Access to Health Care in Rural Jajarkot Baseline Survey Report of Findings

International Rescue Committee-Nepal Access to health care in rural Jajarkot Baseline Survey Report of Findings Prepared by Neema Rani Tamang, IRC-Nepal Public Health Officer 2 November 2008 IRC/ISS health project VDCs Funded by ECHO The European Commission’s Humanitarian Aid department funds relief operations for victims of natural disasters and conflicts outside the European Union. Aid is channelled impartially, straight to victims, regardless of their race, ethnic group, religion, gender, age, nationality or political affiliation. Table of contents List of acronyms.......................................................................................................................3 Executive summary..................................................................................................................4 1 Study context and justification.........................................................................................7 2 Objectives ...........................................................................................................................7 2.1 Primary objectives ..................................................................................................................7 2.2 Secondary objectives...............................................................................................................7 2.3 Study questions........................................................................................................................7 3 Methods ..............................................................................................................................8 3.1 Study population .....................................................................................................................8 3.2 Sample size calculation ...........................................................................................................8 3.3 Sampling method ....................................................................................................................8 3.4 Study period ............................................................................................................................8 3.5 Data collection .........................................................................................................................9 3.6 Data entry and validation.......................................................................................................9 3.7 Data analysis............................................................................................................................9 3.8 Ethical considerations.............................................................................................................9 4 Results...............................................................................................................................10 4.1 Household characteristics and health access components.................................................10 4.2 Factors associated with health access..................................................................................21 5 Discussion .........................................................................................................................24 6 Conclusions ......................................................................................................................26 Annex 1: Questionnaire (English, Nepali) ...........................................................................27 Annex 2: Informed consent form (English, Nepali)............................................................33 Annex 3: Statistical tables .....................................................................................................35 Annex 4: List of 30 selected wards (clusters).......................................................................38 International Rescue Committee Page 2 of 38 List of acronyms ECHO – European Commission’s Humanitarian Aid department FCHV – Female Community Health Volunteer HP – Health Post IRC – International Rescue Committee ISS – Interdependent Society MCHW – Maternal and Child Health Worker NGO – Non Government Organization OR – Odds ratio ORC – Outreach clinic PHC – Primary Health Care Centre SHP – Sub-health post VDC – Village Development Committee VHW – Village Health Worker International Rescue Committee Page 3 of 38 Executive summary This survey was undertaken as part of IRC’s efforts in Jajarkot to improve access to and quality of health care in 10 VDCs. The study had three primary objectives: • Measure the access to health care in sub-health posts in 10 Village Development Committees (VDCs) of Jajarkot • Determine a baseline for measuring project impact • Investigate causes of lack of access to health care so that project interventions can be appropriately molded Out of those 10 VDCs (90 wards), 30 wards were selected at random, proportional to the ward population. In each ward, 26 households were selected randomly from voter registration lists and visited by teams of field interviewers during a period of just over two weeks in August 2008. A total of 774 households were interviewed and asked questions about access to health care over the previous three months. Based on the results of the survey, answers to the three study questions were obtained: 1. Of the population who were sick in the three months prior to the survey, what percentage received care in a government health facility? 29% of households – with a 95% confidence interval of 21%-36% – in IRC’s 10 working VDCs received care at government facilities for a household member who was sick in the previous three months, as charted in Figure ES-1 below. Figure ES-1: Access to health care in government facilities, Jajarkot, August 2008 The outcomes are remarkably similar to the figures obtained from the baseline access survey IRC and ISS conducted in Surkhet in September 2007, as shown in Table ES- 1 below, suggesting that the study methodology is robust. Table ES-1: Comparison of outcomes from Jajarkot (August 2008) and Surkhet (September 2007) baseline surveys Outcome Jajarkot baseline Surkhet baseline Went to government facility 42% 43% If went to government facility, received care 68% 66% Went to government facility and received care 29% 28% International Rescue Committee Page 4 of 38 2. For those people who were sick but did not receive care in a sub-health post, what was the reason(s)? The primary reason for people not accessing care in government facilities was lack (or perceived lack) of drugs – 61% of households gave that as a reason with a 95% confidence interval of 51%-70%. Other significant reasons were the facility being too far (22%), non-availability of staff (19%), the patient not being very sick (9%), not enough money (7%), and facility hours bad (4%). Those top six reasons are shown in Figure ES-2 below. Top 6 reasons for not gaining access to health care, Aug 2008 (n=544) 70% 60% 50% 40% 30% 20% 10% 0% Percentage of respondents of Percentage Drug Too far Staff Not Money Facility problems problems sufficiently problems hours bad sick Reason Figure ES-2: Why patients did not access care in government facilities, Jajarkot, August 2008 3. For those people who were sick and did receive care in a sub-health post, what if any were the obstacles that had to be overcome in getting care? People receiving care were not unduly burdened by paying for it, with 87% paying no more than 50 rupees (less than one dollar) – see Figure ES-3 below – and only 4% having to sell land or livestock to afford care, though 35% receiving care did have to pay something, despite the fact that care in sub-health posts is supposed to be free for all. International Rescue Committee Page 5 of 38 Cost of care in gov facility (rupees), Aug 2008 (n=217) Don't know/no answer 101-500 1% 5% >500 7% 51-100 0% 1-50 No cost 23% 64% Figure ES-3: Cost of care in government facilities, Jajarkot, August 2008 IRC and ISS can and will address the drug problems in sub-health posts, which has the potential to increase access another 61%, though of course that figure is not achievable in practice. The issue of distance will be addressed by IRC and ISS by conducting mobile clinics to supplement government outreach clinics and simultaneously provide on-the-job training for FCHVs. The staffing issues can be improved by government efforts toward better staff motivation, training, and time management. And the money obstacle can be avoided through more effective and consistent implementation of the existing free-care policy. The survey results give IRC and ISS a clear roadmap for the future. The survey will be repeated at the end of the project to measure progress toward improving access. International Rescue Committee Page 6 of 38 1 Study context and justification The International Rescue Committee (IRC) started working in Jajarkot in August 2008 to improve access to and quality of health care at the sub-health post level, with funding from ECHO and with local NGO partner the Interdependent Society (ISS). Although the project has a number of indicators to measure quality, and several proxy indicators for measuring access (such as the number of consultations in sub-health posts), a facility-based figure cannot capture the status of people who do not visit the facility. Using existing data, there is no direct way of measuring the extent to which people have access to health care nor whether by its end IRC’s project will have achieved an increase in access. This survey was necessary to establish a

Load more