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Within human services, client satisfaction is highly prioritised and considered a mark of responsiveness in service delivery. A large body of research has examined the concept of satisfaction from the perspective of service users. However, not much is known about how service providers construct client satisfaction. The purpose of this paper is to throw light on healthcare professionals’ perspectives on patient satisfaction, using tuberculosis (TB) clinics as a case study.

In-depth interviews were conducted with 35 TB clinic supervisors purposively sampled from six out of the ten regions of Ghana. An unstructured interview guide was employed. The recorded IDIs were transcribed, edited and entered into QSR NVivo 10.0 and analysed inductively.

Respondents defined service satisfaction as involving education/counselling (on drugs, nature of condition, sputum production, caregivers and contacts of patients), patient follow-up, assignment of reliable treatment supporters as well as being attentive and receptive to patients, service availability (e.g. punctuality at work, availability of commodities), positive assurances about disease prognosis and respect for patients.

Complementing opinions of health service users with those of providers can offer key performance improvement areas for health managers.

To the best of the authors’ knowledge, this is a first study that has examined healthcare providers’ views on what makes their clients satisfied with the services they provide.

Older males having sex with younger females is known to increase unsafe sex practices, exacerbated by power and economic imbalances between partners. The purpose of this paper is to examine transactional sexual relationships (i.e. long-term relationships constructed as “girlfriends not ‘prostitutes’” based on the exchange of gifts and other obligations) among female students of University of Cape Coast, Ghana. It particularly explores the implications for HIV education in institutions of higher learning. HIV/AIDS has been labelled as a disease of the poor and the uneducated, and it might be expected university students would engage in safer sexual practices: if they do not it highlights the problem around gender and economic imbalances and their repercussions even more clearly.

Using snowballing, 40 university-educated female students engaged in transactional sex were interviewed using unstructured interview. The data were analysed thematically.

These young women were not simple victims, these relationships were the result of complex and conscious choices. They did not want to marry their partners and were clear that these were short-term relationships primarily for material gain, which they nevertheless kept secret from family and most friends for fear of stigma, particularly in blighting their future marriage prospects. They protected themselves from emotional involvement, although they often saw their partners as loving, taking the provision of gifts as a sign of affection and sometimes a replacement for parental love. Their motivation was primarily economic, to fulfil “wants” not survival “needs” – the relationships enabled them to purchase the trappings of affluent society such as clothes, hairstyles, fast food and gadgets. They were also motivated by the enhanced experiences these relationships allowed, such as feeling protected, respected, “high class”, part of a daring elite of women and being able to travel and continue their education. The unequal nature of the relationships (often described as “father-daughter”) in a society in which parents, older people and men are given unquestioning respect, reduced their abilities to negotiate safe sex practices. In so far as they practiced safer sex it was to avoid pregnancy rather than disease, believing they would be able to tell from physical signs if their partner was infected.

This study shows that the “privileged” status’ that higher education offers is no match for the socioeconomic and cultural factors which make female youths, whatever their educational background, compromise on safer sexual practices, rendering them vulnerable to STIs and particularly, HIV infection. It is also clear that students in higher education are nevertheless ignorant about the risk and invisible nature of sexually transmitted disease. Institutions of higher education need to do more to provide robust sex and relationship educational interventions for their students and faculty about HIV/AIDS, which take into account the complex and socially situated decisions that surround sexual relationships.

Most of the work on transactional sexual relationships has come from South Africa – this is the first study in a Ghanaian context and of educated young women.