Utilization Of Public Health Facilities Research Articles

Learnings From the Implementation of an Electronic Human Resource Management System for the Health Workforce in Uttar Pradesh, India.

The state of Uttar Pradesh (UP), India, has one of the largest single public health systems globally, serving about 235 million people through more than 30,000 public health facilities with approximately 160,000 health personnel. Yet, the UP health system has a shortfall of public health facilities to meet the population's needs, a shortage of clinical and nonclinical health personnel, inequitable distribution of existing health personnel, and low utilization of public health facilities. A robust and effective electronic human resource management system (eHRMS) that provides real-time information about the lifecycle of all health professionals in UP may aid in improving the health workforce, resulting in better health services and improved health outcomes. The Government of UP rolled out Manav Sampada, a comprehensive eHRMS that complied with global norms and requirements. We describe the implementation of Manav Sampada at scale and elaborate on key learnings and adoption strategies. Manav Sampada was based on key principles of integration and data-sharing with other digital systems, included functional components, a minimum dataset, used a lifecycle-based approach, and a workflow-based system, all of which acted to improve human resource data quality. The eHRMS emerged as a valuable tool for key stakeholders in reviewing worker performance, identifying skill-building needs, and allocating resources for training, leading to improved availability and equity in the distribution of a few critical cadres. The eHRMS in UP is well positioned to become an integral part of the Ayushman Bharat Digital Mission, the backbone of India's integrated digital health infrastructure. Linking eHRMS to a planned beneficiary-centric unitized health service delivery system (capturing information at the individual level rather than the aggregate level) will enable the measurement of service delivery and quality, leading to improved workforce management.

Scourge of out-of-pocket expenditure on health: A study on its burden and predictors in a rural community of West Bengal.

Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses. A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics. Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage. Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.

Social and Regional Disparities in Utilization of Maternal and Child Healthcare Services in India: A Study of the Post-National Health Mission Period.

BackgroundIndia has enjoyed enhanced economic growth, but has fared poorly in human development indicators and health outcomes, over the last two decades. Significant health inequities and access to healthcare continue to exist and have widened within communities across states. This study examine the changes and disparities in maternal and child healthcare (MCH) among disadvantaged and advanced social groups in three states of India.Data and MethodsFour rounds of National Family Health Survey data were used to measure infant mortality rate (IMR) and under-five mortality rate (U5MR) according to the social groups for the selected states. This study investigates the socio-economic inequities manifested into caste and class differentials and inequities in availability, utilization, and affordability of maternal and healthcare services. Descriptive statistics and the logistic regression model were used. Individual- and household-level covariates were employed to understand the differentials in healthcare utilization.ResultsThe probability of not receiving full antenatal care (ANC) or full immunization for the children was highest among the Scheduled Caste/Scheduled Tribe (SC/ST) families, followed by economic class, mother's education and residence. Tamil Nadu showed the highest utilization of public health facilities, while Bihar was the poorest in terms of health outcomes and utilization of MCH care services even after the pre-National Health Mission (NHM) period. Bihar and West Bengal also showed private healthcare dependence.ConclusionThis study detected the presence of significant caste/tribe differentials in the utilization of MCH care services in the selected states of India. Limited accessibility and unavailability of complete healthcare were the foremost reasons for the under-utilization of these services, especially for people from disadvantaged social groups. The result also suggested that it is perilous to confirm “Health for All” immediately. It will be the efficiency with which India addresses inequities in providing healthcare services and guarantees quality care of health services.

Lessons learned? Intended and unintended effects of India's second-generation maternal cash transfer scheme.

The maternity benefit scheme piloted as Indira Gandhi Matritva Sahyog Yojana (IGMSY) since 2011 and recently rolled out as Pradhan Mantri Matru Vandana Yojana (PMMVY) incentivizes mothers to participate in infant health-promoting activities. It has become India's largest conditional cash transfer program ever, outrivaling the country's first-generation maternity benefit scheme Janani Suraksha Yojana (JSY), which incentivizes institutional delivery and has been criticized for its unintended side effects on fertility. We approach IGMSY's geographically targeted pilot phase as a natural experiment and use data from a large national health survey to estimate its effects by a matched-pair difference-in-differences approach. Consistent with the program's conditions, we find increases in infant immunization. As side effect, long-term utilization of public health facilities becomes more frequent and intervals between eligible births increase by 17%. Our findings suggest that India'ns second-generation maternity benefit scheme has been more carefully designed than its predecessor, with side effects that support the program's broader objectives. But both direct and indirect effects are small and can make only a small contribution to redressing India's dismal maternal and child health record.

Transnational Mobility and Utilization of Health Services in Northern Thailand: Implications and Challenges for Border Public Health Facilities.

Introduction/Objective:Transnational populations from the Association of Southeast Asian Nations are crossing borders regardless of whether their status is legal or undocumented, to receive health services in the border regions of Thailand. The implications and challenges of transnational mobility and the utilization of public health facilities in Thailand’s border regions are therefore investigated in this study.Methods:Four public health facilities were selected, located in 2 economically-active border areas in Northern Thailand: Mae Sai–Tachileik at the Thailand–Myanmar border and Chiang Saen–Ton Phueng at the Thailand–Lao PDR border. Qualitative data were obtained from in-depth interviews with 8 medical and non-medical hospital staff responsible for implementing facility-level policies and providing health services for the transnational population.Results:Five themes were identified through analysis of the implications and challenges for transnational mobility and the utilization of public health facilities under study: contextual determinants of illness in specific border areas; uncompensated care as opposed to financial management in serving the transnational population; health service opportunities for the transnational population; cross-border collaboration on public health; and the remaining challenges of transnational mobility in border regions.Conclusion:Conventional content analysis with interpretative induction of in-depth interview data offers recommendations for improving the capacity of border health facilities to reduce the burden placed upon them to provide services to the transnational population.

Leveraging Technology to Enable Effective Preventive Screening of NCDs at Population Scale: Initial Observations

India is undergoing an epidemiological transition to non-communicable diseases (NCDs), with NCDs contributing to nearly 60 percent of all deaths in India. NCDs are challenging to manage given their silent onset, low health awareness, significant informational asymmetry, and low health-seeking behavior among the rural population and the poor in India. The Ministry of Health and Family Welfare (MoHFW), Government of India, launched Ayushman Bharat to move from a sectoral and segmented approach of health service delivery to a more comprehensive one. As part of this effort, a program was launched for population-based screening (PBS) and management of five common NCDs—hypertension, diabetes, oral, breast, and cervical cancers. The success of the program, among other things, will be determined largely by the early detection, timely treatment, and diligent follow-ups to manage the five NCDs. In line with WHO’s Global action plan for the prevention and control of NCDs 2013–2020, India is the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025. However, challenges like human resource shortfall, limited capacities of the health workers, heavy burden of managing multiple health priorities, and poor utilization of public health facilities may affect the outcomes of this ambitious initiative Technology can serve as an enabler in solving some of these problems. Dell Technologies and Tata Trusts have partnered with the Ministry of Health and Family Welfare, Government of India, to develop a technology solution for the PBS NCD initiative. It consists of a suite of mobile and web apps on a cloud platform for health workers, doctors, and health administrators to enable care delivery for people across the country. The solution has been deployed in states across the country with adoption gaining momentum amongst health care providers. While early process indicators are encouraging, it is important to examine individual clinical outcomes, population outcomes and cost effectiveness which are the primary objectives of such a program. The learnings from this digital health program can then be transposed to similar healthcare settings. The paper covers four challenges commonly encountered in the context of running large-scale digital health programs in a multi-state, multi-facility, and multi-stakeholder system. These are adoption of technology by health workers with low digital literacy, feasibility of running tech solutions in remote areas, value proposition of the solution for users and finally the know-how on building and rolling-out technology at scale to reach millions of people.

Non-communicable diseases and public health facility utilization: a study in rural Kerala

Background: The burden of non-communicable diseases increased significantly in India and Kerala carries the highest burden among Indian states. People with chronic non-communicable diseases (NCDs) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health care needs. Provision of health services through public health facilities will reduce the health care expenses and will increase NCD care utilization. This study aimed to assess socioeconomic-factors related to public health service utilization among four major non-communicable disease patients in Pathanmthitta district of Kerala.Methods: A cross-sectional household survey using WHO CSDH frame work conducted among 715 individuals from 3randomely selected panchayaths in Pathanmthitta district, Kerala. Simple frequencies were used to calculate the prevalence of NCDs in the study population. Chi-square test followed by binary logistics regression was applied (using SPSS 21 statistical package) to examine the effects of demographic and socioeconomic variables of NCD respondents on public health utilization.Results: Among 715 household survey respondents 472 (66%) reported as Non-communicable disease (NCD) patient. The majority (60.5%) of NCD respondents reported using government facility for health care irrespective of their socioeconomic status. Chi-square test analysis, ration card status, age, gender, education, occupation, income and economic dependency show significance (p<0.005). Public health utilization was seen to be high in female (OR=7.1, p=0.000), people with lower education (OR=11.5, p≤0.002) and lower income (OR=4.1, p=0.000). Public health facility utilization reported high among partially depended people (OR=39.8, p=0.000).Conclusions: Irrespective of their socioeconomic status NCD patients wants to reduce their financial burden of health care through the utilization of public health facilities. A comprehensive health care financing scheme for chronic NCD patients which is crucial to protect most vulnerable groups.

Analysis of distribution, capacity and utilization of public health facilities in Borno, North-Eastern Nigeria

IntroductionThis study aimed to analyze the spatial distribution and capacities of public health facilities and assess utilization of the facilities in Biu area of Borno State, Nigeria.MethodsA descriptive survey of health facilities and households were conducted by stratifying the area into 11 electoral wards. Data collection instruments include a hand-held GPS (Garmin 76CSx) and 2 sets of structured questionnaires (facility and household). The hand-held GPS was used in taking the coordinates of each health facility in the area. Twenty-five facility-based and 400 household-based questionnaires were administered.ResultsIt was identified that 138 public health personnel serve the area’s population of 240,838. Medical professionals (doctors/nurses/midwives) to patient ratio is 1:2973, about 7 times less than the minimum WHO recommendation of 2.5 medical personal per 1000 population. Uneven distribution of facilities exists, which impact on utilisation. For instance, a ward (Mandaragrau) with a population of 18,732 have 5 facilities (4 dispensaries and 1 primary health care) in comparison to a ward (Miringa) with a population of 21,343 with only one Dispensary. Income level and distance were significant socio-economic factors affecting service utilisation (p < 0.001). Area’s households Gini index was 26.7, most of which (49.7%) survive on less than USD2/day and majority (33.6%) spend an average cost of treatment of ₦2,750 (approx. $8) per clinic visit.ConclusionIt was concluded that insufficiency and inequity in distribution of healthcare services exist in Borno State. It is thus recommended that future policies be directed toward improving healthcare in under-served areas.

The evolution of socioeconomic health inequalities in Ecuador during a public health system reform (2006\u20132014)

One of the challenges in international health care policy is the reduction of health inequalities. We study the case of a recent health care reform in Ecuador, based on a revised model of public provision and financing of comprehensive care. The policy challenged not only the health care system but also key determinants of health, seeking to grant access and reduce persistent inequalities in utilization of health care services. This study evaluates the progress made on the socioeconomic health inequalities before and after reforms, between 2006 and 2014. The Living Standards Measurement Survey 2006 and 2014 are used to examine trends in inequality of two health dimensions: health status and health care utilization in Ecuador. The analysis includes the estimation and decomposition of the concentration index of health care utilization variables to understand which the most important contributors to inequality are, and how they change during the period analyzed. Health inequality reduced after the public health system reform in Ecuador. The utilization of curative visits shows a pro-rich bias, which significantly reduced over the period of analysis. The use of a public facility for a doctor visit also shows a moderate reduction in socioeconomic inequality; although concentrated among the poor, the findings confirm an increase in the utilization of public health facilities by all socioeconomic groups. The decomposition analysis concludes that the most relevant determinants of the inequality in health care utilization variables are income, family size and education. Moreover, the contribution of income decreased dramatically in the utilization of curative visits after the reforms. This is the first study that assesses the inequality implications of recent policies targeted at guaranteeing the right to health, equity and social protection of the Ecuadorian population. We provide evidence of a significant reduction of health care inequality, following a well-rounded set of public interventions and investments to attack health and inequality determinants. Yet policies aimed at improving the distribution of education and income are necessary to further reduce health inequalities.

Patient satisfaction with healthcare services: A Bangladesh scenario

Patient satisfaction is a useful measure to provide an indicator of quality in healthcare services. Concern over the quality of healthcare services in Bangladesh has led to loss of faith in healthcare providers, low utilization of public health facilities, and increasing outflow of Bangladeshi patients to hospitals in abroad. The main barriers to accessing health services are inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached, very short consultation time, lack of empathy of the health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and, occasionally, disregard for the suffering that patients endure without being able to voice their concerns—all of these service failures are reported frequently in the print media. Such failures can play a powerful role in shaping patients’ negative attitudes and dissatisfaction with healthcare service providers and healthcare itself.

Patient Satisfaction: Bangladesh Perspective

Patient’s satisfaction is a useful measure to provide an indicator of quality in healthcare services. Concern over the quality of healthcare services in Bangladesh has led to loss of faith in healthcare providers, low utilization of public health facilities, and increasing outflow of Bangladeshi patients to hospitals in abroad. The main barriers to accessing health services are inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached, very short consultation time, lack of empathy of the health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and, occasionally, disregard for the suffering that patients endure without being able to voice their concerns—all of these service failures are reported frequently in the print media. Such failures can play a powerful role in shaping patients’ negative attitudes and dissatisfaction with healthcare service providers and healthcare itself.

Impact of a "Diagonal" Intervention on Uptake of Sexual and Reproductive Health Services by Female Sex Workers in Mozambique: A Mixed-Methods Implementation Study.

Female sex workers (FSWs) have high risks for adverse sexual and reproductive health (SRH) outcomes, yet low access to services. Within an implementation research project enhancing uptake of SRH services by FSWs, we piloted a "diagonal" intervention, which combined strengthening of FSW-targeted services (vertical) with making public health facilities more FSW-friendly (horizontal), and tested its effect. The study applied a convergent parallel mixed-methods design to assess changes in access to SRH services. Results of structured interviews with FSWs pre-intervention (N = 311) and thereafter (N = 404) were compared with the findings of eight post-intervention focus group discussions (FGDs) with FSWs and two with FSW-peer educators (PEs). Marked and statistically significant rises occurred in consistent condom use with all partners (55.3-67.7%), ever use of female condoms (37.9-54.5%), being tested for HIV in the past 6 months (56.0-76.6%), using contraception (84.5-95.4%), ever screened for cervical cancer (0.0-16.9%) and having ≥10 contacts with a PE in the past year (0.5-24.45%). Increases mostly resulted from FSW-targeted outreach, with no rise detected in utilization of public health facilities. FGD participants reported that some facilities had become more FSW-friendly, but barriers such as stock-outs, being asked for bribes and disrespectful treatment persisted. The combination of expanding FSW-targeted SRH services with improving access to the public health services resulted in an overall increased uptake of services, but almost exclusively because of the strengthened targeted (vertical) outreach services. Utilization of public SRH services had not yet increased and many barriers to access remained. Our diagonal approach was thus only successful in its vertical component. Improving access to the general health services remains nevertheless important and further research is needed how to reduce barriers. Ideally, the combination approach should be maintained and more successful approaches to increase utilization of public services should be explored.

Determinants of Health Service Utilization by Urban Households in India

In this article, an attempt has been made to examine the factors associated with the utilization of health care services among the urban households in India based on NSS case-level data of 42nd (1986–1987) and 60th round (2004–2005). The result of multivariate logistic regression analysis reveals that the education level of household head is not only an important positive predictor in the utilization of health services in general but is also found as a negative predictor to determine the utilization of public facilities in particular (National Sample Survey, 1998). It is also found that the weaker social class like scheduled caste (SC) is less likely to use curative health care facilities but the chances of using public facilities are much higher compared to non-SC households (National Sample Survey, 2006). It is found that the influence of household income for accessing health care services has been sharpened over the period. The study also reveals that the utilization of public health facilities is much higher in low-income states but the rate of improvement of public health care utilization is much higher in case of outpatient care services. The size of town has shown a significant impact on the utilization of health services. The chances of using public facilities have increased in small- and medium-sized town compared to metro cities. The level of intra-household disparities in access to health facilities with respect to age and gender has increased in urban India. Significant gender disparities are found in case of public health service utilization both for inpatient and outpatient care services in urban India.

Utilization of Kenya’s free maternal health services among women living in Kibera slums: a cross-sectional study

IntroductionThis study was aimed at determining factors affecting utilization of public health facilities by pregnant Kenyan women living in Kibera slums, Nairobi since the implementation of the Free Maternal Service (FMS) Program in 2013.MethodsThis was a cross-sectional study done on 396 women who delivered between 2014 and 2015. Interview questions addressed socio-demographic characteristics, perception of quality of care in public health facilities, awareness of the FMS Program, antenatal care (ANC) and delivery service utilization.Results43.9% delivered in a public health facility, 30.3% in a private non-profit health facility (NGO), 22.7% in a private health facility and 3.0% at home. Of the 97% of the women who delivered in a health facility, only 43.9% delivered in a public health facility despite these facilities having free maternal services. Factors that favoured the Free Maternal Service uptake included a positive perception of the public health facility, living within close proximity, learning about the Program from a support group and a short waiting time before being examined by the doctor. On the other hand, safe delivery, quality of service, accessing a health facility on foot, ANC attendance at a private and a non-profit health facility were associated with low uptake of the free maternal services.ConclusionThe uptake of the Free Maternal Service program can improve if the Kenyan government directs its efforts towards changing women’s perception on quality of care in public health facilities and to improve access to health facilities in slum areas of Nairobi.

Burden of Disease and Benefit Incidence of Public Health Expenditure in Northeast India

Burden of communicable and non-communicable diseases are high in northeast (NE) India. The region is underdeveloped economically and public health care infrastructure is inadequate. This article sheds light on reasons for poor utilization of public health facilities and gap in the rich–poor benefit incidence of public health expenditure. The findings of the study indicate non-availability of facilities, long waiting time and poor quality of care as main reasons for non-utilization of public health facilities. As regards benefit incidence of public health expenditure for outpatient, the poor gets the larger share but in totality, the rich benefits more than the poor. The article concludes that multi-prong strategies and reorientation of health system to suit the health care needs of northeast India are imperative to reduce burden of disease and to restore equity in the benefit incidence of public health care expenditure.

Impact of indirect cost on access to healthcare utilization

Background: Majority of the citizens in developing country like India seeks healthcare in private facilities. In spite of several sustainable measures taken by the government, public healthcare facilities often face various problems, including worker absenteeism and dual public–private practice, low demand for their use, and shortages of supplies and staff. In contrast, private healthcare varies greatly in quality of care, being unregulated and financed largely through out-of-pocket payments. Accessibility, affordability, and availability to healthcare services are the significant factors in improving utilization of public health facilities. Objectives: This study explores the challenges faced in healthcare sector especially in terms of indirect cost (user fees) incurred by the rural households of rural Karnataka in seeking a public health care center. Materials and Methods: A set of well-structured questionnaire was administered to examine the indirect cost incurred by the households in terms of travel cost, waiting cost, and out-of-pocket expenditure. A total of 600 samples were randomly collected. To study the demand for healthcare services provided by public hospitals in rural Karnataka, we conducted a regression analysis. Results: Findings explains that odds ratio is higher for the nearest healthcare center than that in the next village, which specifies that accessibility to the nearest center is more significant than that in the next village. It is inferred that when distance increases, accessibility to public hospitals is impossible every time. In case of waiting time and out-of-pocket expenditure, both are statistically significant to use. Conclusion: The economic performance of the healthcare services is crucially linked to the overall economic well-being of country and its citizens; there is a need for alternative option to come out of this indirect cost incurred by rural households.

Book Reviews

David I. Levine of University of California, Berkeley reviews “Paying Out-of-Pocket for Drugs, Diagnostics and Medical Services: A Study of Households in Three Indian States”, by Moneer Alam. The Econlit abstract of this book begins: “Examines the out-of-pocket health care expenses of low-income households in the Indian states of Uttar Pradesh, Rajasthan, and Delhi. Discusses population size and composition of sample households; socioeconomic variations, consumption poverty, and health-generated inequalities in the sample population; self-reported ailments and hospitalization—differentials in utilization of health care; catastrophic spending on health by sample households—some results; decomposing out-of-pocket health spending—share of drugs, medical services, and other components; utilization of public health facilities—a situational assessment; and policy directions. Alam is Professor of Economics and Head of the Population Research Centre with the Institute of Economic Growth, Delhi.”

Choice of Delivery Facility among Expectant Mothers in Ghana

This article examines the effect of health insurance ownership among expectant mothers on facility-based delivery, having controlled for a host of socio-economic and demographic characteristics. Home deliveries often endanger the health of women, where complications are often referred to appropriate health facilities only when the condition has already deteriorated. Consequently, this study examines the extent to which expectant mothers’ access to health insurance influence their choice of delivery facilities broadly categorized into public health facilities, private health facilities and home delivery. Methodologically, the multinomial logistic regression is employed in the empirical estimation. Using the 2008 Ghana Demographic and Health Survey, we found at both the bivariate and multivariate level that women with access to health insurance are more likely to deliver in modern health facilities namely public and private allopathic health facilities relative to home delivery. In particular, women with access to health insurance are approximately 18 percentage points more likely to deliver in a public health facility as compared to home delivery. Also, the propensity to deliver in private health facilities relative to home delivery increases by one percentage point for women with health insurance. Thus, for expectant mothers with health insurance, the utilization of public health facilities predominates. Some of the control variables that were found to significantly influence the choice of delivery facilities include age, educational attainment, wealth quintile, area of residence, religion and region of residence. The study makes a case for scaling up access to health insurance among expectant mothers due to its positive effect on the choice of appropriate delivery facilities.

Influence of government-community healthcare financing partnership on human and material characteristics of primary health care facilities in Anambra State, Nigeria

Background: The Nigerian public health sector, over the years, has been characterised by inadequate funding causing decay in human, material, and services infrastructure. These along with the payment of user-fees have rendered the public health facilities unattractive and therefore poorly patronized by the people. The introduction of the government-community healthcare co-financing scheme in Anambra State of southeastern Nigeria provided additional funds to improve the quality of public health services in the State. The effect of this scheme on the human and material characteristics of primary health care facilities in the State is examined.Methods: The is a descriptive, comparative study of two health centres, one of which had intervention under the State Government-Community health care co-financing scheme.Findings: Physical infrastructure, equipments, drugs and consumables, together with the number and cadre of health providers all showed significant improvement at the intervention health centre following the introduction of the scheme, and also when compared with the control health centre. The result is a significant improvement in the overall utilization of services at the intervention health centre.Conclusions: Community based health insurance, will increase the human and material resources necessary to improve the quality of health care delivery in the community, encourage the utilization of public health facilities within the community and ultimately ensure an overall&nbsp; improvement of health care delivery in the State.Keywords: Government-Community healthcare financing, Human and material characteristics, primary health care facilities, Anambra State, Nigeria.

Patient satisfaction with health services in Bangladesh

Concern over the quality of health care services in Bangladesh has led to loss of faith in public and private hospitals, low utilization of public health facilities, and increasing outflow of Bangladeshi patients to hospitals in neighbouring countries. Under the circumstances, assessment of the country's quality of health care service has become imperative, in which the patient's voice must begin to play a greater role. This study attempts to identify the determinants of patient satisfaction with public, private and foreign hospitals. A survey was conducted involving inpatients in public and private hospitals in Dhaka City and patients who have experienced hospital services in a foreign country. Their views were obtained through exit polls using probability and non-probability (for foreign hospital patients) sampling procedures. Regression models were derived to identify key factors influencing patient satisfaction in the different types of hospitals. Doctors' service orientation, a composite of 13 measures, is the most important factor explaining patient satisfaction. Policy implications are discussed.