Improvement in Access and Equity for Maternal and Neonatal Health Services
Comparative Advantages of Contracted out versus Non-Contracted our Facilities
Background:
- 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.
Objectives:
- 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
Project Team:
Dr Shehla Zaidi, Dr Fauziah Rabbani, Dr Shiraz Shaikh, Dr Peter Hatcher, Gul Nawaz Khan, Dr Nousheen Pardhan, Hassan Fazli, Atif Ali
Methods:
- 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.
Outcome Measured:
- 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.
