The study shows that a considerable higher percentage of the patients were dissatisfied with the laboratory services provided in the country including phlebotomy, phlebotomists' attitude, instructions, results notification, results communication, waiting time and privacy. This is contrary to results in developed countries where they have found high level of satisfaction with hospital services .
The main complaints were observed in waiting time, results notification, privacy and timely instruction. Additionally, level of privacy in the consultation room was described as unsatisfactory by 24.1% of patients, which compares with a study done in other country in Africa like Egypt . In our study like in other studies done in Egypt and USA found no association between overall patient's dissatisfaction with age and gender [2, 4]. However, we found an association between dissatisfaction and level of education and type of facility of either being public or private. In USA it has been shown that improving laboratory information system, (especially on turn around time), repeatedly patient satisfaction surveys, and continuous monitoring of providers of laboratory services can improve quality laboratory services [1, 4, 5]. This can also be done in our country to improve quality of laboratory services in those aspects which patients were not satisfied.
Substantial proportions of the patients were not satisfied with the waiting time and result notification. Patients wanted to receive their results in timely manner, shortly after the physician or provider receives the results. Baldwin and his colleagues (2005) uncovered that patient's privacy, assured confidentiality of test results and diagnosis is of importance to the patient. Thus, privacy, responsive and interactive feedback, convenience, and timeliness with detailed information may be critical for patient satisfaction and for improving patient safety . The competitive forces in today's health care environment require medical practices to address issues related to patient's satisfaction . In this survey we have found that users of private laboratories were more likely to be satisfied with cleanness and privacy than the public laboratory users. Most of buildings in public health facilities are very old and difficult to clean. Rarely the medical personnel in public health facilities spare enough time to talk with patients in privacy, perhaps due to long time shortage of human resources in this sector. However highly educated patients were more likely to be dissatisfied with privacy and waiting time. Gone are the days when most patients tolerated impersonal service from their health-care providers in general. Every day, patient's satisfaction becomes more critical to a health-care provider's success and survival. We therefore recommend interventions to improve quality of laboratory services, especially, in public health services.
The study involved all laboratories that conduct HIV related testing and therefore caution should be taken when inferring to other laboratories in the country. We also admit the fact that, we slightly interviewed more patients than expected by about 2.4%. This is a small increase and is not likely to influence our findings in either way because the percentage of missing value is low to have noticeable effect on our findings. Also for practical reasons, patients were selected on a first come basis and the dichotomy method was used instead of Likerts method, which could have probably affected the findings in either way toward satisfaction or dissatisfaction. However, since this study involved several facilities in different regions, including rural and urban settings, it is less likely to have unforeseen biasing factor that could have constantly operated in all visited facilities. Therefore, the effect of this phenomenon could have less impact in the findings.