Devolution and public perceptions and experience of health services in Pakistan: linked cross sectional surveys in 2002 and 2004

Ansari, Umaira; Cockcroft, Anne; Omer, Khalid; Ansari, Noor; Khan, Ataullah; Chaudhry, Ubaid Ullah; Andersson, Neil

doi:10.1186/1472-6963-11-s2-s4

Cited by 18 publications

(10 citation statements)

References 12 publications

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“…Our findings on perception of medical trainees towards devolution of healthcare concur with other studies that have reported on this matter [ 10 ]. There is clearly an apathetic attitude towards the devolution process from the students’ standpoint.…”

Section: Discussionsupporting

confidence: 92%

Perceptions of medical students towards healthcare devolution: an online cross-sectional study

Nyongesa¹,

Munguti²,

Odok³

et al. 2015

Pan Afr Med J

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IntroductionThere have been worries concerning the preparedness and capacity of the counties to take over health care services. As the current medical students are going into this new system, we sought their opinions on the issue of devolution. The objective is to assess beliefs and attitudes of medical students towards devolution of healthcare services.MethodsA cross sectional survey was conducted at University of Nairobi medical school during the period of February-May 2014. Though a calculated random sample of 384 medical students was powerful enough to fulfill our objectives, all eligible medical students were invited by email to fill in a semi structured online questionnaire. Computed results from Google sheets were reported in frequencies and percentages.ResultsData was collected from 191 respondents with majority of them in their clinical years (levels 3, 4 and 5) of study. More participants considered working in private/ mission health institution (40%) after graduating as compared to public or non health institution (30%). The media provided most of information concerning devolution (77%). Few respondents reported using government documents (36%) or public forums (24%) to get information on healthcare devolution. While most of the respondents were of the opinion that health information system (68%), health finance (63%), procurement of medical products (54%), leadership and governance (73) should be devolved, only 18% wanted health personnel to be devolved. Most of the opinions on healthcare devolution were not in agreement with the goal of devolution: more than 50% thought the process would not result in improved efficiency, resource allocation, disease control programs or maintenance of infrastructure.ConclusionDespite the envisioned benefits of healthcare devolution, there is a low opinion among medical trainees concerning these reforms and their implementation. Nevertheless, it is early to speculate whether such viewpoints will be carried to the future once teething problems are dealt with.

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Section: Discussionsupporting

confidence: 92%

Perceptions of medical students towards healthcare devolution: an online cross-sectional study

Nyongesa¹,

Munguti²,

Odok³

et al. 2015

Pan Afr Med J

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“…A study in 2007 found that about two-thirds of care-seekers consulted village doctors first [ 34 ]. This preference for seeking health care from non-government providers is not confined to Bangladesh [ 25 , 35 - 38 ] and there is ongoing debate about the role of the private sector in health care in developing countries [ 39 , 40 ]. The very high use of unqualified practitioners of Western medicine is striking in Bangladesh.…”

Section: Discussionmentioning

confidence: 99%

Health services reform in Bangladesh: hearing the views of health workers and their professional bodies

Cockcroft

Milne²,

Oelofsen

et al. 2011

BMC Health Serv Res

Self Cite

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BackgroundIn Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies.MethodsSome 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA).ResultsNearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP.Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically appropriate care. The BMA considered it would be dangerous to attempt to train and register unqualified practitioners.ConclusionsThe continuing dissatisfaction of health workers may have undermined the effectiveness of the HPSP. Presenting the views of the public and service users to health managers helped to focus discussions about quality of services. It is important to involve health workers in health services reforms.

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“…Local governance ordinance established the district health system, transferring responsibility of service planning, provision, monitoring and evaluation from provincial to district levels (32,33). While district coordination officers established EPI targets, human resource and bridge financing was under provincial purview, causing conflicts in programme prioritization and financing (34).…”

Section: Programme Structure and Managementmentioning

confidence: 99%

Routine immunization services in Pakistan: seeing beyond numbers

Husain¹,

Omer²

2016

East Mediterr Health J

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Vaccine-preventable diseases continue to be a major cause of morbidity and mortality among children under 5 years of age in Pakistan, and the country remains one of the last reservoirs of polio, posing a threat of viral spread within the region and globally. This structured review describes challenges in the achievement of vaccination targets and identifies arenas for policy and programmatic interventions and future research. Burdened with limited demand and inefficient vaccination services, the recently devolved Expanded Programme on Immunization (EPI) faces multiple hurdles in increasing immunization volumes, improving the quality of services and ensuring timely vaccination. The EPI requires multi-pronged, multi-level, coordinated interventions to improve programme functioning and to enhance vaccination uptake at community level. Additionally, a lack of rigorous scientific enquiry on vaccination services limits the introduction of well-developed, responsive interventions. The paper describes systemic bottlenecks, proposes potential solutions and suggests lines of further enquiry to understand and reduce the languishing immunization rates in Pakistan. ‫األرقام‬ ‫وراء‬ ‫ملا‬

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Devolution and public perceptions and experience of health services in Pakistan: linked cross sectional surveys in 2002 and 2004

Cited by 18 publications

References 12 publications

Perceptions of medical students towards healthcare devolution: an online cross-sectional study

Perceptions of medical students towards healthcare devolution: an online cross-sectional study

Health services reform in Bangladesh: hearing the views of health workers and their professional bodies

Routine immunization services in Pakistan: seeing beyond numbers

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