To assess the extent of, and factors influencing individuals choice for, utilization of health facilities in a rural community of District Dadu, Sindh, Pakistan

Health is a right of every human being. All nations have agreed and endorsed this right, time and again, from various international fora. Pakistan, being one of the member and signatory to various charters, is still lagging behind many nations in terms of basic health indicators like reduced infant and maternal mortality despite various efforts such as huge investments for the construction of new health facilities and up-gradation of existing ones. In a country like Pakistan where about l/3rd of the population lives below poverty line, these government health facilities offer affordable curative as well as preventive and promotive health services to the people whereas private sector, specially in rural areas, offers mostly profit oriented curative services. The services delivered through these government health facilities need to be evaluated and factors that may serve as barriers, between these services and the client community, need to be identified and addressed. Present study has been conducted to assess the proportion of people who opted for a government health facility, for curative care of the last illness only, and factors that influence respondent individual\u27s option while seeking healthcare for the same illness. A cross sectional study was conducted, in a rural community of district Dadu, Sindh, Pakistan, during April-May, 1998. We gathered information about socio-demographic factors, physical accessibility, financial affordability and healthcare service factors. Additional information about factors related to a woman\u27s decision making status was collected from female respondents only. Two independent random samples of male and female respondents (658 respondents in each population) were interviewed. Our sampling strategy was different for the two respondent populations. Due to cultural restrictions, only the female interviewers were allowed inside the houses where eligible female respondents were interviewed. However, the male interviewers were usually escorted to any one of the common seating places, where male members of the village also gathered and eligible male respondents were interviewed from the gathering. Out of those interviewed; 21.6% of male and 21% of female respondents opted for a government health facility for the treatment of their last illness. The respondents (both male and female) who opted for government health facility were more likely to travel less than 6 kilometers as compared to those who opted for a private healthcare provider (OR: 2.6 95% Cl: 1.72 - 3.93 and. OR: 3.55 95% CI: 2.25 - 5.61 respectively). These male & female respondents, who went to a government health facility, were more likely to spend less than Rs.10 on account of fare for single round trip (OR: 1.87 95% Cl 1 .19 - 2.96 and OR: 2.59 95% Cl: 1.57 - 4.29). Also, these respondents were more likely to spend less than Rs.300 on account of total cost of treatment (excluding fare), as compared to those who went to a private health care provider (OR: 1 .53 95% CI: 1.02 - 2.29 and OR: 1 .59 95% Cl: 1.04 -2.43). These respondents were also more likely to have received medicines from a government health facility (OR: 8.80 95% Cl: 5.32 - 14.58 and OR: 31.29 95% Cl: 17.39 - 56.31). However, the male respondents who opted for a government health facility were more likely to be unsatisfied with the treatment that they received for their illness, as compared to those who opted for a private healthcare provider (OR: 1.71 95% CI: 1.05 - 2.82). This study points out that the government health services are located near the community and that they appear to be financially more affordable. Despite these favorable factors only a minority of people (21%) uses these government health facilities. The concern arising out of this minority choice in favor of government health facilities is based on two perspectives, that is: 1.The government perspective; whereby the efforts of the government to provide primary healthcare services to people are nullified and 2.The community perspective; wherefore majority of people who do not opt for government health facilities get distanced from preventive/promotive activities as well. Finally, our study also suggests that, despite favorable factors, people are not satisfied with the treatment provided at these government health facilities as compared to private healthcare providers. Therefore, we recommend that professional capabilities of the health personnel at government health facilities be assessed and enhanced through continuous educational programs besides proper supervision and motivation. Also, further studies aimed to explore qualitative aspects of service provision would hopefully help in bridging the deterrent gap between communities and government health facilities