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Trust as a predictor of service utilization: Implications for output-based aid in Ugandan STD treatment

Ben Bellows, MPH1, Malcolm Potts, MB, PhD, FRCOG1, and Edgar Mulogo, MD2. (1) Epidemiology Division, University of California, Berkeley, 140 Warren Hall, Berkeley, CA 94708, 510-643-7627, bbellows@berkeley.edu, (2) Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda

Output-based assistance (OBA) involves delegating service delivery to a third-party, which can be private or not-for-profit operators such as NGOs or approved Government clinics under contracts, that tie disbursement of the public funding to the services or outputs actually delivered. The Uganda Ministry of Health (UMoH) and the German Credit for Development Bank (KfW) developed a pilot voucher-driven disbursement program to subsidize the diagnosis and treatment of sexually transmitted infections (STIs) at accredited service providers in Mbarara district. A baseline survey of 40 clusters in Mbarara and Bushinye districts assessed community individual levels of trust, SES, age, parity, family planning history, and community level mobility characteristics. Controlling for other covariates, trust was associated with STD treatment service utilization in the past 12 months. SES appeared to modify the relationship. It may be that those of higher SES are more likely to share social networks with service providers. Highly networked individuals likely trust service providers and are more willing to use health services. Trust is associated with health service utilization and health outcomes. In places where large percentages of the population have limited access to services, simply using any service greatly improves the probability of a positive health outcome. In as much that health service utilization is a “social phenomenon” it is a function of psychological states, social connectedness, household economics and policy environments.

Learning Objectives:

Keywords: Service Delivery, Risk Factors

Related Web page: www.output-based-aid.net/index_eng.html

Presenting author's disclosure statement:

Not Answered

Contemporary Issues in Health Care Reform

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA