PROFESSIONALISM, PATIENT SATISFACTION AND QUALITY OF HEALTH-CARE - EXPERIENCE DURING ZIMBABWE STRUCTURAL ADJUSTMENT PROGRAM

In 1991, Zimbabwe embarked on a structural adjustment programme. In th e health sector, collection of fees was enforced and fees were later i ncreased. Utilisation subsequently declined. This paper examines the p erceptions of both government nurses and health care consumers regardi ng the impact of adjustment on overall quality of care, including nurs e professionalism, the nurse-client relationship and patient satisfact ion with care. These issues were explored in a series of focus group d iscussions held in December 1993, about three years after policy refor ms. The discussions suggested many areas of shared concern (fees, drug availability, waiting times), but divergent views regarding the proce ss of care. Nurses were concerned mainly with overwork and patient ing ratitude, and failed to recognise nurse behaviour as a major source of patient dissatisfaction. Community women saw nurses as hardened and i ndifferent, especially in urban areas. These differences are rooted in the perceived class differences between nurses and the communities th ey serve, but appear to have sharpened during the period of structural adjustment. (C) 1997 Elsevier Science Ltd. All rights reserved.