Client Satisfaction: Does Private or Public Health Sector Make a Difference? Results from Secondary Data Analysis in Sindh, Pakistan
Introduction: Researchers globally have strived to explore diverse factors that augment the continuation and uptake of family planning methods. Clients’ satisfaction is one of the core determinants facilitating continuation of family planning methods. There is a major debate yet scanty evidence to contrast public and private sectors with respect to client satisfaction. The objective of this study is to compare quality-of-care provided by public and private sectors of Pakistan through a client satisfaction lens. Methods: We used Pakistan Demographic Heath Survey 2012-13 dataset on 3133 women. Ten different multivariate models were made. to explore the relationship between client satisfaction and dependent outcome after adjusting for all known confounding factors and results are presented as OR and AOR (95% CI). Results: Multivariate analyses showed that clients were less satisfied in contraceptive provision from private sector as compared to public sector (AOR 0.92, 95% CI 0.63-1.68) even though the result was not statistically significant. Clients were more satisfied from private sector as compared to the public sector with respect to other determinants of quality-of-care follow-up care (AOR 3.29, 95% CI 1.95-5.55), infection prevention (AOR 2.41, 95% CI 1.60-3.62), counseling services (AOR 2.01, 95% CI 1.27-3.18, timely treatment (AOR 3.37, 95% CI 2.20-5.15), attitude of staff (AOR 2.23, 95% CI 1.50-3.33), punctuality of staff (AOR 2.28, 95% CI 1.92-4.13), timely referring (AOR 2.34, 95% CI 1.63-3.35), staff cooperation (AOR 1.75, 95% CI 1.22-2.51) and complications handling (AOR 2.27, 95% CI 1.56-3.29). Discussion: Public sector has successfully attained substantial satisfaction levels with respect to provision of contraceptives, but it contrasts previous literature from a multi country studies. Our study though in is concordance with a study from Tanzania where public sector was more likely to offer family planning services to clients as compared to private facilities. Conclusion: In majority of the developing countries, public sector is more involved in FP service provision; however, in Pakistan clients’ satisfaction in private sector is more, which opens doors for public-private partnerships and collaboration in the near future.
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 Jain, A. K. Fertility reduction and the quality of family planning services. Stud FamPlann, 1989; 20(1):1-16.
 Williams, T. Schutt-Aine, J. Cuca, Y. Measuring Family Planning Service Quality through Client Exit Interviews. International Family Planning Perspectives, 2000; 26(2):9.
 Berman, P. Laura, R. The role of private providers in maternal and child health and family planning services in developing countries. Health Policy Plan, 1996; 11(2):142-155.
 Agha, Sohail. Do, Mai. The quality of family planning services and client satisfaction in the public and private sectors in Kenya, International Journal for Quality in Health Care, 2009; Volume 21, Number 2: pp. 87-96.
 Hutchinson, Paul. Do, Mai. Agha, Sohail. Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana, Hutchinson et al. BMC Health Services Research, 2011; 11:203.
 Deodatus, C. Kakoko, Evert, Ketting, Switbert, R. Kamazima, Ruerd, Ruben. Provision of Family Planning Services in Tanzania: A Comparative Analysis of Public and Private Facilities, Afr J Reprod Health, 2012; 16(4):140-148).
 Shiwani, H. Clinical governance in Pakistan: myth or reality?, Journal of Pak Med Association, 2006; vol. 56, no. 3.
 Nakhaee, N. Mirahmadizadeh, A. R. Iranian women’s perceptions of family-planning services quality: a client-satisfaction survey. Eur J ContraceptReprod Health Care, 2005;10:192–198.
 Simbar, M. Ahmadi, M. Ahmadi, G. et al. Quality assessment of family planning services in urban health centers of Shahid Beheshti Medical Science University, 2004. Int J Health Care Qual Assur IncLeadersh Health Serv, 2006; 19: 430-442.
 Hassan, R. Rehman, A. Facilities of gynecology department in public and private hospitals of Rawalpindi and Islamabad, Journal of Gender & Social Issues, 2007; vol. 6, no. 1.
 Adeela, Rehman. Saif-ur-Rehman, Saif, Abbasi. Availability of health care services for women at district Headquarter hospitals of Punjab province, JGIP, 2013; Volume 6, Issue 10, pp. 11-23.
 Stephenson, R. Tsui, A. O. Sulzbach, S. Bardsley, P. Bekele, G. Giday, T. Ahmed, R. Gopalkrishnan, G. Feyesitan, B. Franchising reproductive health services, Health Serv Res, 2004; 39(6 Pt 2):2053-2080.
 Agha, S.Do, M. Does an expansion in private sector contraceptive supply increase inequality in modern contraceptive use? Health Policy Plan, 2008; 23: 1–11.
 Brugha, R. Zwi, A. Improving the quality of privately provided public health care in low and middle income countries: challenges and strategies. Health Policy Plan, 1998; 13:107–20
 World Bank, World development report 1993, Investing in Health. Washington, 1993.
 Boller, C. Wyss, K. Mtasiwa, D. et al. Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania. Bull World Health Organ, 2003; 81: 116-122
 Kost, K. Singh, S. Vaughan, B. et al. Estimates of contraceptive failure from the 2002 National Survey of Family Growth, Contraception, 2008; 77: 10-21.
 Isaacs, J. N. Creinin, M. D. Miscommunication between healthcare providers and patients may result in unplanned pregnancies, Contraception, 2003; 68: 373-376.
 Peabody, J. W. Rahman, O. Fox, K. et al. Quality of care in public and private primary health care facilities: structural comparisons in Jamaica. Bull Pan Am Health Organ, 1994; 28:122-141.
 McBride, J. Ahmed, R. Social Franchising as a Strategy for Expanding Access to Reproductive Health Services: A case study of the Greenstar Service Delivery Network in Pakistan Commercial Market Strategies; Washington DC, USA; 2001.
 Healthy people 2000: National health promotion and disease prevention objectives: Full report, with commentary. Washington, DC: Superintendent of Documents, U.S. Government Printing Office, 1991
 Carton, T. W. Agha, S. Changes in contraceptive use and the method mix in Pakistan: 1990-91 to 2006-07. Health Policy and Planning; 2011
 Hamid, S. Stephenson, R. Provider and health facility influences on contraceptive adoption in urban Pakistan, International Family Planning Perspectives, 2006; 32(2): 71-78.