Abstract
BackgroundTo determine whether training of providers participating in franchise clinic networks is associated with increased Family Planning service use among low-income urban families in Pakistan.MethodsThe study uses 2001 survey data consisting of interviews with 1113 clinical and non-clinical providers working in public and private hospitals/clinics. Data analysis excludes non-clinical providers reducing sample size to 822. Variables for the analysis are divided into client volume, and training in family planning. Regression models are used to compute the association between training and service use in franchise versus private non-franchise clinics.ResultsIn franchise clinic networks, staff are 6.5 times more likely to receive family planning training (P = 0.00) relative to private non-franchises. Service use was significantly associated with training (P = 0.00), franchise affiliation (P = 0.01), providers' years of family planning experience (P = 0.02) and the number of trained staff working at government owned clinics (P = 0.00). In this setting, nurses are significantly less likely to receive training compared to doctors (P = 0.00).ConclusionsThese findings suggest that franchises recruit and train various cadres of health workers and training maybe associated with increased service use through improvement in quality of services.
Highlights
To determine whether training of providers participating in franchise clinic networks is associated with increased Family Planning service use among low-income urban families in Pakistan
29% received Family Planning training from Government of Pakistan, and 41% were trained in the private sector by franchises and non-governmental organizations (NGO)
Regarding Post-Abortion Care training, 13% were trained by Government, 7% were trained by franchises and NGOs and 1% reported other source of training. 68% of providers worked in the private sector and 32% worked in the public sector
Summary
Poor health managerial capacity and inadequate referral mechanisms have led to gross inefficiencies in the public sector; and too often, these referrals are not managed at the basic level because of lack of resources, lack of managerial training, lack of patient-centred care and staff shortages [6]. To overcome these deficiencies in primary health care facilities, contracting out management and delivery of preventive services to NGOs or healthcare providers, has been proposed, underscoring the need for Government to establish a regulatory framework [6]
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