Satisfaction with Quality of Sexual and Reproductive Health Services Provided by Governmental Health Care System in the Gaza Strip, Palestine


  • Nasser Ibrahim Abu-El-Noor College or Nursing, Islamic University of Gaza
  • Bettina Bottcher
  • Mysoon K. Abu-El-Noor



Client satisfaction, Sexual and reproductive health, Antenatal care, Postnatal care, Gaza Strip, Palestine


Background and aim: In our dynamically changing world, incorporating patients’ perception into quality assessment and assessing clients’ satisfaction about provided services became a major component in the healthcare mission. The aim of this study is to assess clients’ satisfaction with sexual and reproductive health services provided by governmental primary health care centers in the Gaza Strip.

Methods: A cross-sectional, descriptive design was used. A total of 128 clients who used sexual and reproductive healthcare services provide by governmental primary health care centers completed a survey that was prepared by the research team.

Results: The majority of participants (77.3%) were satisfied with the services they received. Most of the items of the questionnaire received scores close to the neutral point of 3 on a Likert scale of 1-5. The only demographic variable that influenced participants’ level of satisfaction was age.

Conclusion: Although the majority of participants in this study were satisfied with the sexual and reproductive health services they received, the mean scores for most items of the questionnaire were around the neutral point of three. This should be an impetus for healthcare policy makers and healthcare providers to work harder to improve quality of provided healthcare services, and thus; improving clients’ satisfaction with provided services.

Author Biography

Nasser Ibrahim Abu-El-Noor, College or Nursing, Islamic University of Gaza

Assistant Professor, College of Nursing


• Abu-El-Noor, N. I., Abu-Sultan, N., Alkasseh, A. S., El-Shokry, M., Fareed, M., & Saleh, K. (2018). Quality of antenatal Care in Governmental Primary Health Care Centers in the Gaza strip as perceived by nurses and midwives: an indication for policy change. IUG Journal of Natural Studies, 26(2).

• Agency for Healthcare Research and Quality. (2017). A Quick Look at Quality. Retrieved 13/07, 2017, from

• Ahmadi, Z., & Azimi, H. (2009). Evaluation of mothers’ satisfaction with midwifery cares received in the delivery room. Scientific Journal of Hamadan Nursing & Midwifery Faculty, 19(67), 30-35.

• Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman medical journal, 29(1), 3.

• Alkasseh, A. S., Mwafy, S., Abu-El-Noor, N., & Abu-El-Noor, M. (In Press). Assessing the quality of postnatal care provided at government hospitals in the Gaza Strip, Palestine as perceived by service users: a direction for policy change. Holistic Nursing & Midwifery Journal.

• Bernitz, S., Øian, P., Sandvik, L., & Blix, E. (2016). Evaluation of satisfaction with care in a midwifery unit and an obstetric unit: a randomized controlled trial of low-risk women. BMC pregnancy and childbirth, 16(1), 143.

• Birhanu, Z., Assefa, T., Woldie, M., & Morankar, S. (2010). Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: a cross sectional study. BMC health services research, 10(1), 78.

• Black, R. E., Cousens, S., Johnson, H. L., Lawn, J. E., Rudan, I., Bassani, D. G., . . . Cibulskis, R. (2010). Global, regional, and national causes of child mortality in 2008: a systematic analysis. The Lancet, 375(9730), 1969-1987.

• Boyer, L., Francois, P., Doutre, E., Weil, G., & Labarere, J. (2006). Perception and use of the results of patient satisfaction surveys by care providers in a French teaching hospital. International journal for quality in health care, 18(5), 359-364.

• Britton, J. R. (2012). The assessment of satisfaction with care in the perinatal period. Journal of Psychosomatic Obstetrics & Gynecology, 33(2), 37-44.

• Bӧttcher, B., Abu-El-Noor, N., Aldabbour, B., Naim, F. N., & Aljeesh, Y. (2018). Maternal mortality in the Gaza strip: a look at causes and solutions. BMC pregnancy and childbirth, 18(1), 396.

• Chavane, L., Dgedge, M., Bailey, P., Loquiha, O., Aerts, M., & Temmerman, M. (2017). Assessing women's satisfaction with family planning services in Mozambique. J Fam Plann Reprod Health Care, 43(3), 222-228.

• Chemir, F., Alemseged, F., & Workneh, D. (2014). Satisfaction with focused antenatal care service and associated factors among pregnant women attending focused antenatal care at health centers in Jimma town, Jimma zone, South West Ethiopia; a facility based cross-sectional study triangulated with qualitative study. BMC research notes, 7(1), 164.

• Edie, G. E. H. E., Obinchemti, T. E., Tamufor, E. N., Njie, M. M., Njamen, T. N., & Achidi, E. A. (2015). Perceptions of antenatal care services by pregnant women attending government health centres in the Buea Health District, Cameroon: a cross sectional study. Pan African Medical Journal, 21(1).

• Elaine, Y., Gail, C., & Richard, R. (2002). The Measurement of Patient Satisfaction Journal Nurse Care Quality.

• Erci, B., & Ivanov, L. (2004). The relationship between women's satisfaction with prenatal care service and the characteristics of the pregnant women and the service. The European Journal of Contraception & Reproductive Health Care, 9(1), 16-28.

• Ghobashi, M., & Khandekar, R. (2008). Satisfaction among expectant mothers with antenatal care services in the Musandam Region of Oman. Sultan Qaboos University Medical Journal, 8(3), 325.

• Gregory, P. A., Heaman, M. I., Mignone, J., & Moffatt, M. E. (2019). Predictors of Women’s Satisfaction with Prenatal Care in a Canadian Setting. Maternal and Child Health Journal, 1-10.

• Hailu, Y. (2014). Factors Affecting Utilization of Postnatal Care Service in Amhara Region, Jabitena District, Ethiopia. Science Journal of Public Health, 2(3), 169-176.

• Handler, A., Rosenberg, D., Raube, K., & Lyons, S. (2003). Prenatal care characteristics and African-American women’s satisfaction with care in a managed care organization. Women's Health Issues, 13(3), 93-103.

• Hildingsson, I., & Rådestad, I. (2005). Swedish women's satisfaction with medical and emotional aspects of antenatal care. Journal of Advanced Nursing, 52(3), 239-249.

• Hoseini, B. L., Saeidi, M., Beheshti Norouzi, Z., Kiani, M. A., & Rakhshani, M. H. (2019). Assessment of Maternal Satisfaction with the Quality of Obstetric Care Provided in the Maternity Unit of Mobini Hospital, Sabzevar, Iran. International Journal of Pediatrics, 7(5), 9369-9377.

• Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press.

• Janse, A., Gemke, R., Uiterwaal, C., Van Der Tweel, I., Kimpen, J., & Sinnema, G. (2004). Quality of life: patients and doctors don't always agree: a meta-analysis. Journal of clinical epidemiology, 57(7), 653-661.

• Kikuchi, K., Yasuoka, J., Nanishi, K., Ahmed, A., Nohara, Y., Nishikitani, M., . . . Nakashima, N. (2018). Postnatal care could be the key to improving the continuum of care in maternal and child health in Ratanakiri, Cambodia. PLoS One, 13(6), e0198829.

• Korenbrot, C. C., Wong, S. T., & Stewart, A. L. (2005). Health promotion and psychosocial services and women’s assessments of interpersonal prenatal care in Medicaid managed care. Maternal and Child Health Journal, 9(2), 135-149.

• Lakew, S., Ankala, A., & Jemal, F. (2018). Determinants of client satisfaction to skilled antenatal care services at Southwest of Ethiopia: a cross-sectional facility based survey. BMC pregnancy and childbirth, 18(1), 479.

• Lawn, J. E., Blencowe, H., Oza, S., You, D., Lee, A. C., Waiswa, P., . . . Christian, P. (2014). Every Newborn: progress, priorities, and potential beyond survival. The Lancet, 384(9938), 189-205.

• Lawn, J. E., Cousens, S., & Zupan, J. (2005). Neonatal survival 1.4 million neonatal deaths: When? Where? Why? Lancet, 365(9462), 891-900.

• Lawn, J. E., Cousens, S., Zupan, J., & Team, L. N. S. S. (2005). 4 million neonatal deaths: when? Where? Why? The Lancet, 365(9462), 891-900.

• Lawn, J. E., Lee, A. C., Kinney, M., Sibley, L., Carlo, W. A., Paul, V. K., . . . Darmstadt, G. L. (2009). Two million intrapartumâ€related stillbirths and neonatal deaths: where, why, and what can be done? International Journal of Gynecology & Obstetrics, 107(Supplement), S5-S19.

• Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., . . . Black, R. E. (2015). Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. The Lancet, 385(9966), 430-440.

• Lozano, R., Wang, H., Foreman, K. J., Rajaratnam, J. K., Naghavi, M., Marcus, J. R., . . . Atkinson, C. (2011). Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. The Lancet, 378(9797), 1139-1165.

• Marley, K. A., Collier, D. A., & Meyer Goldstein, S. (2004). The role of clinical and process quality in achieving patient satisfaction in hospitals. Decision Sciences, 35(3), 349-369.

• Mesgarzadeh, M., Baghaei, R., Ebrahimi, M., & Orujlu, S. (2014). Survuy of mother's satisfaction from provided care in delivery unit in the Khoy Qamar Bani Hashem hospital in 2012. The Journal of Urmia Nursing and Midwifery Faculty, 12(10), 919-925.

• Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., . . . Langer, A. (2016). Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. The Lancet, 388(10056), 2176-2192.

• Mirzaei, K., Oladi Ghadikolaee, S., Mousavi Bazzaz, M., & Ziaee, M. (2016). Mother’s satisfaction of postpartum care and its relationship with midwifery care at Urban Health Centers, Mashhad, Iran. Journal of Midwifery and Reproductive Health, 4(3), 679-688.

• Mortensen, B., Diep, L. M., Lukasse, M., Lieng, M., Dwekat, I., Elias, D., & Fosse, E. (2019). Women’s satisfaction with midwife-led continuity of care: an observational study in Palestine. BMJ open, 9(11).

• Nabbuye-Sekandi, J., Makumbi, F. E., Kasangaki, A., Kizza, I. B., Tugumisirize, J., Nshimye, E., . . . Peters, D. H. (2011). Patient satisfaction with services in outpatient clinics at Mulago hospital, Uganda. International journal for quality in health care, 23(5), 516-523.

• Naghizadeh, S., Rezaie, M. E. M., Sehhati, F., Barzanje, S. A., & Ebrahimi, H. (2014). Assessment Mothers Satisfaction of postpartum care. Advances in Nursing & Midwifery, 23(82), 71-78.

• Nwaeze, I., Enabor, O., Oluwasola, T., & Aimakhu, C. (2013). Perception and satisfaction with quality of antenatal care services among pregnant women at the university college hospital, Ibadan, Nigeria. Annals of Ibadan postgraduate medicine, 11(1), 22-28.

• Oestergaard, M. Z., Inoue, M., Yoshida, S., Mahanani, W. R., Gore, F. M., Cousens, S., . . . Mathers, C. D. (2011). Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS medicine, 8(8), e1001080.

• Onyeajam, D. J., Xirasagar, S., Khan, M. M., Hardin, J. W., & Odutolu, O. (2018). Antenatal care satisfaction in a developing country: a cross-sectional study from Nigeria. BMC public health, 18(1), 368.

• Sachsanidis, P. I. (2018). Evaluating Women’s Satisfaction With Health Services Received During Childbirth: A Study of Hospitals in Athens, Greece. Journal of Clinical Gynecology and Obstetrics, 7(1), 1-12.

• Simkhada, B., Teijlingen, E. R. v., Porter, M., & Simkhada, P. (2008). Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. Journal of Advanced Nursing, 61(3), 244-260.

• Srivastava, A., Avan, B. I., Rajbangshi, P., & Bhattacharyya, S. (2015). Determinants of women’s satisfaction with maternal health care: a review of literature from developing countries. BMC pregnancy and childbirth, 15(1), 97.

• Streiner, D. L. (2003). Starting at the beginning: an introduction to coefficient alpha and internal consistency. Journal of personality assessment, 80(1), 99-103.

• Vo, B. N., Cohen, C. R., Smith, R. M., Bukusi, E. A., Onono, M. A., Schwartz, K., . . . Turan, J. M. (2012). Patient satisfaction with integrated HIV and antenatal care services in rural Kenya. AIDS care, 24(11), 1442-1447.

• Wachira, J., Middlestadt, S., Reece, M., Peng, C.-Y. J., & Braitstein, P. (2014). Physician communication behaviors from the perspective of adult HIV patients in Kenya. International journal for quality in health care, 26(2), 190-197.

• Waldenström, U., Rudman, A., & Hildingsson, I. (2006). Intrapartum and postpartum care in Sweden: women's opinions and risk factors for not being satisfied. Acta obstetricia et gynecologica Scandinavica, 85(5), 551-560.

• WHO. (2009). Monitoring emergency obstetric care Retrieved from

• WHO. (2016). Maternal mortality: Fact sheet. Retrieved 7/12, 2017, from

• WHO. (2019). Maternal mortality. Retrieved 20,01, 2020, from

• Wiegers, T. A. (2009). The quality of maternity care services as experienced by women in the Netherlands. BMC pregnancy and childbirth, 9(1), 18.

• World Health Organization. (2011). WHO statement on antenatal care: Geneva: World Health Organization.




How to Cite

Abu-El-Noor, N. I., Bottcher, B., & Abu-El-Noor, M. K. (2020). Satisfaction with Quality of Sexual and Reproductive Health Services Provided by Governmental Health Care System in the Gaza Strip, Palestine. Asian Journal of Pharmacy, Nursing and Medical Sciences, 8(2).