NDLI: Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan

Content Provider	Springer Nature : BioMed Central
Author	Zaidi, Shehla Riaz, Atif Rabbani, Fauziah Azam, Syed Iqbal Imran, Syeda Nida Pradhan, Nouhseen Akber Khan, Gul Nawaz
Abstract	Background The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. Methods An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. Results Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. Conclusion Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele.
Related Links	https://health-policy-systems.biomedcentral.com/counter/pdf/10.1186/s12961-015-0041-8.pdf
Ending Page	56
Page Count	10
Starting Page	47
File Format	HTM / HTML
ISSN	14784505
DOI	10.1186/s12961-015-0041-8
Journal	Health Research Policy and Systems
Issue Number	1
Volume Number	13
Language	English
Publisher	BioMed Central
Publisher Date	2015-11-26
Access Restriction	Open
Subject Keyword	Health Administration R & D Technology Policy Medicine Public Health Health Services Research Health Policy Contracting out Maternal and newborn health Public health facilities R & D/Technology Policy Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Health Policy
Journal Impact Factor	3.6/2023
5-Year Journal Impact Factor	4.3/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Bridging evidence, policy, and practice to strengthen health systems for improved maternal and newborn health in Pakistan

What can Pakistan do to address maternal and child health over the next decade?

Determinants of evidence use by frontline maternal, newborn and child health staff in selected health facilities in Ghana

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective

Promoting universal financial protection: contracting faith-based health facilities to expand access – lessons learned from Malawi

Access to comprehensive emergency obstetric and newborn care facilities in three rural districts of Sindh province, Pakistan

Analysis of misoprostol and chlorhexidine policy gains in Pakistan: the advocacy experience of Mercy Corps Pakistan

Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda

Improving maternal and child health policymaking processes in Nigeria: an assessment of policymakers’ needs, barriers and facilitators of evidence-informed policymaking

Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan

Similar Documents

Bridging evidence, policy, and practice to strengthen health systems for improved maternal and newborn health in Pakistan

What can Pakistan do to address maternal and child health over the next decade?

Determinants of evidence use by frontline maternal, newborn and child health staff in selected health facilities in Ghana

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective

Promoting universal financial protection: contracting faith-based health facilities to expand access – lessons learned from Malawi

Access to comprehensive emergency obstetric and newborn care facilities in three rural districts of Sindh province, Pakistan

Analysis of misoprostol and chlorhexidine policy gains in Pakistan: the advocacy experience of Mercy Corps Pakistan

Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda

Improving maternal and child health policymaking processes in Nigeria: an assessment of policymakers’ needs, barriers and facilitators of evidence-informed policymaking

Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan