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Access to Health Services in Diber and Fier Regions

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Access to Health Services in Diber and Fier Regions Access to Health Services in Diber and Fier Regions Baseline Evaluation Report – Health for all Project Sabine Kiefer 30 September 2016 Financed by the Swiss Agency for Development and Cooperation Contacts Health for All Project (HAP) Project implementation Unit Swiss Tropical and Public Health Institute Themistokli Germenji St. Socinstrasse 57 Tirana, Albania 4002 Basel, Switzerland Dr. Joao Costa Website: www.swisstph.ch Project manager Prof. Dr. Kaspar Wyss [email protected] Senior Public Health Specialist Head of Department Swiss Centre for International Health Tel: +41 61 284 81 40 [email protected] Terre des hommes Save the Children Schweiz Avenue de Montchoisi 15 Sihlquai 253 1006 Lausanne, Switzerland 8005 Zürich, Switzerland Website : www.Tdh.ch www.savethechildren.ch Mr. Thierry Agagliate Ms Martina Frank Program Manager Senior Health Programme Officer Tel : + 41 58 611 06 31 Tel: + 41 44 267 74 89 [email protected] [email protected] i Acknowledgements The report was developed under the guidance and inputs of several people: Kaspar Wyss, Besnik Kadesha, Ardita Kongjonaj, Joao Costa and Ehad Mersini. We would further like to acknowledge the previous work of Barbara Matthys on the knowledge and behaviour on chronic conditions on which one component of the data collection heavily draws. Further Ms. Emira Galanxhi, Social Statistics Director of INSTAT, Albania provided valuable comments that have improved the design of the study. The data collection was done by EUNACAL Institute. Particularly we would like to highlight the commitment and professionalism of Alban Nelaj, as national supervisor and coordinator. We are further indebted to our interviewers and the regional supervisors (Corbin Kappler - Diber & Klodiana Tosuni - Fier) who have been working day by day in the field. Without the dedication of interviewers and supervisors this survey would not have been possible. They all have been supported by a number of staff, including drivers and technical staff to whom we would also like to express our thanks. Lastly we would greatly like to thank all participants in the study who patiently answered our questionnaire and who have been welcoming and friendly to our interviewers. Disclaimer Although this study has been commissioned by the Swiss TPH, Terres des hommes and Save the Children under a contract with the Swiss Agency for Development and Cooperation, these entities bear no responsibility for, and are not in any way, committed to the views and recommendations expressed herein, which are the responsibility of the author of this report. ii Table of Contents Executive Summary ............................................................................................................ 1 1 Background and objectives ........................................................................................... 5 2 Methodology .................................................................................................................. 6 2.1 Study area and design ........................................................................................... 6 2.2 Target population and sample size ....................................................................... 7 2.3 Questionnaire development .................................................................................. 7 2.4 Sampling Procedure and Field Data Collection.................................................... 8 2.5 Data analysis ....................................................................................................... 12 2.6 Ethical considerations ......................................................................................... 12 3 Results ........................................................................................................................ 13 3.1 Characteristics of households and individuals ................................................... 15 3.1.1 Relative wealth of study households ............................................................ 17 3.1.2 Households‘ geographical distance to next health facilities ........................ 18 3.1.3 Health status and insurance coverage of all household members .............. 20 3.2 Selected patients with chronic condition ............................................................ 26 3.2.1 Profile of interviewees .................................................................................. 26 3.2.2 Situation of chronic disease patients: Illness patterns ............................... 26 3.2.3 Health seeking behaviour & barriers .......................................................... 28 3.2.4 Satisfaction with services for chronic conditions ......................................... 34 3.2.5 Health expenditures for chronic conditions ................................................. 35 3.3 Selected patients with an acute health problem ................................................ 37 3.3.1 Profile of interviewees .................................................................................. 37 3.3.2 Situation of patients with an acute health problem: Illness patterns ........ 38 3.3.3 Health seeking behaviour & barriers .......................................................... 39 3.3.4 Satisfaction with services for acute health problem .................................... 42 3.3.5 Health expenditures for acute health problem ............................................ 43 3.4 Mother and child health ...................................................................................... 45 3.4.1 Profile of interviewees .................................................................................. 45 3.4.2 Postnatal care ............................................................................................... 46 3.4.3 Child monitoring, development & growth check-up .................................... 47 iii 3.5 Knowledge, Attitude and Practice ...................................................................... 48 3.5.1 Cardiovascular disease, diabetes, obesity & health beliefs ......................... 48 3.5.2 Child health .................................................................................................. 53 4 Study limitations and bias ......................................................................................... 55 5 Discussion and recommendations .............................................................................. 57 6 Conclusion .................................................................................................................. 61 Annex ................................................................................................................................. 63 Annex A: Abbreviations ................................................................................................. 63 Annex B: Approval letter from MoH ............................................................................. 64 Annex C: Additional tables & graphs ............................................................................ 65 Household level .......................................................................................................... 65 Chronic conditions ...................................................................................................... 72 Acute conditions ......................................................................................................... 79 Mother and Child Health ........................................................................................... 86 Knowledge, Attitude and Practice – Child Health .................................................... 87 Annex D: Sampled clusters and data collection schedule ............................................. 89 Annex E: Knowledge, Attitude and Practice – Questionnaire ...................................... 92 Annex E.1: Cardiovascular, diabetes & obesity ............................................................ 92 Annex E.2: Child health & development ....................................................................... 95 Annex F: Log-frame indicators informed by HH survey .................................................. 98 iv List of Tables Table 1: Overview on sampling of households ................................................................... 13 Table 2: Denominators and definitions .............................................................................. 14 Table 3: Socio-economic household characteristics ............................................................ 16 Table 4: Socio-demographic characteristics of individuals living in households .............. 17 Table 5 Mean socio-economic score by quintile .................................................................. 18 Table 6: Preferred health providers ................................................................................... 19 Table 7: Reasons for not having a valid health insurance card ........................................ 24 Table 8: Demographic profile of chronic disease patients included in the sample ........... 26 Table 9: Proportion of total costs in the past four weeks for chronic conditions............... 36 Table 10: Demographic characteristics of interviewees with an acute health problem ............................................................................................................................... 37 Table 11: Proportion of total costs in the past four weeks for acute conditions ................ 45 Table 12: Demographic characteristics
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