Lb. Acharya et J. Cleland, Maternal and child health services in rural Nepal: does access or quality matter more?, HEAL POL PL, 15(2), 2000, pp. 223-229
This study seeks to establish the relative importance of service access and
quality on utilization of preventive health services in the western and mi
ddle-western Hill region of Nepal. Access was measured in terms of travel t
ime to the nea rest health post a nd coverage by outreach workers. The qual
ity of static services was defined in structural terms: physical infrastruc
ture, number of staff, availability of drugs and holding of special materna
l and child health clinics. The initial analysis showed that no single indi
cator of quality was of overriding importance and therefore an overall qual
ity index was constructed. After adjustment for access and for socioeconomi
c characteristics of families and communities, a very pronounced relationsh
ip between overall structural quality of the nearest health post and servic
e uptake persisted. The adjusted odds of using some form of antenatal servi
ce were 6.6 times higher in the catchment areas of high quality posts than
in areas served by low quality posts. The corresponding figure for receipt
of BCG vaccination is 8.1. By comparison, the effects of travel time to the
nearest health post are modest. Uptake of services is about twice as high
when there is a health post in the community, Regular monthly visits by out
reach workers also had a marked effect on service utilization. These result
s suggest that investment in the quality of health posts is more important
than further increases in their number and that a further expansion of outr
each services is a priority.