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.

Objectives:

• 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
• Equity
  
• To quantify estimates of the cost of providing contracted out services

Project Team:

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

Methods:

• 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.

Outcomes Measured:

• 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.