Suchergebnisse

SummaryThere is certainly a growing need to justify the significance of studying health-seeking behaviours for designing advocacy campaigns, lobbying for a policy shift and convincing donors to invest in priority areas. Moreover, policymakers need to be encouraged to design evidence-based policies that take into account information relating to health-promoting, -seeking and -utilization behaviour and the factors determining these behaviours. This paper primarily covers the 'methodology' used in the study of health-seeking behaviours and determinants of health services utilization in a predominantly rural district of Pakistan. The paper substantiates that this methodology is comprehensive and reliable, and there is potential for replicating this in similar settings. The approach of Kroeger in his research on the study of health-seeking behaviours, particularly in developing countries, provides the most holistic framework for examining, analysing and interpreting factors and determinants of health-seeking behaviours and health services utilization in developing countries. This study endeavoured to validate Kroeger's framework in a Pakistani setting, exploring all the factors listed through mixed method research, and qualitative supplemented by representative quantitative enquiry. This approach has also helped in understanding the inter-relationship of various factors and drivers of health-seeking behaviours from all angles.

BACKGROUND: The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. METHODS: An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. RESULTS: Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. CONCLUSION: Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele.