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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Available from: Babar Tasneem Shaikh
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    • "➢ Family size[14,44]3–2: Cultural factors ➢ Cultural beliefs about health which lead to self-care as well as using home remedies and consultation[13,16,19[13,20]➢ Cultural preferences[15,16]➢ Traditional interventions and professional attitude[37,41,45]➢ Superstition, rumors and legends[37]➢ Fear of stigma[45]➢ Previous and current perception of disease[30,45]➢ Understanding the value of health[38]➢ Cultural taboos[51]➢ Negative cultural experiences such as pressure to succeed, win or physical violence[44]➢ Expectations of aging[12,22,39,41,56,57]➢ Absence of the head of household or other key decision makers[54]➢ Head of household's awareness, occupation and level of education[15,41,46,49]➢ Ethnicity[16,22,56]➢ Marital status[22,36]➢ Denial of disease, especially by women[45]. 3–3: Economic Factors ➢ Family income[14,16,17,20,22,23,38,41,42,44,47,51,56]➢ Treatment and commute costs[13,19,20,57]➢ Having insurance[16,22,51]3–4: Disease pattern and issues related to health services ➢ Physical access to health services[12–17, 19–23, 41, 51]➢ Distance to health service center[14,46,58]➢ Poor performance of health services[13,58]➢ Availability of drugs[13,17,19,51,58]➢ Can buy OTC medications without or with consulting a pharmacist[19,47,51]Expected quality of services[11,15,50]➢ Pluralism or existence of different health systems in a cultural setting[23,35,49]➢ Attitude toward health personnel[13,41]➢ Perceived severity of illness[13,22,41,42]➢ Knowledge and duration of illness[22]➢ Lack of suitable referral system[23,32]bases of the strategies for developing individualized nursing interventions and health education plans. Principally, nursing is involved with retaining and improving the health of the society members through both primary and secondary health promoting interventions as well as illness management via facilitation of progress evaluation, self-monitoring and lifestyle changes. "
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    ABSTRACT: Background Organizational citizenship behavior (OCB) improves efficiency and employees’ participation and generally provides a good ambiance. This study was conducted to determine the role of job satisfaction (JS), organizational commitment (OC) and procedural justice (PJ) in explaining OCB among nurses working in fifteen educational-treatment centers in Tehran-Iran, to provide guidelines for health care managers’ further understanding of how to encourage citizenship behavior among nurses. Methods In this multi-center descriptive-correlational study 373 nurses were evaluated through a Multi-stage cluster sampling method after obtaining approval from the Ethics Committee of Islamic Azad University, Tehran Medical Branch and Tehran University of Medical Sciences Research Deputy. Nurses who signed the informed consent and holding a bachelor or master degree, having a minimum one year of job experience and not having organizational management position during the questionnaire distribution were included in the study. In order to collect data, Demographic questionnaire, Podsakoff et al. (Leadersh Q 1(2):107–142, 1990) OCB questionnaire, OC questionnaire, Aelterman et al. (Educ Stud 33(3):285–297, 2007) JS questionnaire and PJ questionnaire were used. These questionnaires were translated into Persian and content validity was confirmed by an expert group; their reliability was calculated by the internal consistency Cronbach alpha coefficient and it was satisfied. Data were analyzed by descriptive statistics, Comparative mean tests, correlation coefficient and multiple-regression in the SPSS software version 11. Result The general mean and all five aspects of OCB that ranked higher than 3 were evaluated in a “quite desired” state. The mean for perceived procedural justice, the general mean for JS and the mean of general grade for OC from the nurses’ was in “quite desired” state. Finding from multiple regression indicated that OC and PJ exhibit about 19 % of OCB variance totally which is statistically significant (P < 0.01). JS had no significant impact on explaining OCB. Conclusion OC was the strongest predictor of nurses’ OCB followed by perceived procedural justice. So, improving these factors can initiate better citizenship behavior among nurses.
    Full-text · Article · Dec 2015 · BMC Research Notes
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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.
    Full-text · Article · Sep 2014 · BMC Women's Health
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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.
    Full-text · Article · Jul 2014 · Health Policy and Planning
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