Their voices matter: assessing patients' experience with healthcare quality in a war-torn country

Sudan is experiencing the largest displacement crisis globally due to the ongoing war. One key displacement area is the White Nile state. Despite the state's relative safety, the indirect effects of the war are felt in its health system. In conflict and fragile settings, patients' experiences with healthcare quality receive little or no attention. Thus, our study aimed to assess the experience of patients admitted to governmental hospitals in White Nile state.

The study took place in the largest cities in the White Nile State: Kosti, Rabak, and Ad Douiem. A total of 799 patients from Medicine, Surgery, Obstetrics and Gynaecology wards were interviewed from September to October 2023 using the In-Patient Assessment of Health Care survey, which addresses communication with doctors and nurses, the physical environment, medication communication, pain management, and the overall care.

A total of 799 participants were interviewed. The median age was 28, and most (85.2%) were females. The internally displaced persons (IDPs) were (20.7%), and most of them were staying in host communities (69.1%). The overall quality of care rating was relatively low, with only (19.5%) rating the hospital as "5" best. About (82.4%) of the patients would recommend the hospital. Regarding the predictor of the overall rating of quality, physical environment was found to be a strong predictor (OR 1.337; 95% CI 1.208-1.480; p < 0.001). Regarding recommendations of the hospital, IDPs were found to have a lower tendency to recommend the hospital (OR 0.561; 95% CI 0.358-0.881; p 0.012).

The overall rating of quality of care was relatively low. However, most patients would recommend the hospital. This contradiction may highlight their low expectations of the health system. Such a perspective must drive the efforts of healthcare providers and policymakers to improve patients' experiences and thus improve patient-centred care.