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As African countries continue to improve their healthcare quality, a study of this nature that sought to examine satisfaction with healthcare services from the perspective of healthcare users cannot be overemphasized, as the findings serve as a benchmark to guide policy decisions in the healthcare sector. This study assessed perception of satisfaction on the quality of decentralised healthcare service delivery from a positivist research orientation. A total of 408 users of healthcare services from 10 districts of Lesotho were selected to respond to a set of questionnaires and a researcher-administered survey developed from the six World Health Organisation–defined dimensions of quality healthcare: safety, equity, acceptability, accessibility, efficiency, and effectiveness. Descriptive and inferential statistics were used for analysing the data obtained. The findings of the study revealed mixed feelings among users of healthcare services in Lesotho. For example, healthcare users were generally satisfied with how receptive service providers were to innovative service delivery, honesty, and the overall competence of healthcare service providers. However, significant deficits were observed in treatment safety, record-keeping, equitable geographic service distribution, and timely access. Particularly worrying were concerns about drug administration, rural service equity, and duplication of health procedures. There were no significant differences in the respondents’ satisfaction regarding healthcare services despite variations in their sexual orientation and age distribution. The study highlights the systemic inequalities and inefficiencies that counter the desired objectives of decentralised healthcare and the critical need for participatory health governance, digital health systems, improved communication strategies, health infrastructure investments and adaptive governance frameworks to bridge the disconnect between the lived experiences of healthcare users and decentralised health policy frameworks. The results offer evidence-based insights for healthcare administrators, donors, health communicators and policymakers seeking to enhance equity and quality in healthcare in resource-constrained African settings.

Caregivers play an essential role in the prevention and management of childhood illnesses. The experiences caregivers encounter when utilizing healthcare services for children under-five years of age profoundly influence their propensity to use these services in the future. This paper aims to explore the positive experiences of caregivers utilizing under-five child healthcare services in Vhembe district healthcare facilities. A qualitative, explorative and descriptive design was used for this study. Sixteen caregivers were purposefully sampled, and in-depth individual interviews were conducted. Braun and Clarke's (2006) thematic analysis steps were followed to analyze the data. Trustworthiness criteria were observed, and ethical approval was obtained for the study. The findings show that caregivers had positive experiences with the service they received. The care was of good quality, as reflected in timely service provision, availability of medicines, nurses' competence and professionalism, and person-centred care. The healthcare environment was welcoming; communication was effective, and nurses portrayed a positive attitude, resulting in caregivers' satisfaction with the care received. Caregivers felt Supported and empowered as they were involved in childcare. Positive experiences are crucial for the optimal utilization of healthcare services and improved health outcomes. The findings highlight the need to enhance staff competency and professionalism by mandating IMCI training.