Awareness and usability of community and facility-based health sector client feedback mechanism in Tanzania public health system. A mixed methods study

Client feedback systems are increasingly becoming important in person-centered health care. The systems provide opportunities to the public to interact with the health care providers and policymakers, present their concerns related to the performance of the health care system in order to improve the quality, equity, and responsiveness in the provision of services, hence increase social accountability. This study aimed to assess the situation of client feedback systems in Tanzania, focusing on the awareness and usability of existing facility- and community-based feedback platforms from the client’s perspective. The study employed a concurrent mixed-method design using both quantitative and qualitative methods. Quantitatively, surveys were administered in July 2023 to 1009 clients who received either inpatient or outpatient services from 109 health care facilities in 20 councils across 10 regions of Tanzania mainland to gather structured data on satisfaction levels, perceptions of feedback mechanisms, and suggestions for improvement. Qualitative data were collected through Focus group Discussion (FGD) to get in-depth healthcare workers and or clients’ perspectives and experiences. These methods provided nuanced information, contextual insights, and a deeper understanding of the client feedback process. Combining these approaches yielded a comprehensive, multi-dimensional view of the client feedback mechanism landscape. We used Generalized Linear Mixed Model and thematic analysis for quantitative and qualitative data respectively. Our findings revealed that, the majority of the clients were aware of their right to provide feedback (79.78 %), and in particular familiar with the suggestion box (82.95 %) followed by phone calls (34.49), nevertheless most of them never provided feedback (67.3 %). Phone calls (83.75) and SMS (44.10 %) were the most preferred platforms to provide feedback. Comparatively, clients attending higher level health facilities, clients who visited facilities 4–5 times or more, those who received services for 45–60 min or more and those who were aware of existence of client feedback system than their counterparts were significantly more likely to provide feedback. Moreover, in qualitative findings availability of real time feedback, authenticity, user-friendliness of the system, digitalization, clarity in referral pathway and information use to support decisions and quality improvement was important factors to enhance usability. Improving the usability of client feedback system is essential to attain person-centered health care and advance universal health coverage. The majority of the clients attending heath care facilities are aware of their right to provide feedback, nevertheless, most of them never provide feedback. Our study, have shed light on the need to invest on user friendly systems through co-creation and digitalization in order to improve client feedback systems in Tanzania. Moreover, the need to promote the use of available feedback systems and information generated to support decision making and quality improvement is critical for success.