Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kaveh Khoshnood




The utilization of primary health care in many countries in sub-Saharan Africa has been limited. The objective of this study was to evaluate the factors that influenced why patients sought care at health centers versus primary hospitals in the primary health care unit (PHCU) in three regions in Ethiopia. The study also examined whether these factors varied based on a patient’s clinical or demographic characteristics and by whether they had sought prior care.

Methods and Findings

We conducted a cross-sectional study using face-to-face interviews in the local language with 796 people (99% response rate) seeking outpatient care in three primary health care units. We used unadjusted chi-square tests to detect significant differences between the hospital and health center samples on factors that influenced care-seeking behavior. The frequency of the self-reported factors differed significantly by health facility. Among those at the health center, the top four self-reported factors were distance (47.4%), quality of services (23.3%), previous positive experience (20.1%), and comfort or familiarity (12.4%). Among those at the hospital, the top four self-reported factors were quality of services (31.6%), distance (16.0%), no improvement after first visit to a health facility (15.3%), and level of health providers (14.8%). Those who bypassed lower levels of health care cited quality of services, level of health providers, and previous positive experience as significant reasons for seeking care directly at the hospital


This study found that there are significant differences in the reasons why patients utilize health centers versus primary hospitals, which highlights the need for tailored reforms based on the community’s perceived strengths and weaknesses of different primary care delivery sites.


This is an Open Access Thesis.

Open Access

This Article is Open Access