Assessment of Customer Satisfaction in Menelik II Health Science College, Addis Ababa, Ethiopia, 2018

Customer satisfaction is defined as “the number of customers, or percentage of total customers, whose reported experience with a firm, its products, or its services (ratings) exceeds specified satisfaction goal [1]. Customer satisfaction can be experienced in a variety of situations and connected to both goods and services. It is a highly personal assessment that is greatly affected by customer expectations. Satisfaction also is based on the customer’s experience of both contacts with the organization and personal outcomes. Some researchers define a satisfied customer within the private sector as “one who receives significant added value” to his/her bottom line a definition that may apply just as well to public services [2].


Introduction
Customer satisfaction is defined as "the number of customers, or percentage of total customers, whose reported experience with a firm, its products, or its services (ratings) exceeds specified satisfaction goal [1]. Customer satisfaction can be experienced in a variety of situations and connected to both goods and services. It is a highly personal assessment that is greatly affected by customer expectations. Satisfaction also is based on the customer's experience of both contacts with the organization and personal outcomes. Some researchers define a satisfied customer within the private sector as "one who receives significant added value" to his/her bottom line a definition that may apply just as well to public services [2].
To reinforce customer orientation on a day-to-day basis, a growing number of companies choose customer satisfaction as their main performance indicator [3]. In an increasingly competitive environment, companies must be customer oriented [4]. Customer satisfaction is about relationships between the customer and product or service and the provider of a product or service. Customer satisfaction is a highly personal assessment that is greatly influenced by individual expectations. Some definitions are based on the observation that customer satisfaction or dissatisfaction results from either the confirmation or disconfirmation of individual expectations regarding a service or product [5].
Measuring customer satisfactions provide a comprehensive insight to the customer pre and post purchase behavior. Without this approach understanding, improving and developing better customer services could not be possible.
Increased competition, dynamic educational environment, challenges such as budget cut, higher costs in obtaining college education, changing demographics in the population, declining enrollments, and a general public call for accountability have educational institutions realize the importance of student satisfaction [6,7]. Studies have shown student satisfaction to have a positive impact on student motivation, student retention, recruiting efforts and fundraising [8,9].
The students' positive feeling and satisfaction is contingent to the students' academic and social experiences obtained at the particular institution [10][11][12][13]. However, most student studies in higher education focus more on intrinsic factors of student motivation. As a result, student satisfaction among graduate students is assumed and only usually considered when competition affects enrolment.
There is need for more research in higher education that focuses more on student needs and concerns for the purposes of improving academic programs. In addition, extrinsic factors need to be considered as well. Being able to identify and address students' needs and expectations allows educational institutions to attract and retain quality students as well as improve the quality of their programs [14].
Satisfied and motivated teachers are important for any educational system. The success or failure of the education system depends mainly positive academic and social experiences expressed greater satisfaction with their overall college experience. Other key determinants of student satisfaction include academic performance, quality of curriculum, quality of instruction, quality of academic advising, student satisfaction with major, and the level of interaction between faculty members and students is also a factor affecting student satisfaction in their academic experiences [31].
The findings of the study used to improve the quality of service to customers, and implement strategies through necessary modification that would lead to improve teaching and learning process, and to meet the needs and concerns of the current students who are already enrolled. Moreover, the results of this study will assess teachers, administrative staff satisfaction on activities of their job and identifying the gaps affecting their satisfaction and it adds to the importance of how student satisfaction assessment can be utilized as a tool to ensure the program's quality and effectiveness. Therefore Menelik II Health Science College has to determine the satisfaction level of existing students in different departments, their instructors, administrative staff indifferent aspects of the college services in order to improve and develop better customer service in line with the mission of the College, that is, by duly responding to conducive teaching and learning process and the undertaking of quality and efficient health professional education in different programs, commits to produce honest and loyal health professionals who can solve the health problem of the Addis Ababa city Administration and above all the country, which in turn enable the society to be capable of becoming healthy and productive it is vital for educational institutions to determine and deliver what is important to students.

Study design, area and period
Institution-based cross-sectional study design was conducted at Menelik II Health Science College from December 2015-January, 2016. Menelik II Health Science College was established in 1956 and located at Yeka sub city in the compound of Menelik II Hospital. It is one of the first Health Training sectors which provide unreserved services to the community beginning from its establishment. The College is serving as a prime partner of the Addis Ababa city administration health Bureau in delivering convenient trainings and services to substantial number of health professionals.

Source population
Source population for the study were all Menelik II Health Science College Customers.

Study population
Menelik II Health Science College Students, Instructors, administrative staffs were the study population.

Ethical consideration
Research clearance and Approval was obtained from Menelik II Health Science College Ethical review and Approval committee of Research and Publication office. The study subjects were requested to give their consent after receiving adequate explanation about the purpose, significance, anonymity and how they could give their responses. They were also told about their rights to withdraw from the study, and not to answer questions whenever they felt uncomfortable. Oral informed verbal consent was obtained from every respondent. on satisfied teachers, but also on satisfied managers and administrators. Teachers, specifically, spend a great amount of time with their students in class, and hence they have a significant impact on student achievement [15,16].
Customer satisfaction is a term frequently used in marketing. It is a measure of how products and services supplied by a company meet or surpass customer expectation [17].
Quality service is defined as the situation in which the consumer's perception of service performance meets or exceeds their expectation of what the service firm should do. The key to service quality, then, is to meet or exceed consumer expectations. One problem with measuring customers' satisfaction is that there may often be discrepancies between the consumer's viewpoints and the provider's understandings of what constitutes quality service [18].
Any differences between consumer viewpoints and the organization's perception of consumer viewpoints on quality are important to identify and determine the level and quality of the service provided [19].
Satisfaction with the teaching component has important consequences. It means that the teachers are happy, dedicated and committed, and it also helps them to bring their best qualities to their schools, so that students, parents, and the society may benefit from their services [20].
Satisfied and motivated teachers are important for any educational system. The success or failure of the education system depends mainly on satisfied teachers, but also on satisfied school managers and administrators. Teachers, specifically, spend a great amount of time with their students in class, and hence they have a significant impact on student achievement [21].
Job satisfaction is also defined as the general emotional evaluations of service providers for their job situation and job experiences [22]. Job satisfaction has a positive effect on the customer (student) orientation of service providers [23]. It can be the foundation to enhance a positive interaction between service providers (teachers) and customers (students) [24].
It is important to note that maintaining the provision of effective education at school requires a coordinated effort from all the bodies concerned. Among others, it demands the devotion of policy makers, administrators, teachers' associations, the parents, the students themselves, as well as members of the wider community. It requires the provision of effective facilities and spaces, and the training and assignment of qualified administrative and other support staff. However, while each of the mentioned groups has important contributions to make, providing effective learning environments in schools depends in particular on the skills, morale, knowledge and commitment of the teachers [25]. Student satisfaction refers to the attraction, pride, or positive feeling that the students develop toward the program or institution [26].
The level of students' positive feeling or satisfaction is associated with students' being able to find adequate resources to meet their academic and social interests. The students' ability to project and implement their self-concepts as a students or viewing themselves as part of the institution is also related to their positive feeling of satisfaction [27,28]. The students' positive feeling and satisfaction is also contingent to the students' academic and social experiences obtained at the particular institution [29]. The academic and social experiences of students are the vehicles that drive students into the life of the institution [30]. Previous studies have shown that students who report

Sample size determination
The sample size of the study for the students was determined by using single population proportion. The prevalence rate of customer satisfaction obtained from other similar study is 70.8%. Based on this assumption, the actual sample size for this study was computed: Since the source population is less than 10,000 correction formula is used. n1=no/1+(no/N) no=is the minimum sample size, z=95% confidence level (1.96), d2=the margin of sampling error (5%), P=is the prevalence rate of satisfaction (0.708%), Correction Formula n1=Final sample size using correction formula, N=total size of study population. Then the final sample size will be 240 participants.

Data collection instrument
The instrument was a standardized tool that was formerly used in a related study conducted in Debere Marko's University and modified for use in the current study depending on the various customers' satisfactions within the college and its validity and reliability was tested using Cranach's Alpha (0.871). All the items were scored on a five-point Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied).

Sampling procedures
Students, Teachers and Administrative staff who work in the college for a minimum of six months and volunteers were invited to the study. Systematic random sampling technique was conducted. The first student in the list was randomly selected through a lottery method and then every 3rd interval was chosen to take the sample. All Teachers and administrative staff, who were volunteers, are included in the study.

Data collection procedures
Data collection was done from December 12-16, 2016. Five MSc individuals were recruited and trained to obtain consent and administer the questionnaire privately and maintain confidentiality throughout the process. Before the data collection the items on the instrument were checked for its completeness and pre-test wed. The questionnaire was prepared in English and translated into Amharic language and then back to English to keep its consistency. Data collectors were trained for two days. Close supervision was undertaken during data collection and every questionnaire was cross checked daily by the supervisors and the principal investigators.

Operational definition
Customer: Menelik II Health Science College students, Instructors, and administrative staff.
Customer satisfaction: performance matches with the expectations of individual.
Customer dissatisfaction: performance falls short with the expectation of individuals.

Independent and outcome variables:
Outcome variable of this study was customer satisfaction. Independents variable for this study were:-Management of the college, Teaching and Learning process, Library service, ICT service, General Service of the college, Registrar service, student service, Finance service, administration service and, Human resource service.
Data processing and analysis: Five points likert scale has been used to distribute the respondents' options. The levels of the scale were given the following rating (1) very dissatisfied, (2) dissatisfied, (3) neutral (4) satisfied, (5) very satisfied. The standard mean of all statements equals to their grand mean. The study considered the value below the grand mean is dissatisfied and above and equal that is satisfied, this scale mean management has been (Factors Affect Mobile Phone Brand Choices-Studying the Case of Jordan Universities Students in 2011 [32]. Simple descriptive statistics in the form of frequency counts and percentage distributions were utilized for analyzing quantitative data.

Socio-demographic characteristics of the student
A total of 233 students from different department took part in the study with a response rate of 233 (97.1%). According to the finding of this study, 147 (63.1%) and 86 (36.9%) were females and males respectively. From this most of the respondents were in the age group of 37.3% (20-24) and 36.1% (25)(26)(27)(28)(29). Majority of the respondents 91 (39.1%) and 60 (25.8%) were from Midwifery and Nursing departments respectively. 187 (80.3%) of the respondents were BSC students from this 120 (48.5%) and 176 (75.5%) day and second year students respectively.

Level of satisfaction of students with teaching and learning process
The study shows that satisfaction of students in teaching learning process on instructors methods of delivering courses and method of assessment and fairness in correcting exams satisfaction was rated highest 121 (51.9%) satisfied, 29 (12.4%) very satisfied, and 120 (51.5%) satisfied, 28 (12.0) very satisfied respectively. And satisfaction was rated very dissatisfied and dissatisfied in highest score with the speed and timeliness of the department to respond promptly to students request was 71 (30.5%) very dissatisfied and 69 (29.9%) dissatisfied. In general the overall satisfaction of students on teaching and learning process articulated in mean (greater than and equal 2.4 indicates satisfaction) from this 55. 8% of the students were satisfied in teaching and learning process.

Level of satisfaction of students with the library service of the college
The finding shows that the satisfaction of students with Library books in kind and number and their relevancy to the education given in the college was 24 (10.3%) very dissatisfied, 70 (30.0%) dissatisfied, 111 (47.6%) satisfied, 23 (9.9%) very satisfied, and 5 (2.1%) neutral. Regarding library service satisfaction in terms of time days/hours was rated highest 131 (56.2%) satisfied 40 (12.4%) very satisfied. And satisfaction was rated very dissatisfied and dissatisfied in highest score on the question of accessibility of service facilities and being free from disturbance of noise was 54 (23.2%) very dissatisfied and 63 (27.0%) dissatisfied. In general the overall satisfaction of students on the Library service articulated in mean (greater than and equal 2.5 indicates satisfaction) from this 48.1% of the students were satisfied on the Library services.

Level of satisfaction of students with the registrar service of the college
The satisfaction of students on the accessibility of the service was 28 (12.0%) very dissatisfied, 75 (32.2%) dissatisfied, 104 (44.6%) satisfied, 26 (11.2%) very satisfied. Knowledge and skills exhibited by the staff (friendliness, politeness) response was rated highest 108 (46.4%) satisfied, 22 (9.4%) very satisfied and 109 (46.8%) satisfied, 24 (10.3%) very satisfied respectively. In general, 51.5% of the students were satisfied on Registrar services.

Socio-demographic characteristics of teacher
There were 44 teachers in the College from this a total of 20 teachers from different department took part in the study, of which a response rate of 100%. The rest of participants were department heads and those served the college less than six months were excluded from the study. According to the finding of this study, 13 (65%) males and 7 (35%) were Females. Most of the respondents were in the age group of 57.6% [30][31][32][33]. Majority of the respondents 9 (45%) and 6 (30%) were from Midwifery and Nursing departments respectively. Half of the respondents served the college 5 and above years.
The study suggested that the satisfaction of teachers on leadership skills of the top management was very dissatisfied 0%, 25% dissatisfied, 70% satisfied and 5% very satisfied. Among teachers, accessibility of top management was rated highest 13 (65%) satisfied, 6 (30%) very satisfied.

Level of satisfaction of teachers with the library service of the college
From the variables of Library service the study shows that the satisfaction of teachers on Library books in kind and number and their relevancy to the education given in the college was 2 (10%) very dissatisfied, 6 (30%) dissatisfied, 11 (55%) satisfied, 1 (5%) very satisfied.
The arrangement of book and catalogue service easiness to find books in the library was rated highest 13 (65%) satisfied 5 (15%) very satisfied. And satisfaction was rated very dissatisfied and dissatisfied in highest score on the question of Library service for students in terms sufficient time and internet service in the library was 4 (20%), 8 (40%) very dissatisfied and 9 (45%) 5 (25%) dissatisfied respectively. In general the overall satisfaction of teachers on the library service articulated in mean (greater than and equal 2.7 indicates satisfaction) from this 45% of the teachers were satisfied on library services.

Level of satisfaction of teachers with the registrar service of the college
From the questions of the registrar service the survey shows that the satisfaction of teachers on the quality of student's attendance and mark list preparation was 1 (5%) very dissatisfied, 4 (20%) dissatisfied, 11 (55%) satisfied, 4 (20%) very satisfied. Regarding Degrees of service knowledge and skills exhibited by the staff and staffs' professional behavior (friendliness, politeness) response was rated highest 12 (60%) satisfied, 6 (30%) very satisfied. And satisfaction was rated very dissatisfied and dissatisfied in highest score on the question of students grade report and academic calendar preparation and utilization was 1 (5%), 7 (35%) very dissatisfied, 2 (10%), 6 (30) dissatisfied respectively. In general the overall satisfaction of teachers on the registrar service articulated in mean (greater than and equal 3.0 indicates satisfaction) from this 45% of the teachers were satisfied on registrar services.

Satisfaction of teachers with procurement, finance, and general service of the college
From the questions of Procurement, Finance, and General Service the finding shows that the satisfaction of teachers on the quality of teaching and learning materials was 3 (15%) very dissatisfied, 7 (35%) dissatisfied, 9 (45%) satisfied, 1 (5%) very satisfied.
Speed and timeliness of finance and cleaning service was rated highest 13 (65%), 14 (70) satisfied, 2 (10%), 29 (10%) very satisfied respectively. Satisfaction was rated very dissatisfied and dissatisfied in highest scores on the question of teaching learning materials speed and timeliness of procurement and the fulfillment of equipment and being comfortable in the teaching learning process was 5 (25%), 3 (15%) very dissatisfied, 9 (45%), 9 (45%) dissatisfied respectively. In general the overall satisfaction of teachers with Procurement, Finance, and General activities articulated in mean (greater than and equal 3.0 indicates satisfaction) from this 60% of the teachers were satisfied on Procurement, Finance, and General Services of the College).

Administrative staff socio-demographic characteristics
A total of 29 administrative staff from different department took part in the study from 50 staffs, the rest of the staff were department head and whose service was less than six months, of which a response rate of 29 (100%). According to the finding of this study, 9 (31%) males and 20 (69%) were Females. From this most of the respondents were in the age group of 28.3% (25)(26)(27)(28)(29). Majority of the respondents were from procurement and Finance office 7 (24.1%) and 5 (17.2%) respectively.

Satisfaction of administrative staff with different components top management activities
The study suggested that the satisfaction of accessibility of top management was very dissatisfied (13.8%), (13.8%) dissatisfied, (37.9%) satisfied and (24.1%) very satisfied. Among administrative staff, Leadership skills of the top management was rated highest 19 (65.5%) satisfied, 4 (13.8%) very satisfied. And satisfaction was rated very dissatisfied and dissatisfied in highest score on the question promoting college strong employees was 7 (24.1%) very dissatisfied and 11 (37.9%) dissatisfied. In general 44.8% of the administrative staff was satisfied on top management activities.

Satisfaction of administrative staff with the service of the college
The satisfaction of administrative staff on fairness, speed and timeliness and transparency of human resource office was 7 (24.1%) very dissatisfied, 8 (27.6%) dissatisfied, 8 (27.6%) satisfied, 6 (20.7%) very satisfied. Speed and timeliness of procurement service finance and cleaning service was rated highest 17 (58.6%) satisfied, 3 (10.3%) very satisfied. Satisfaction was rated very dissatisfied and dissatisfied in highest scores on the question of quality procured materials and fulfillment of equipment and its comfort was 5 (17.2%), 13 (44.8%) very dissatisfied, 13 (44.8%), 12 (41.4%) dissatisfied respectively (Tables 1-11). In general 55.2% of the administrative staffs were satisfied on Procurement, Finance, and General Service of the College.

Discussion
Students have different degree of satisfaction in different components of the colleges' services, this opinion is similar to the study conducted in Norway at oslow university Higher education places a big emphasis on meeting student expectation, but since all people are different, it is impossible to meet each person's expectations. So it is natural that some students would be unsatisfied with one or more aspects of their educational experience.
All the respondents had some aspects that they would like to improve and some aspects with which they were completely satisfied. Also, all the students have their own interest and goals in their studies. That is why it is obvious that the respondents paid attention to the aspects they were interested in and wrote their suggestions on improvements. Some students actively use the library and pay more attention to what it has to offer. Some students use the internet resources more, making the library collection less important to them [33].
The overall satisfaction of students on teaching and learning process, Library service, Registrar, Procurement, Finance, and General Service of the College articulated in grand mean range from 42.1 to 55.8% of student services to teaching learning process, indicates many customers have had dissatisfaction on teaching learning process, Library, registrar and students services. This result is similar to the qualitative study that shows teachers are dependent on LCD, the problem with this method are teachers cannot effectively utilize the time allocated for the session, in addition they cannot further elaborate, simply they read the information stated on the power. Some of teachers are not good in teaching and even who are not able to answer, when students ask them things which are not clear.
The demonstration room is narrow and the equipment is insufficient and old. Students from specialty trainings informed shortage of books in their fields, librarians do not know all types of available books and when students asked them a book they may take 20 to 30 minutes to search the name and the location of the books, there is no service at     night time after 6:00 or 6:30 PM o' clock, students cannot use their laptops because of lack of sockets, students have library pocket card but they are not able to borrow books. Registrar staff don't respond timely their questions, even grades may be changed by the registrar, and unable to see their result when wrong result is posted and also there are no programmed schedules of the registrar as students compared the college with other universities.
Moreover, there is no coordination among program coordinators and deans of the colleges and also the quality of teaching and learning materials procurement also had poor quality. All the above problems made students not satisfied on teaching and learning process The satisfaction of teachers on top management activities was a mean of 2.7 (45%) that indicate 55% of teachers were dissatisfied with similar study conducted by Gedefaw Kassie in high school teacher's satisfaction in Addis Ababa indicates mean of 2.10 also confirms the teachers' negative views regarding the support provided by their school [33]. When we come to registrar and library service the result of the study indicates teachers were better satisfied where as the result shows many students of the college were dissatisfied on registrar and library services.