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. 2009 Aug 4:8:29.
doi: 10.1186/1475-9276-8-29.

Three methods to monitor utilization of healthcare services by the poor

Abbas Bhuiya  1 , Sma Hanifi, Farhana Urni, Shehrin Shaila Mahmood
Affiliations

Three methods to monitor utilization of healthcare services by the poor

Abbas Bhuiya et al. Int J Equity Health. .

Abstract

Background: Achieving equity by way of improving the condition of the economically poor or otherwise disadvantaged is among the core goals of contemporary development paradigm. This places importance on monitoring outcome indicators among the poor. National surveys allow disaggregation of outcomes by socioeconomic status at national level and do not have statistical adequacy to provide estimates for lower level administrative units. This limits the utility of these data for programme managers to know how well particular services are reaching the poor at the lowest level. Managers are thus left without a tool for monitoring results for the poor at lower levels. This paper demonstrates that with some extra efforts community and facility based data at the lower level can be used to monitor utilization of healthcare services by the poor.

Methods: Data used in this paper came from two sources- Chakaria Health and Demographic Surveillance System (HDSS) of ICDDR,B and from a special study conducted during 2006 among patients attending the public and private health facilities in Chakaria, Bangladesh. The outcome variables included use of skilled attendants for delivery and use of facilities. Rate-ratio, rate-difference, concentration index, benefit incidence ratio, sequential sampling, and Lot Quality Assurance Sampling were used to assess how pro-poor is the use of skilled attendants for delivery and healthcare facilities.

Findings: Poor are using skilled attendants for delivery far less than the better offs. Government health service facilities are used more than the private facilities by the poor.Benefit incidence analysis and sequential sampling techniques could assess the situation realistically which can be used for monitoring utilization of services by poor. The visual display of the findings makes both these methods attractive. LQAS, on the other hand, requires small fixed sample and always enables decision making.

Conclusion: With some extra efforts monitoring of the utilization of healthcare services by the poor at the facilities can be done reliably. If monitored, the findings can guide the programme and facility managers to act in a timely fashion to improve the effectiveness of the programme in reaching the poor.

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Figures

Figure 1
Figure 1
Concentration Curves of inequality in the use of skilled assistance during delivery, Chakaria 2005–2007. (Black line) – Line of equality (Blue line) – 2007 (Red line) – 2006 (Green line) – 2005
Figure 2
Figure 2
Application of Benefit Incidence Ratio to assess whether a Govt. health facility is used adequately by the poor, Chakaria, March-May 2006.
Figure 3
Figure 3
Application of Benefit Incidence Ratio to assess whether a private health facility is used adequately by the poor, Chakaria, March-May 2006.
Figure 4
Figure 4
Application of Sequential Sampling Scheme to decide whether a Govt. health facility is used by the poor adequately, Chakaria, June 2006. Note: Results based on thresholds 40%–60%; alpha 5%; power 80%
Figure 5
Figure 5
Application of Sequential Sampling Scheme to decide whether a private health facility is used by the poor adequately, Chakaria, June 2006. Note: Based on thresholds 40%–60%; alpha 5%; power 80%
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