The delivery of mother and child health care in Jerusalem: Client evaluations and their relationship to ethnic composition of staff and clients.

This study concerns the delivery of health care services in multiethnic communities. It explores client evaluations of health care centers which differ in two respects--the ethnic composition of providers and clients. This issue was explored in the context of preventive mother and child health care centers in Israel. A field study was carried out at 5 centers in Jerusalem over a 13-month period beginning October, 1985. The study revealed that although the proportion of Jerusalem's Arab infants receiving essential care increased considerably between 1967 and 1982, Arab infants were less likely than Jewish infants to receive essential care. In addition, the study found that the services available to the Arab population were less accessible and of lower quality than the services available to the Jewish population. One hundred and three Arab and fifty-three Jewish mothers were interviewed at two voluntary and three municipal centers. The centers differed in the ethnic composition of both their clients and staff. Typically, respondents were reasonably satisfied with the performance of the centers and their staffs. Mothers at two of the centers, however, were considerably less satisfied. Mothers at a center serving predominantly Jewish clients were dissatisfied with the poor functioning of the physicians. Compared to Arab mothers using all-Arab centers, those Arab mothers using a mixed Jewish and Arab client center expressed relatively negative views about the nursing staff. The study revealed that while the services rendered to these Arab clients were equal to or better than the service rendered to clients of all-Arab centers, they were inferior to the services available to the Jewish clients of the mixed client center. The strongest negative views were expressed by Arab mothers who felt that they were discriminated against by the Jewish nurses. It is suggested that the negative evaluations of Arab mothers were based on their perceptions of the quality and content of services offered to the Jewish clients at the center. It is further argued that the discontented mothers attributed the inferior services to the ethnic composition of the staff which was predominantly Jewish. The study concludes that in addition to service equity, health care planning should consider two important structural elements within the service delivery context, i.e., the ethnic composition of clients and the ethnic composition of providers.PhDEthnic studiesPublic healthPublic policyUrban planningUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161886/1/8813027.pd