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Service quality in contracted facilities.

Fauziah Rabbani1, Nousheen Akber Pradhan, Shehla Zaidi

  • 1Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.

International Journal of Health Care Quality Assurance
|May 29, 2015
PubMed
Summary

Contracting out healthcare services in Pakistan significantly improved maternal and neonatal health (MNH) care readiness in facilities. Contracted sites showed better performance across all assessed domains compared to government-managed ones.

Keywords:
Balanced scorecardContractingMaternal and neonatal healthPakistanQuality careRural health centres

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Area of Science:

  • Healthcare Management
  • Public Health
  • Maternal and Neonatal Health

Background:

  • First-level healthcare facilities in Pakistan face challenges in delivering quality maternal and neonatal health (MNH) care.
  • The effectiveness of contracting out healthcare services as a strategy to improve MNH care quality remains under-explored.

Purpose of the Study:

  • To assess and compare the readiness of contracted versus non-contracted first-level healthcare facilities in Pakistan for delivering quality MNH care.
  • To evaluate the impact of contracting out on MNH service delivery using a balanced scorecard framework.

Main Methods:

  • A cross-sectional study design compared two contracted Rural Health Centers (RHCs) with four government-managed RHCs.
  • A balanced scorecard (BSC) framework with 20 indicators across five domains (facility functionality, service provision, staff capacity, staff and patient satisfaction) was utilized.
  • Statistical tests including Pearson χ2, Fisher's Exact, and Mann-Whitney were employed to identify significant differences.

Main Results:

  • Contracted facilities demonstrated superior performance compared to non-contracted facilities across all five BSC domains.
  • Patient preference for facility-based delivery was significantly higher at contracted facilities (80%) versus non-contracted facilities (43%, p=0.006).

Conclusions:

  • Contracting out healthcare services shows considerable potential for enhancing MNH care quality in Pakistan.
  • This study provides novel insights by being the first to use the BSC framework to compare MNH service delivery quality in contracted and non-contracted facilities.