Evaluation of an off campus primary care facility of a private university hospital at Karachi

In Pakistan the health indicators have improved over the years but the improvement has been very slow and is showing signs of stagnation for the last couple of years. Public spending on health in Pakistan is very low (1 % of GDP) even among the developing countries and countries of the region and the private sector is currently spending 65 to 70 percent of the total health expenditure. Despite the presence of a huge private sector, there is no monitoring system to regulate their activities. The quality of service they are providing is also sometimes questionable and there are no standard practice guidelines that they follow. Primary care is the backbone of the health system and the health indicators of any country cannot improve if this level of the system is not working properly. Keeping this in view, a study was designed to evaluate the off campus facility of a private university hospital at Karachi to see whether it is providing quality medical care to the community it is serving. A participatory approach was used so that the views of all the stakeholders, including the clients, can be captured. It was a facility based evaluation project which consisted of client\u27s satisfaction cross sectional survey, in depth interviews of representatives of management and center\u27s staff, review of facility manuals and protocols and review of the secondary data of the health facility. For the client\u27s satisfaction survey, sample size was 385 and due to time and resource constraint convenience sampling method was adopted. Data was collected through an exit interview by means of a structured questionnaire. Representatives of management, different services, in-charge and staff of the facility were interviewed in depth so that their perspective could also be added. All the manuals, protocols and guidelines were assessed and the secondary data of the facility regarding patient\u27s volume and revenue were reviewed. The evaluation questions which the study tried to answer were regarding growth of the facility over the period of time in terms of patient\u27s volume and revenues, quality of services, availability and implementation of guidelines and protocols, level of client\u27s satisfaction, unmet needs of the local community and how the services of the center can be improved? Analysis of client\u27s satisfaction survey shows that the level of satisfaction of clients is very high regarding the timings, cleanliness, services, cost of services and attitude and behavior of staff however there is much room for improvement as far as the level of satisfaction regarding the lab service is concerned. The waiting time for the center was 28 minutes. Clients gave various suggestions for improvement which included increase in staff, timings, seating capacity and availability of Television, newspaper, magazines and health education material. Working under a centralized management, MMS has comprehensive policies and protocols for all its services which are in practice. The data of the health facility shows that the number of patients and the utilization of different services are increasing over the years. For the laboratory service, the number of clients increased from 17,503 in 2001 to 65,674 in 2004. Similarly pharmacy service also recorded a rise from 6,653 to 33,266 in number of clients and patients attending family medicine clinic increased from 1465 to 4941 during the same period. The consulting clinics showed a rise from 456 in 2003 to 697 in 2004. Malir Medial Services is providing quality medical services to the people of Malir however there is room for improvement in the waste disposal system, management style and patient\u27s complaint system. At present, patient\u27s welfare system and community awareness programs are missing from the repertoire of the facility and management should work on the ways to provide these facilities at the center. It is a great challenge not only for the management but also for all the staff of MMS is to sustain the quality of service delivery along with client\u27s satisfaction and to improve it further. To evaluate the ongoing programs seems to be the most promising strategy for up at scaling the health systems. There should be a code of practice to ensure that evaluation is built in at the beginning of the programs and there is a commitment to be guided by the evidence that emerges as a consequence. Such evaluations will lead to a better understanding of when and why interventions are or are not effective and to the development of feasible methods for monitoring quality of care in low-income countries. There is a need in our country to evaluate our heath system especially the public sector to ensure quality and enhance its utilization through evaluation and monitoring