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Information Resources"Health
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REPRODUCTIVE, MATERNAL AND CHILD Executive Summary Early in 2000 the Delivery of Improved Services for Health (DISH) project, using data from 80 sentinel sites, observed declines in use of family planning, antenatal and assisted delivery services. These trends raised concerns as to whether service utilisation in general was declining or whether clients were shifting from the sentinel sites to private and other newly established public facilities. Another possible explanation of these trends was the accuracy of the data. Therefore, to explain the decline, the project initiated research focusing on the above-mentioned possible explanations. The research started with cross-checking sentinel sites monthly return forms vis-a-vis daily registers to investigate accuracy of data. The findings showed that the data was fairly accurate. Next, regarding possibility of a general decline in use of services, investigations referred to recent population based studies. These studies showed contrary evidence, they did not report any decline in use of service. These findings implied that switching from public to private or to other public sector facilities was the likely explanation of the declining trends. In this regard, the project embarked on research to investigate this shift. Because in most areas the public sector facilities have not significantly expanded, this research that covered two urban districts, namely, Jinja and Kampala, focused on the shift from the public to the private sector. Service statistics data were collected from selected public and private sector organizations involved in providing reproductive health to compare utilization trends between Government, NGO and private sector health facilities. In addition, a facility-level survey of private sector facilities was conducted. This survey interviewed facilities as well as clients seeking services from these facilities. It also conducted Focus Group Discussions of family planning private sector clients. The results showed evidence of clients shifting from the public to the private sector facilities, especially for family planning services. During the period when public sector facilities experienced declines, the private sector experienced increases in service utilization. In addition, 20% of clients found at private facilities had switched from the public sector, not to mention that 80% had never sought services from public facilities. Clients were attracted to the private facilities because of convenient and more accessible location, less waiting time and good service at these facilities. Other reasons for preferring the private sector included credit facilities and better availability of drugs. Clients acknowledged private sector limitations that mainly included inadequate staff qualification and poor availability of medical equipment and drugs. Besides limitations mentioned by clients, this study found that private sector facilities lacked in the areas of record keeping and staff refresher training.
This study concluded that factors such as poor physical accessibility, long waiting time and poor provider behavior push clients away from public facilities. Meanwhile factors such as high accessibility because of convenient location and a denser network, less waiting time, availability of drugs and good inter-personal communication pull clients to the private sector in urban areas.
To increase health service utilization, this study recommended efforts to address service delivery problems in the public as well as in the private sector. In the short run, the Push factors in the public sector and the limitations faced by the private sector should be addressed concurrently. Meanwhile, in the long run, policies should aim at ensuring quality services in the private sector that should predominate in offering basic services. The public sector facilities should be prepared predominantly for referral services. However, these recommendations apply to the urban areas, further research is needed to cover the rural areas.
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