WE DO WHAT WE CAN - HEALTH-SERVICE PROVID ERS FACING THE SERVICE UTILIZATION PROBLEM

This study presents the second part of cite general results obtained b y a qualitative study conducted within the National Health Survey II. The abject of this study was to identify main patterns and micro-socia l determinants which affect. the process of selection and utilization of health services in order to propose policies aimed at more equity q uality and efficiency in health service delivery. The study was conduc ted in urban areas among the middle and middle-low class sectors. A to tal of 192 individual open-ended interviews and eight focus groups wer e completed among health users in four cities. Also, 61 service provid ers bath from public and private services were interviewed, Since a pr evious work reported findings related to health service users, this st udy focuses only on the results pertaining to health service providers . The first part briefly discusses the study design which allowed to e xplore the meaning that actors-health service providers-attach to thei r job and working conditions. The second part presents the main findin gs. The sense of economic and material precariousness with which healt h providers from public institutions do their work is among the most i mportant results, Common conflicts between health service users and pr oviders are also mentioned, mainly those which arise from the organiza tional problems of the health center and from the scarcity of the basi c drug stock. The third part reports the main coincidences and diverge nces between health service users and providers. Some of the divergenc es may be the reason for the under-utilization of health services. The work concludes with a series of policy recommendations aimed at impro ving the quality and opportunity of health services provided by public institutions for the needs of the population.