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REPRODUCTIVE, MATERNAL AND CHILD 3. Conclusion 3.1 Clients’ shift from public to private sector. This study set out to establish evidence of a shift of clients from Government to private facilities. It mainly examined use of family planning, antenatal care and assisted deliveries and found evidence of a shift from public to private sector. However the shift varied by type of service. The shift is more pronounced for family planning services than for the other services. This finding corroborates findings from the 1999 DES findings of an increase in the proportion of clients seeking family planning services from private facilities while the proportion seeking the same services from Government facilities was declining. It is also consistent with the remarkable increase in number of private-for-profit facilities offering family planning services. These facilities are responding to demand from clients who have never sought as well as those shifting from public sector facilities.
Results in this report also suggest that the antenatal care and assisted delivery client load was increasing faster in the private sector than in the public sector. However evidence of the shifting was less compelling 3.2 Reasons for shifting to the private sector This study also examined reasons for shifting from the public to the private sector. It used exit interviews and FGD to establish these reasons. The reasons are compiled directly from responses to the questions asking for these reasons, as well as indirectly from recommendations to improve services at government, NGO and private clinics. The findings suggest that clients are shifting from the public to the private sector primarily because of accessibility. Because of a denser network, private facilities are more conveniently located in order to attract clients. In addition to location, clients shift to the private clinics because of shorter waiting time. These two major reasons for shifting suggest that clients are shifting mainly because of convenience. The third and forth factors for shifting to private sector were good provider behaviour and better availability of drugs at private facilities. Both these issues relate to quality of services in general and contribute to client satisfaction with service at the private facilities. The other rather minor factor was credit facilities available at private facilities. It should be noted that clients are aware of the limitations such as lack of qualified staff, equipment and drugs at the private clinics. Clients are particularly concerned about private sector attention to, ability to deal with contraceptive side effects problems. 3.3 The cause of declines in service utilisation at public facilities This study shows that the decline in use of public sector services recorded in 1999 is matched by an increase of use of private sector services. The findings show that, Push factors such as accessibility, long waiting time, poor provider behaviour and stock-outs at public facilities and the Pull factors such as convenient location and shorter waiting time and "good service" at private facilities combine to attract clients from the former to the latter sector. These Push and Pull factors explain the decline observed in the public sector service utilisation data and negate the concern that these declines reflected a general decline in use of services. The forthcoming Uganda Demographic and Health Survey 2000 is expected to confirm this finding.
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