Different Types Of Health Facilities Research Articles

A newly developed tool for measuring the availability of human resources for emergency obstetric and newborn care services: prospective analytic study in two district-level public facilities in Bangladesh

BackgroundIn Bangladesh, while the infrastructure of public health facilities to provide maternal and newborn care services is adequate, services are not always available due to insufficient staffing. A human resource availability index for health facilities is needed for monitoring and advocacy. This study aimed to develop indices for measuring the availability of different types of human resources to provide round-the-clock emergency obstetric and newborn care (EmONC) service at district-level public facilities.MethodsAs part of a larger intervention study, 30 days of prospective observation of providers was done at a district hospital (DH) and a mother and child welfare centre (MCWC) in one district of Bangladesh using checklists. A scoring system was developed to create an index to quantify the availability of providers for maternal and newborn care.ResultsBased on the newly developed index, medical doctors in the emergency department of the DH were 100% available, but ranged from 27 to 41% availability in the obstetrics/gynecology (ob/gyn) and pediatric wards. In MCWC, the corresponding indices ranged from 32 to 36%. In the DH, the availability of nurses in the ob/gyn ward (96%) was relatively better than in the pediatric ward (65%) but that in operation theatre was only 31%. In the MCWC, the index for the presence of a paramedic or nursing aid was 82% in the ob/gyn ward and 63% in the operation theatre. However, the availability scores of facility support staff for maintenance and security were generally high (over 90%) in both facilities.ConclusionsOur newly developed index on availability of providers demonstrated huge gaps in availability of providers in evening and night shifts in most of the disciplines in the study facilities. This provider availability index is easy to create and can be used as a meaningful tool to quantify gaps in human resources by type in various types of district-level health facilities. Further studies are needed for adaptation of this tool in different types of health facilities and to assess its implication as an advocacy tool.

Exploring perceptions of group antenatal Care in Urban India: results of a feasibility study

BackgroundMaking high-quality health care available to all women during pregnancy is a critical strategy for improving perinatal outcomes for mothers and babies everywhere. Research from high-income countries suggests that antenatal care delivered in a group may be an effective way to improve the provision, experiences, and outcomes of care for pregnant women and newborns. A number of researchers and programmers are adapting group antenatal care (ANC) models for use in low- and middle-income countries (LMIC), but the evidence base from these settings is limited and no studies to date have assessed the feasibility and acceptability of group ANC in India.MethodsWe adapted a “generic” model of group antenatal care developed through a systematic scoping review of the existing evidence on group ANC in LMICs for use in an urban setting in India, after looking at local, national and global guidelines to tailor the model content. We demonstrated one session of the model to physicians, auxiliary nurse midwives, administrators, pregnant women, and support persons from three different types of health facilities in Vadodara, India and used qualitative methods to gather and analyze feedback from participants on the perceived feasibility and acceptability of the model.ResultsProviders and recipients of care expressed support and enthusiasm for the model and offered specific feedback on its components: physical assessment, active learning, and social support. In general, after witnessing a demonstration of the model, both groups of participants—providers and beneficiaries—saw group ANC as a vehicle for delivering more comprehensive ANC services, improving experiences of care, empowering women to become more active partners and participants in their care, and potentially addressing some current health system challenges.ConclusionThis study suggests that introducing group ANC would be feasible and acceptable to stakeholders from various care delivery settings, including an urban primary health clinic, a community-based mother and child health center, and a private hospital, in urban India.

Does pre-diagnostic loss to follow-up among presumptive TB patients differ by type of health facility? An operational research from Hwange, Zimbabwe in 2017.

IntroductionWhile there are many studies assessing the pre-treatment loss to follow-up (LFU) among tuberculosis patients in public sector, there is no evidence from private-for-profit health sector and pre-diagnostic LFU from Zimbabwe. We aimed to assess the gaps in the cascade of care of presumptive TB patients registered during January-June 2017 in different types of health facilities in Hwange district, Zimbabwe.MethodsThis was a cohort study involving review of routine programme data. Pre-diagnostic LFU was defined as the proportion of presumptive TB patients not tested using sputum microscopy or Xpert MTB/RIF. A log binomial regression was done to assess factors associated with pre-diagnostic LFU.ResultsOf 1279 presumptive TB patients, 955(75%) were tested for TB and 102(8%) were diagnosed as having TB. All TB patients were started on treatment. Pre-diagnostic LFU (overall 25%) was significantly higher among patients visiting private-for-profit health facilities (36%), local self-government run council health facilities (35%) and church-run mission health facilities (25%) compared to government health facilities (14%). Pre-diagnostic LFU was significantly higher among patients in rural areas (30%) compared to urban areas (18%). Type of health facility was associated with pre-diagnostic LFU after adjusting for HIV status and area of residence.ConclusionWhile pre-diagnostic LFU was high, there was no pre-treatment LFU. Pre-diagnostic LFU was especially high in private-for-profit and council health facilities and rural areas. National TB Programme should take immediate steps to improve access in rural areas and support the private-for-profit and council health facilities by improving sputum collection and transport.

Satisfaction of Health Care Users with the Quality of Health Care Services in Senegal: A Multi-Level Approach

This paper analyzes the satisfaction of health care users with the quality of health care in the different types of health facilities in Senegal. The data used come from a survey of the Senegalese health system. In this framework, the multi-level approach with three levels of aggregation was used: patients (level 1), health facilities (level 2) and 14 administrative regions (level 3). The estimation results indicate a diversity, on the one hand, between regions, and on the other hand between health facilities. In addition, the individual characteristics of the patients have diverse effects across the levels of aggregation: the significance of most of them differs with respect to the context (e.g., gender, education level, age, smoking status and ownership of health insurance). While the waiting time and the applied rate effects differ slightly in terms of significance, the former influences negatively the satisfaction when waiting time is less than the duration of an appointment of the following day, whereas the level of satisfaction increases with the rate applied on health care.

Patient and health-care provider perspectives of pregnancy-related health-care provision in Guangdong, China: a qualitative interview-based study

BackgroundPregnancy-related care can reduce the risk of adverse pregnancy outcomes in women with type 1 diabetes. But little is known about the special health-care needs related to pregnancy of these women, or about the gap between these needs and health-care provision in China. We aimed to identify the perceived needs in women with type 1 diabetes and health-care providers for pregnancy-related care. The goal is for the findings to assist in the establishment of optimised management of this population in China. MethodsWe did in-depth interviews, a method widely used in social science to investigate people's attitudes and behaviours. The intended interviewees included women with type 1 diabetes (aged ≥18 years) and health-care providers of both diabetes-related and pregnancy-related disciplines living in Guangdong, China. Written informed consent was obtained from all participants. Selective sampling was used to ensure that the recruited women with type 1 diabetes covering different areas of Guangdong, and were of diverse age, disease duration, marital and child-bearing status, income, and education level; and to ensure that the included health-care providers were from different types of health-care facilities. Transcripts of the interviews were coded into themes by three investigators (SX, SL, and CW) via a thematic framework method and NVIVO (version 10) qualitative software. The recruitment ended when no new themes emerged. Rendered themes of women with type 1 diabetes and health-care providers were compared by thorough discussion within the study team. FindingsThe recruitment started in April, 2015, and ended in June, 2016. 30 women with type 1 diabetes (mean age 26·9, SD 5·7 years) and 35 health-care providers (17 physicians and 18 nurses; 24 from general hospitals and 11 from community health facilities) were included in the study. Pregnant women and health-care providers agreed that pregnancy-related health-care resources were scarce and knowledge of pregnancy-related health care needs of both patients and health-care providers was limited. Both groups agreed that pregnancy-related health care in various forms should be started at the age of maturity (18 years old) and done by well-trained multidisciplinary health-care providers. Both groups acknowledged the importance of peer support in pregnancy-related health care. And both groups agreed on the need for guidelines for planned pregnancy and management of blood glucose and diabetic complications during pregnancy. However, health-care providers reported that bodyweight management, fetal development monitoring, type 1 diabetes-specific screening tests, and postnatal lifestyle should also be emphasised. Health-care providers had a generally positive attitude to outcomes of pregnancy if glycaemic control was satisfactory, whereas patients tended to have a pessimistic perspective. Finally, women with type 1 diabetes expressed great unmet needs: thorough and timely communication with health-care providers, psychological consultation, and type 1 diabetes knowledge in non-diabetician health-care providers. Most health-care providers did not show awareness of these needs, although they were aware of insufficient pregnancy-related knowledge and expressed their intent for further training. InterpretationWomen with type 1 diabetes had various unmet needs for pregnancy-related health care, but the health-care resources were scarce in Guangdong. Both patients and health-care providers had gaps in knowledge of the need for pregnancy-related health care, indicating that further education should be given to patients, and the role of professional and psychosocial support should be enhanced. These findings identify gaps between the needs of women with type 1 diabetes and current health care provision, and would be helpful to guide the establishment of a patient-centered pregnancy-related health care system in Guangdong. FundingNational Health and Family Planning Commission Foundation for public welfare industry research project (201502011), World Diabetes Foundation (WDF14-921), and Sun Yat-Sen University clinical research 5010 program (2007030).

Breast Camps for Awareness and Early Diagnosis of Breast Cancer in Countries With Limited Resources: A Multidisciplinary Model From Kenya.

Breast cancer is the most common cancer of women in Kenya. There are no national breast cancer early diagnosis programs in Kenya. The objective was to conduct a pilot breast cancer awareness and diagnosis program at three different types of facilities in Kenya. This program was conducted at a not-for-profit private hospital, a faith-based public hospital, and a government public referral hospital. Women aged 15 years and older were invited. Demographic, risk factor, knowledge, attitudes, and screening practice data were collected. Breast health information was delivered, and clinical breast examinations (CBEs) were performed. When appropriate, ultrasound imaging, fine-needle aspirate (FNA) diagnoses, core biopsies, and onward referrals were provided. A total of 1,094 women were enrolled in the three breast camps. Of those, 56% knew the symptoms and signs of breast cancer, 44% knew how breast cancer was diagnosed, 37% performed regular breast self-exams, and 7% had a mammogram or breast ultrasound in the past year. Of the 1,094 women enrolled, 246 (23%) had previously noticed a lump in their breast. A total of 157 participants (14%) had abnormal CBEs, of whom 111 had ultrasound exams, 65 had FNAs, and 18 had core biopsies. A total of 14 invasive breast cancers and 1 malignant phyllodes tumor were diagnosed Conducting a multidisciplinary breast camp awareness and early diagnosis program is feasible in different types of health facilities within a low- and middle-income country setting. This can be a model for breast cancer awareness and point-of-care diagnosis in countries with limited resources like Kenya. This work describes a novel breast cancer awareness and early diagnosis demonstration program in a low- and middle-income country within a limited resource setting. The program includes breast self-awareness and breast cancer education, clinical exams, and point-of-care diagnostics for women in three different types of health facilities in Kenya. This pilot program has the potential of being replicated on a national scale to create awareness about breast cancer and downstage its presentation.

The effect of hospital information systems on healthcare facilities efficiency indicators

Aim. Comparative assessment of an automation facilities influence on labor input and business processes’ productivity indicators related to primary functions of healthcare facilities of different types.Methods. We performed medical personnel’s work timing in emergency rooms, as well as medical records timing in clinical departments. The automated electronic health records processing while operating hospital information systems created by authors among different types of healthcare facilities was also performed. Output data included personal health record operation periods values and system events timestamps.Results. The data concerning hospital information systems’ influence on electronic health records operating time changes and hospitalization delays was obtained. A correlation between the initial hospitalization delay and hospital capacity was discovered (r=0.917). The emergency room automation significantly reduces hospitalization delays. Under clinical information system operating conditions, the primary examination time recording increases twice, while the time spent for all other electronic health records decreases in higher order. Considerable difference between primary examination recording time and the time, necessary for other personal health record registrations, has satisfactory interpretation within the heterogeneous medical data sources integration model, but not within usability model. In general, the gained data does not confirm results of previously published researches pointing the increased time doctors spent for data management in automation conditions.Conclusion. Hospital information systems implementation improved the specialist’s labor productivity and main working processes work capacity. The obtained data indicate a greater influence of automation in large healthcare facilities and reject usability hypothesis of hospital information systems efficiency.

The clock is ticking: the rate and timeliness of antiretroviral therapy initiation from the time of treatment eligibility in Kenya

IntroductionUnderstanding the determinants of timely antiretroviral therapy (ART) initiation is useful for HIV programmes intent on developing models of care that reduce delays in treatment initiation while maintaining a high quality of care. We analysed patient- and facility-level determinants of time to ART initiation among patients who initiated ART in Kenya.MethodsWe collected facility-level information and conducted a retrospective chart review of adults initiating ART between 2007 and 2012 at 51 health facilities in Kenya. We evaluated the association between patient- and facility-level covariates at the time of ART eligibility and time to ART initiation. We also explored the determinants associated with timeliness of ART initiation.ResultsThe analysis included 11,942 patients. The median age at the time eligibility was first determined was 37 years (interquartile range [IQR] 31–45). Overall, 75% of patients initiated ART within two months of eligibility. The median CD4 cell count at the time eligibility was first determined rose from 132 (IQR 51–217) in 2007 to 195 (IQR 91–286) in 2011 to 2012 (p<0.001). The cumulative probability of ART initiation among treatment-eligible patients increased over time: 87.1% (95% confidence interval [CI] 85.1–89.0%) in 2007; 96.8% (96.0–97.5%) in 2008; 97.1% (96.3–97.7%) in 2009; 98.5% (98.0 −98.9%) in 2010; and 99.7% (95% CI 99.4 −99.8%) in 2011 to 2012 (p<0.0001). In multivariate analyses, attending a health facility with high ART patient volumes within two months of eligibility was considered the key facility-level determinant of ART initiation (adjusted odds ratio 0.57, 95% CI 0.45–0.72, p<0.001). Patient-level determinants included being eligible for ART in the years subsequent to 2007, advanced World Health Organization clinical stage and low CD4 cell count at the time eligibility was first determined.ConclusionsOverall, the time between treatment eligibility and ART initiation decreased substantially in Kenya between 2007 and 2012, with uniform gains across different types of health facilities. Our findings highlight the slow increase in CD4 cell counts at the time of ART eligibility over time, indicating that a large number of patients are still beginning ART with advanced HIV disease. Our findings also support the decentralisation of ART services at all health facilities that have the capacity to initiate treatment. Continued evaluation of programme- and country-level data is needed to monitor timeliness of ART initiation as countries continue to expand treatment access.

Fulfilling the competencies of members of a nursing team

The paper deals with the competencies of individual members of a nursing team. The aims of the paper were to describe the current state of fulfilling the competencies of members of nursing teams in inpatient facilities in the Czech Republic as perceived by managers of non-medical professions; to compare the differences in activities of the nursing process, and to assess the needs and education of patients in different types of health-care facilities. The research was conducted using quantitative research methods applying a questionnaire technique of personal design. Individual items were formulated on the basis of the legally established competencies of paramedical staff and expert recommendations, which ensured the content validity of the questionnaire. Results showed that all members of a nursing team perform activities beyond their “internal” and “external” competencies or do not fulfil them at all. The differences between various types of health-care facilities in implementing activities of the nursing process and evaluating the self-sufficiency and education of patients were not established. Activities that are solely the responsibility of nurses are being provided by other medical staff members (medical assistants, nursing assistant and orderlies). In contrast, nurses significantly contribute to performing less skill-required care. This situation not only does not meet the requirements of safe and quality nursing care, but it also directly affects the rights of patients to receive medical services at the appropriate level of expertise and the responsibility of providers to ensure quality health services. The failure to use competency management of members of a nursing team represents an inefficient process within the personnel management of health-care facilities.

Does stewardship make a difference in the quality of care? Evidence from clinics and pharmacies in Kenya and Ghana.

To measure level and variation of healthcare quality provided by different types of healthcare facilities in Ghana and Kenya and which factors (including levels of government engagement with small private providers) are associated with improved quality. Provider knowledge was assessed through responses to clinical vignettes. Associations between performance on vignettes and facility characteristics, provider characteristics and self-reported interaction with government were examined using descriptive statistics and multivariate regressions. Survey of 300 healthcare facilities each in Ghana and Kenya including hospitals, clinics, nursing homes, pharmacies and chemical shops. Private facilities were oversampled. Person who generally saw the most patients at each facility. Percent of items answered correctly, measured against clinical practice guidelines and World Health Organization's protocol. Overall, average quality was low. Over 90% of facilities performed less than half of necessary items. Incorrect antibiotic use was frequent. Some evidence of positive association between government stewardship and quality among clinics, with the greatest effect (7% points increase, P = 0.03) for clinics reporting interactions with government across all six stewardship elements. No analogous association was found for pharmacies. No significant effect for any of the stewardship elements individually, nor according to type of engagement. Government stewardship appears to have some cumulative association with quality for clinics, suggesting that comprehensive engagement with providers may influence quality. However, our research indicates that continued medical education (CME) by itself is not associated with improved care.

English

&nbsp; Since 2006 there has been universal acceptance in both developing and industrializedsocieties that HIV treatment and related services, including more effective programs, be available to all citizens. However, as a result of the worldwide recession and shifting health priorities, progress toward these goals has stalled. While the epidemic continues to grow (approximately 34 million globally, with 2.7 million new cases in 2010), fewer resources are dedicated to treatment and prevention than previously, and clinical staffs, especially nurses are challenged by more patient care responsibilities. This paper focuses on the relationships of HIV/AIDS care, coping strategies and work environmental stress for nurses working in an African country (Botswana) with a significant epidemic. Data for this study was obtained through questionnaires completed by a sample of 201 nurses working in different types of health facilities in rural and urban areas of Botswana. Results show that 65% of the nurses frequently provided care to clients with HIV/AIDS. Only 35% of the nurses provided care to clients with HIV/AIDS infrequently. Those caregivers who often worked with patients infected with HIV reported significantly (p&lt;.05) more &quot;role demand&quot;, &quot;job control&quot; and &quot;shift work&quot; stress and said that their coping strategies were more likely to include taking food supplements. Implications for professional &quot;burn out&quot; among HIV/AIDS caregivers in developing societies are discussed together with strategies for more effective allocations of health care personnel. &nbsp; &nbsp; Key words:&nbsp;HIV/AIDS, nurses, healthcare, psychological outcome, Botswana

Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level?

Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level?

Mental Health Differences Between Rural and Urban Men Living with HIV Infection in Various Age Groups

Despite the disproportionate increase in rural, Southern residents and older persons during the third era of the HIV/AIDS epidemic, no known study has examined whether older, rural men living with HIV infection face a double jeopardy and have poorer psychosocial profiles than other subgroups of men. We investigated whether area of residence (rural, urban), age (young, middle-age, old), and the interaction of residence and age would be related to mental health factors by using two measurement methods to categorize rural and urban residence (US Census Bureau classification and The Office of Rural Health Policy's, Rural Urban Commuting Area Codes [RUCAs]). We conducted 2-3 hour-long, face-to-face interviews with all but 43 patients who met the study criteria and kept their clinic appointments at three different types of healthcare facilities (i.e., VA, university clinic, public health department) over a 20-month period. The sample consisted of 226 men living in the southeastern US. Rural and urban men of various age groups did not differ in socioeconomic factors, travel distance to clinics, use of medications, satisfaction with care, types of severe stressors, and confidentiality concerns. Using two methods to categorize area of residence, we found that rural men as compared to urban men had similar levels of total stress, AIDS-related stress, social support, active coping and avoidance coping, but higher rates of risk for depression. Rural men had higher levels of non-AIDS-related stress only when the US Census Bureau's categorization was used, which highlights the importance of carefully selecting and describing methods to categorize rural versus urban residence.

Influence of environment and healthcare structures on the survival of patients with colorectal cancer: a French population-based study.

Colorectal cancer is one of the highest-ranking cancers in France, both sexes combined, with 33000 new cases per year. To report on the practice and the efficiency of the healthcare system, an evaluation of the therapeutic management of colorectal cancer was carried out in the department of the Herault, in the south of France. Cases of colorectal cancer in 1992 (344 colorectal cancer incidental cases) in the department of the Herault were reviewed. The diversity of the therapeutic choices and survival were evaluated for the different types of healthcare facilities (private hospitals, nonspecialized and specialized hospitals) and residential areas (rural, semi-urban, urban). Two hundred seventy-one patients with colorectal cancer (78.8%) and 234 patients with colorectal cancer (67.7%) were respectively diagnosed and treated in the private sector. Sixteen cases (23.5%) in the public sector (29.7% in the university hospital) and 24 cases (19%) in the private sector involved surgical emergencies (peritonitis, intestinal obstructions) (P = 0.003). Radiotherapy was performed in 59% of patients with rectal cancer. Preoperative radiotherapy was used primarily in specialized hospitals (80% of radiated rectal cancer; P = 0.002), as opposed to postoperative radiotherapy, which was used predominantly in private hospitals (P = 0.005). Forty-five percent of the patients with colorectal cancer who had lymph node involvement have been treated with chemotherapy. In multivariate analysis, lymph node metastasis and the presence of metastases (Dukes stage) were the most important independent pejorative prognostic factors, followed by the initial treatment in nonspecialized hospitals, complicated colorectal cancer (intestinal obstruction, peritonitis), lack of histological differentiation, and rural and urban residential areas. Apart from independent prognostic factors, such as parietal, ganglionic, or metastatic extensions, the lack of histological differentiation, and the complicated forms, heterogeneity and inequality persist in the distribution, treatment for, and the survival of patients with colorectal cancer based on the type of healthcare facility and the living area of this French population.

A village treatment center for malaria: community response in Sri Lanka

Early diagnosis and treatment of malaria cases is one of the basic elements of the current global malaria control strategy. In order to provide this service to people in rural areas there is a need for new cost-effective approaches. To ensure that such new approaches are acceptable to the target communities, it is important to know the rationale for people's malaria treatment-seeking behavior. The present study provides insights into the reasons for people's preferences for different types of healthcare facilities and describes variation of these preferences within a rural community in Sri Lanka. The study reports on the experiences with the establishment of a village health facility and its effect on the treatment-seeking behavior of the population. After the introduction of the village treatment center it quickly took over the role of main provider for diagnosis and treatment of malaria from the government facilities. The treatment center did not improve the response time in seeking treatment for young children, but the delay for adults was reduced by 1–2 days. Mothers with small children often preferred the government facilities since they wanted a more qualified opinion than available from the locally recruited staff of the village treatment center. The treatment center significantly reduced the stress and discomfort experienced by the elderly and handicapped segment of the community. The study indicated that the effective catchment area of a village treatment center will be influenced by the degree of initial support from key individuals in the communities, the selection procedure and training of assistants, and the history of the relationships between different villages to be served by the center. The government health services and communities across the dry zone of Sri Lanka could benefit substantially from the establishment of more village treatment centers. To ensure the long-term sustainability of these type of facilities it is necessary to assess the feasibility of charging a user fee and establishing multi-purpose clinics. Government policies and administrative procedures will need to be adjusted to make the successful operation of village treatment centers possible.

Health service resources as determinants of infant death in rural Bangladesh: An empirical study

Using empirical data collected from a rural area of Bangladesh, this paper examines the relative importance of availability of health care resources on infant death. Following many health care studies, this paper hypothesizes that the likelihood of infant death is a function of accessibility to different types of health facilities and personnel. Both univariate and multivariate analyses of data indicate that the distance to a qualified physician of Western medicine exerts significant influence on infant deaths. Other variables considered are distance to Upazila Health Complex (UHC), Family Welfare Center (FWC), and non-qualified doctors.

Utilization of health services in developing countries—Tunisia

This paper is based on a WHO study on determinants of utilization of government health services in a province of Tunisia (Governorate of Nabeul). Seven study areas were selected which were considered typical both of different types of health facilities and of towns and rural settings in the province. In these study areas, an interview survey of a sample of households was undertaken and the data gathered from the survey were linked to available medical records for the 3808 members of the 678 households studied. The most striking finding of the study was the much greater use of ambulatory care services by urban than by the rural populations studied. It is argued that this rural/urban differential is a result both of differences among the populations and of differences in technical sophistication of and accessibility to rural and urban health centres. In general, utilization of health services by the study group was low when compared with rates reported in most developed countries. Most persons used the health services only once or twice for a given episode of illness, and the great preponderance of diagnoses made were for acute illnesses, especially the common communicable diseases. It is also shown that when the population is grouped according to categories of respondents from high- and low-user families, a number of contrasting demographic, socio-cultural and economic characteristics, and attitudes tend to differentiate these groups (in both urban and rural areas). Among characteristics more likely to be exhibited by respondents from high-user households are: indicators of literacy and language ability, use of mass media, socio-economic participation, type of occupation and employment status, and positive attitudes towards the health services including health personnel and towards disease prevention. The applicability of analyses of determinants of utilization in developed countries to the situation of developing countries such as Tunisia is discussed. On this basis, a framework for further study is developed which focuses upon modernization as the key predictor of use of health services in developing countries. Some implications and related practical recommendations for better management of the health care delivery system in the studied area are also discussed.