Different mix of clients visit primary health care (PHC) facilities, and the quality of services is critical even in rural communities. The study objective was to determine the relationship between socio-demographic characteristics and client satisfaction with the quality of PHC services in Calabar Municipality, Cross River State, Nigeria. Specifically to describe aspects of the health facilities that affect client satisfaction; determine the health-care providers’ attitude that influences client satisfaction; and determine the socio-demographic characteristics that influence client satisfaction with PHC services. A cross-sectional survey was adopted. Ten PHCs and 500 clients utilizing services in PHC centers in Calabar Municipality were randomly selected. Clients overall satisfaction with PHC services was high (80.8%). Divorced clients were less (75.0%) satisfied than the singles and the married counterparts (81%), respectively. Clients that were more literate as well as those with higher income were less satisfied, 68.0% and 50.0%, respectively, compared to the less educated and lower-income clients, 92.0% and 85.0% respectively. These differences in satisfaction were statistically significant (P = 0.001). Hence, it was shown that client characteristics such as income and literacy level show a significant negative relationship with the clients satisfaction with the quality of PHC services in Calabar Municipality.

Effective health management is critical at every level of African health systems in order to improve services and in turn the current poor health situation in many countries. Specialized professional training equips health-care workers for clinical services, but is limited in preparing them for the management of complex health care systems and organizations. Health management involves technical and social processes for achieving health objectives through effective and efficient use of health resources in view of social, economic, political and cultural realities. Basic functions expected of African health managers include health policy analysis and formulation, health planning, organizing, implementing, leading, coordinating, controlling, monitoring and evaluating services. Health managers at primary, secondary and tertiary levels require additional specialist training in health management to acquire knowledge and skills needed for effective and efficient management of complex health-care organizations. This, in turn, facilitates application of tested theories, systematic approaches and best practices in addressing the health needs of the people. Objective This article advocates effective health-care management in order to achieve the Millennium Development Goals, health goals of the New Partnership for Africa’s Development, national health goals and to promote quality in health care, equity and justice. These culminate in improving health of the people and changing the poor health indices. It also outlines, in brief, the basic functions expected of African health managers and concludes by advocating health-management training for strategic, departmental and operational managers at different levels in the health system. Method I wrote this article based on literature review, experience working with federal and state ministries of health in Nigeria and anecdotal reports from senior health officials and public health students.

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Background: Efforts to combat tuberculosis in Nigeria focus on evaluation of strategies for treatment and prevention, with little attention paid to the impact of the burden of illness and its therapy on the HRQoL of TB patients. This study evaluated the quality of life (QoL) of TB patients in relation to their financial, psychological and social well-being. Method: In 2011, following an active case finding for TB in Akwa Ibom State of Nigeria, a structured questionnaire for evaluating HRQoL was distributed to TB patients who had been on treatment in four DOTs centres of the state for at least three months. The questions were to elicit responses that conveyed the respondents' perspective of the disease. One hundred and eight TB patients (54 males and 54 females) aged 15-80 years were studied. Results: Negative emotions including fear, frustration and worry characterized the reactions of all subjects following news of their diagnosis with TB. However, following treatment, 62% of subjects expressed high expectation of being cured. Inability to continue functioning in their roles at home or as heads of households was recorded in 48.1% (52/108) and 59% (23/39) of respondents respectively and contributed to the negative emotions expressed above. Lack of basic supplies such as food and finances to meet personal and family needs constituted the most important socioeconomic challenges. Socioeconomic status of respondents revealed that 61% had no regular means of income with at least 94% earning less than $50 (8000 naira) a month. Subsistent farmers and petty traders constituted more than 66% of the respondents: 98% ob-* Corresponding author. A. E. Asuquo et al. 200 tained less than or equivalent of high school education. Socially, all health workers and 87% of family members were sympathetic and supportive compared to friends, with 42% exhibiting stigmatization. The most frequent forms of support from family members were financial (25%) and provision of food (37%). Up to 28% were regularly prompted by family to take their medication. Conclusion: In the midst of obvious socioeconomic challenges confronting TB patients in this study, the initial negative emotions declined following the supportive roles of mainly health care workers and family members. Patients were optimistic of achieving cure at the end of the treatment.

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