Objective To assess the level of health system responsiveness (HSR) and its associated factors among outpatients attending primary healthcare units (PHCU) in Arba Minch, South Ethiopia. Design Facility-based cross-sectional study. Setting Three PHCUs (one primary hospital and two health centres) in Arba Minch town, Southern Ethiopia. Participants A total of 379 outpatients aged 18 years and above were selected using a systematic random sampling. Outcome measures Primary outcome : level of HSR, measured across seven domains (communication, confidentiality, basic amenities, dignity, choice, prompt attention and autonomy) using a 28-item tool adapted from the WHO HSR framework. Secondary outcome : factors associated with HSR, identified via bivariate and multivariable linear regression. Results The overall HSR was 59.4%. The highest-performing domains were confidentiality (73.9%) and dignity (70.7%), while the choice of healthcare provider was rated lowest (34.6%). In multivariable linear regression analysis, factors significantly associated with HSR score were travel time to reach the health facility on foot (β = −0.26, 95% CI −0.37 to −0.14); out-of-pocket payment for transport (β = −6.51, 95% CI −8.33 to −4.70); patient satisfaction score (β=1.57, 95% CI 1.27 to 1.88) and perceived quality of healthcare score (β=0.32, 95% CI 0.14 to 0.49). Conclusion HSR among outpatients in PHCU was moderate, with several individual and service-related factors associated with patient experiences. These findings suggest the need for focused interventions to improve responsiveness domains, although more research is required to demonstrate causal relationships.
Bezie et al. (2026) studied this question.