasing access, and reducing cost (Andaleeb SS, Basu AK. 1994.). There is growing evidence that the perceived quality of health care services has a relatively greater influence on patient behaviors (satisfaction, referrals, choice, usage, etc) compared to access and cost. In Nepal, for example, the government made substantial investments in health care to increase access. …

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