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Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan
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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895275/ https://www.ncbi.nlm.nih.gov/pubmed/26792666 http://dx.doi.org/10.1186/s12961-015-0041-8 |
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author | Zaidi, Shehla Riaz, Atif Rabbani, Fauziah Azam, Syed Iqbal Imran, Syeda Nida Pradhan, Nouhseen Akber Khan, Gul Nawaz |
author_facet | Zaidi, Shehla Riaz, Atif Rabbani, Fauziah Azam, Syed Iqbal Imran, Syeda Nida Pradhan, Nouhseen Akber Khan, Gul Nawaz |
author_sort | Zaidi, Shehla |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4895275 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-48952752016-06-10 Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan Zaidi, Shehla Riaz, Atif Rabbani, Fauziah Azam, Syed Iqbal Imran, Syeda Nida Pradhan, Nouhseen Akber Khan, Gul Nawaz Health Res Policy Syst Research 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. BioMed Central 2015-11-25 /pmc/articles/PMC4895275/ /pubmed/26792666 http://dx.doi.org/10.1186/s12961-015-0041-8 Text en © Zaidi et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Zaidi, Shehla Riaz, Atif Rabbani, Fauziah Azam, Syed Iqbal Imran, Syeda Nida Pradhan, Nouhseen Akber Khan, Gul Nawaz Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan |
title | Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan |
title_full | Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan |
title_fullStr | Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan |
title_full_unstemmed | Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan |
title_short | Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan |
title_sort | can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? evidence from pakistan |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895275/ https://www.ncbi.nlm.nih.gov/pubmed/26792666 http://dx.doi.org/10.1186/s12961-015-0041-8 |
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