Trends in and determinants of visiting private health facilities for maternal and child health care in Nepal: comparison of three Nepal demographic health surveys, 2006, 2011, and 2016

Ramesh Prasad Adhikari,Emily N Satinsky,Nawaraj Upadhaya,Manisha Laxmi Shrestha

doi:10.1186/s12884-020-03485-8

Abstract

BackgroundMaternal and child health care services are available in both public and private facilities in Nepal. Studies have not yet looked at trends in maternal and child health service use over time in Nepal. This paper assesses trends in and determinants of visiting private health facilities for maternal and child health needs using nationally representative data from the last three successive Nepal Demographic Health Surveys (NDHS).MethodsData from the NDHS conducted in 2006, 2011, and 2016 were used. Maternal and child health-seeking was established using data on place of antenatal care (ANC), place of delivery, and place of treatment for child diarrhoea and fever/cough. Logistic regression models were fitted to identify trends in and determinants of health-seeking at private facilities.ResultsThe results indicate an increase in the use of private facilities for maternal and child health care over time. Across the three survey waves, women from the highest wealth quintile had the highest odds of accessing ANC services at private health facilities (AOR = 3.0, 95% CI = 1.53, 5.91 in 2006; AOR = 5.6, 95% CI = 3.51, 8.81 in 2011; AOR = 6.0, 95% CI = 3.78, 9.52 in 2016). Women from the highest wealth quintile (AOR = 3.3, 95% CI = 1.54, 7.09 in 2006; AOR = 7.3, 95% CI = 3.91, 13.54 in 2011; AOR = 8.3, 95% CI = 3.97, 17.42 in 2016) and women with more years of schooling (AOR = 1.2, 95% CI = 1.17, 1.27 in 2006; AOR = 1.1, 95% CI = 1.04, 1.14 in 2011; AOR = 1.1, 95% CI = 1.07, 1.16 in 2016) were more likely to deliver in private health facilities. Likewise, children belonging to the highest wealth quintile (AOR = 8.0, 95% CI = 2.43, 26.54 in 2006; AOR = 6.4, 95% CI = 1.59, 25.85 in 2016) were more likely to receive diarrhoea treatment in private health facilities.ConclusionsWomen are increasingly visiting private health facilities for maternal and child health care in Nepal. Household wealth quintile and more years of schooling were the major determinants for selecting private health facilities for these services. These trends indicate the importance of collaboration between private and public health facilities in Nepal to foster a public private partnership approach in the Nepalese health care sector.

Highlights

Maternal and child health care services are available in both public and private facilities in Nepal
Among all children who suffered from diarrhoea, utilisation of private facilities for treatment increased from 32.7% in 2006 to 47.8% in 2016
Among children who suffered from fever/cough, utilisation of private facilities for treatment increased from 34.0% in 2006 to 68.8% in 2016

Summary

Introduction

Maternal and child health care services are available in both public and private facilities in Nepal. Andersen’s Behavioural Model envisages three major components of health care utilisation: predisposing factors (e.g. age, sex, family size, education, employment), enabling factors (e.g. income, insurance, residence), and need factors (e.g. perceived health status, symptoms, days disabled due to illness). These factors combine to determine the use or non-use of health care services [2], and this model has been used extensively in studies investigating health service utilisation [5]. The economic model assumes that economic determinants, including price, income, and other sociodemographic factors determine health care service utilisation [4, 6]

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