Improvement in Access and Equity for Maternal and Neonatal Health Services
Comparative Advantages of Contracted Out vs. Non-Contracted Out Facilities
- 8.2% births take place in public sector facilities.
- Innovative ways for health delivery and financing are required to improve access to maternal and neonatal care.
- Basic Health Units have shown promise in improving health services at primary care levels.
- Contracting-out of Rural Health Centers (RHCs) for maternal and neonatal care is being evaluated for the first time in Pakistan.
- To study the comparative effectiveness (if any) of contracted out vs. non-contracted out RHCs on the improvement in:
- Quality of care for maternal and neonatal health
- Improvement in health service utilization
- To quantify estimates of the cost of providing contracted out services
The project team comprises of Drs Shehla Zaidi, Fauziah Rabbani, Shiraz Shaikh, Peter Hatcher, Nousheen Pardhan, Mr Gul Nawaz Khan, Mr Hassan Fazli and Mr Atif Ali
- A cross-sectional survey was carried out for a comparison of intervention (NGO-managed RHCs) and control (government-managed RHCs) in Thatta and Chitral.
- Health facility Assessment Surveys assessed quality of care parameters at contracted and non-contracted RHCs.
- Household surveys assessed service utilization, patient expenditure, health seeking behavior, household knowledge and practices, and delivery outcomes.
- Focus Group discussions assessed in-depth exploration of financial barriers, including reasons for non-usage.
- Provider cost analysis was used for standardized international checklists for unit cost calculation of facility-based services.
- Maternal care utilization
- Newborn care utilization
- Emergency care maternal and newborn care utilization
- Quality of care index of health facilities
- Patient satisfaction
- Median out of pocket expenditure for range of Maternal and Neonatal Health (MNH) services
- Community perception on barriers to utilization
- Unit cost of provider
Policy and Practice Implication:
- Provide evidence for decisions on up-scaling of contracting out of RHCs for MNH services.
- Monitor reduction in client expenditure as a result of contracting.
- Assess whether benefits of contracting out filter down to the poorest and if additional safety nets are required for the poor to accompany contracting.
- Provide unit costs for implementing a contracted out Basic Emergency Obstetric and Neonatal Care, and Comprehensive Emergency Obstetric and Neonatal Care model.
- Identify successful design related features of current contracting initiative that can be replicated for other contracting initiatives.