Health Seeking Behavior and Health Service Utilization in Pakistan: Challenging the Policy Makers’

Aga Khan University, Pakistan, Kurrachee, Sindh, Pakistan
Journal of Public Health (Impact Factor: 2.04). 04/2005; 27(1):49-54. DOI: 10.1093/pubmed/fdh207
Source: PubMed


There is a growing literature on health seeking behaviours and the determinants of health services utilization especially in the context of developing countries. However, very few focused studies have been seen in Pakistan in this regard. This paper presents an extensive literature review of the situation in developing countries and relates the similar factors responsible for shaping up of a health seeking behaviour and health service utilization in Pakistan. The factors determining the health behaviours may be seen in various contexts: physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behaviour of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioural health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population.

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    • "A majority of Pakistani women is illiterate and dependent on their male guardians (e.g. father, husband, brother, son) for seeking health care or accessing the resources and information needed to maintain their health [1]. With the exception of a tiny privileged minority, women’s social role is largely restricted to household chores. "
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    ABSTRACT: Background More than half of Pakistani women are illiterate, marginalized, and experience myriad health problems. These women are also disadvantaged in terms of their restricted mobility and limited access to public space. Nonetheless, user-friendly information and communication technologies (ICTs) have opened up new opportunities to provide them with information that is essential for their health and well-being. Methods We established an Information and Communication Centre (ICC) in a village in Sialkot (Pakistan) on a pilot basis in 2009. The basic philosophy of the ICC was to provide women with health-related information by exposing them to modern sources of information on their doorstep. By design, the ICC was a community-based and community-managed institution where women could access information through online (e.g., internet, mobile phone etc.) and offline (e.g., CDs, TV etc.) resources. The ICC was managed by a group of local volunteer women who had the capacity and skills to use the devices and tools of modern ICTs. Results We noted an overwhelming participation and interest from local women in the activities of the ICC. The women wanted to receive information on a wide range of issues, from family planning, antenatal care, and childcare to garbage disposal and prevention of domestic violence. Overall, the ICC was successful in initiating a meaningful “information dialogue” at community level, where much-needed information was retrieved, negotiated, mediated, and disseminated through intimate and trusted relations. Conclusion We conclude that ICTs have the capacity to cross the barriers of illiteracy and can reach out to disadvantaged women living under a conservative patriarchal regime.
    BMC Women's Health 09/2014; 14(1):105. DOI:10.1186/1472-6874-14-105 · 1.50 Impact Factor
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    • "The most vocal critics have stated that private providers do not have the same incentive to provide services with public health benefits and may be more likely to provide low-quality treatment while overprescribing diagnostics, procedures and pharmaceuticals (Hanson et al. 2008; Marriott 2009). It is not clear, however, that the private sector functions the same way in every health system (Hanson and Berman 1998; Brugha and Pritze- Aliassime 2003; Parkhurst et al. 2005; Shaikh and Hatcher 2005). "
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    ABSTRACT: Over the past two decades, multilateral organizations have encouraged increased engagement with private healthcare providers in developing countries. As these efforts progress, there are concerns regarding how private delivery care may effect maternal health outcomes. Currently available data do not allow for an in-depth study of the direct effect of increasing private sector use on maternal health across countries. As a first step, however, we use demographic and health surveys (DHS) data to (1) examine trends in growth of delivery care provided by private facilities and (2) describe who is using the private sector within the healthcare system. As Asia has shown strong increases in institutional coverage of delivery care in the last decade, we will examine trends in six Asian countries. We hypothesize that if the private sector competes for clients based on perceived quality, their clientele will be wealthier, more educated and live in an area where there are enough health facilities to allow for competition. We test this hypothesis by examining factors of socio-demographic, economic and physical access and actual/perceived need related to a mother's choice to deliver in a health facility and then, among women delivering in a facility, their use of a private provider. Results show a significant trend towards greater use of private sector delivery care over the last decade. Wealth and education are related to private sector delivery care in about half of our countries, but are not as universally related to use as we would expect. A previous private facility birth predicted repeat private facility use across nearly all countries. In two countries (Cambodia and India), primiparity also predicted private facility use. More in-depth work is needed to truly understand the behaviour of the private sector in these countries; these results warn against making generalizations about private sector delivery care.
    Health Policy and Planning 07/2014; 29 Suppl 1(Suppl 1):i38-i47. DOI:10.1093/heapol/czt103 · 3.47 Impact Factor
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    • "At present, there are 965 tertiary and secondary hospitals, and 13,051 first-level care facilities in the public sector [10]. However, the use of these facilities remains low in Pakistan for several reasons such as long distances to facilities, restricted hours of operations, poor facility infrastructure, lack of staff, equipment and drugs, and financial restrictions [11,12]. Hence, with more than 73,000 private health facilities across the country, about 71% of the population of Pakistan obtain health services from these facilities [10]. "
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    ABSTRACT: Background Globally 7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period. Pakistan has the third highest rate of neonatal mortality globally. To implement evidence-based interventions for the reduction of neonatal mortality, it is important to investigate factors associated with neonatal mortality. The aim of the current study was to identify determinants of neonatal mortality in Pakistan. Methods Data was derived from the Pakistan Demographic and Health Survey 2006–07. All singleton live births between 2002 and 2006 were selected for the current analyses. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Multivariate Cox proportional hazard models were performed using step-wise backward elimination procedures to identify the determinants of neonatal mortality. Results A total of 5,702 singleton live births in the last five years preceding the survey were selected. Multivariate analyses showed that living in Punjab province (Adj HR = 2.10, p = 0.015), belonging to the poorest household wealth index quintile (Adj HR = 1.95, p = 0.035), male infants (Adj HR = 1.57, p = 0.014), first rank baby (Adj HR = 1.59, p = 0.049), smaller than average birth size (Adj HR = 1.61, p = 0.023) and mothers with delivery complications (Adj HR = 1.93, p = 0.001) had significantly higher hazards of neonatal death in Pakistan. Conclusions To reduce neonatal mortality, there is a need to implement interventions focusing on antenatal care, effective referral system and retraining of healthcare providers to manage delivery complications and smaller than average birth size babies in resource poor communities of Pakistan.
    BMC Public Health 06/2014; 14(1):663. DOI:10.1186/1471-2458-14-663 · 2.26 Impact Factor
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