It is known that counseling on MTCT and PMTCT is the most important service out of the services that make up the package of PMTCT services to be offered to all pregnant women visiting ANC clinics. This counseling was offered to 220 (52.0%) pregnant women who were interviewed on the day of their ANC visit. In contrast to our finding, MTCT and PMTCT were discussed on the day of visit for 74.7% of the pregnant mothers interviewed in Addis Ababa . Among those who have received counseling on MTCT and PMTCT (n = 220) in our study, 165 (75%) claimed to have understood the message conveyed. However, in the study conducted in Addis Ababa, they only assessed whether the information was received and did not inquire whether clients felt that they understood the messages.
Clients’ average waiting time and average duration of stay with their health care provider were 24.5 minutes and 12.8 minutes respectively. This finding was by far better than the report from Kenya. In a PMTCT program in Kenya more than 90.0% of the clients waited for an average of 150 minutes in addition to the amount of time set by the program guideline for obtaining the services, which is 90 minutes .
In this study, there was a preference to be counseled by the same counselor in pre and post test counseling during the ANC visit. These findings might be related to clients’ concerns regarding issues of confidentiality. In regards to HIV testing and counseling for PMTCT, it is recommended that the person offering pre-test information provides the post test counseling [16, 17]. However, this may be a challenge in many settings of developing countries because of shortage of trained human resource .
In this study the level of satisfaction was not affected by either age or sex of the counselor. This may indicate that satisfaction might be more affected by other factors than the socio-demographic characteristics of counselors. In this study, a high proportion (74.7%) of clients reported that they were satisfied with the service they had received. In this respect, there was no statistically significant difference in satisfaction among clients who experienced waiting time of less than or equal to 15 minutes, and those who had to wait more. However, long waiting time (more than 15 minutes), poor counseling service, and lack of privacy were reported to be the main challenges in the provision of maternal, neonatal, child & adolescent health services in Ethiopia in the five year period, 2005 to 2010 .
This high proportion of satisfied clients might be due to the fact that clients may not report dissatisfaction with services even when services seem to be poor. A research carried out in a university hospital in Brazil also showed that patients generally stated to be satisfied with the rendered service and positively appraised the quality of provided service, that is, even when critical factor that undermined quality of service provision seem to exist . This may over time result in normalization of egregious violations of standards of practice in health care delivery systems . Besides, normalization of disrespect and abuse by individuals and community is identified to be one among the contributors to disrespect and abuse exercised by service providers during maternity health services .
In this study, clients who liked the discussion they had with their counselor were less likely to be satisfied with the PMTCT service they received. This surprising finding may be due to the fact that the situations faced by clients at health institutions may not be relevant to them if compared to the quality of attention received which can largely affect their satisfaction .
In our study, out of the total PMTCT service providers interviewed, 22 (71.0%) of them said that their workload had increased since the introduction of the PMTCT service and all of them did not get any incentives for providing those PMTCT services. A consultation report from Kenya also validates the fact that the introduction of HIV/AIDS prevention and care into the MCH setting has meant that health workers have been asked to greatly expand their responsibilities and tasks . Others have reported that the additional responsibilities are rarely accompanied by financial and other types of compensation or that they lead to hasty services that affect the quality of the counseling services [22, 23].
This study has deployed a multidimensional approach to understand clients’ satisfaction with PMTCT service and challenges experienced by service providers in providing PMTCT service in the study area; however, the scope is limited in addressing all factors which may affect clients’ satisfaction and which may pose challenges on service providers. In addition, the study is also limited as it does not look into rural-urban differences.