Improvement in Access and Equity for Maternal and Neonatal Health Services
Comparative Advantages of Contracted out versus Non-Contracted our Facilities
- 8.2% of births taking 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 the health services at primary care level
- Evaluation of Contracting-out of Rural Health Centers for maternal and neonatal care is being conducted for the first time in Pakistan.
- To study the comparative effectiveness, if any, of contracted out RHCs versus non contracted out RHCs in:
- Improvement in quality of care of maternal and neonatal health
- Improvement in Health service utilization
- Improvement in equity
- To quantify the estimates of the cost of providing contracted out services
Dr Shehla Zaidi, Dr Fauziah Rabbani, Dr Shiraz Shaikh, Dr Peter Hatcher, Gul Nawaz Khan, Dr Nousheen Pardhan, Hassan Fazli, Atif Ali
- A cross-sectional survey for comparison of intervention (NGO managed RHCs) and control (government managed RHCs) in Thatta and Chitral.
- Health facility Assessment Survey assessed quality of care parameters at contracted and non-contracted RHCs.
- Household survey assessed service utilization, patient expenditure, health seeking behavior, household knowledge and practices, and delivery outcomes.
- Focus Group discussion assessed in-depth explore financial barriers, including reasons for non-usages.
- Provider cost analysis was used for standardized international checklists for unit cost calculation for 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 OOP expenditure for range of MNH services
- Community perception on barriers to utilization
- Unit cost of provider
Policy and Practice Implication:
- Evidence for decisions on up-scaling of Contracting Out of Rural Health Centers for MNH services.
- Monitor reduction in client expenditure as a result of contracting.
- Assess whether benefits of Contracting Out filter down to the poorest or additional safety nets for the poor are required to accompany contracting.
- Provide unit costs for implementing a contracted out BemONC and CemONC model.
- Identify successful design related features of current contracting initiative that can be replicated for other contracting initiatives.