Evaluating health care services in developing countries

Background: In cash strapped bureaucracies, an effective method to assess health programs using available data is important. As policy makers in developing countries look to extend, improve and assess their family planning and reproductive health services, we propose a novel tool and framework to assist them.

Methods: Facility and exit interview data from surveys in Ethiopia and Pakistan of 1718 facilities and 19801 clients from private, public, NGO and social franchised clinics were analysed. A quality score was generated using factor analysis, and equity assessed using income and asset data of clients. Facility efficiency, equity and quality were normalized, and plotted for each type of facility in each country.

Results: The radar diagram described offer policy makers a tool to assess the quality, social equity and cost of family planning services. We provide case studies in Ethiopia and Pakistan, comparing two types of private sector providers, NGO and government providers on these three factors. Our analyses show that social franchises perform consistently high on quality of care, while government facilities provide the greatest access for the poor.

Conclusion: Efficiency of social franchises lags behind that of NGO and private providers, accentuating the trade-off between cost and quality of care, which often faces public stewards of health systems.