Utilization of government health services and factors associated with choice of health care provider by mothers and children in Peshawar

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


The government of Pakistan has established a network of health institutions in the rural areas for provision of health care facilities to the population. A large number of doctors and paramedics are employed in these facilities consuming a budget worth million of rupees. But it is estimated that only 21l% of population opt for government health services as their first choice for curative care, which is considerably less as compared to 48% in Bangladesh and 62% in Sri Lanka, countries of similar economic development. Such utilization of government health facilities is indicating a less efficient use of resources. Mothers face additional risks to their health because of their reproductive biology and low socioeconomic status. Cultural practices including the practice of seclusion and limited decision-making authority impedes women's access to health care services. Thus it was required to collect information about the state of utilization of health services by mothers and their children; and the factors associated with their choice of health care provider on community basis, which would capture both the users and non-users of government health facilities. A cross sectional survey was carried out through a two-stage cluster sampling technique in the rural areas of Peshawar district. A pre-tested structured questionnaire was used to collect information on 806 mothers, having at least one child under three years of age. Data was collected about the last illness, last delivery along with immunization status, and Family Planning use of mothers and the last illness and immunization status of children. Multiple logistic regression analysis was performed to identify factors associated with choice of HCP by mothers and their children for their last illness. We found that 309Vo of mothers for their own and 24.9Vo for child's illness opted for GHF. Waiting time for consultation for more than 15 minutes for mother [AOR 2.3, 95% CI (1.7, 4.4)] and child [AOR 3.1, 95%CI (1.8, 5.6)]; and dissatisfaction with behavior of the health care provider for mother [AOR 3.3, 95%CI (1.8, 5.8)] and child [AOR 2.6, 95%CI (1.5, 4.6)] were the most significant service related factors associated with choice of health care provider along with travel time. Among the illness related factors, severity of illness for mother [AOR 5.1, 95%CI (2.8, 9.2)] and child [AOR 9.1, 95%CI (4.2, 19.7)] and duration of illness were associated with the choice of health care provider for the last illness. Education of the husband for mother [AOR 7.0, 95%CI (3.9, 12.4)], and father for child [AOR 4.7, 95%CI (2.6, 8:5)], time of consultation and mother's authority to go alone to seek care were also associated with the choice of health care provider for last illness of mother and child. In addition age of the mother was associated with mothers; and sex of child and mother's education with choice of health care provider for child's last illnesses. In order to improve utilization of GHF, government may look into the possibility of restructuring in terms of more time availability for consultation and reducing waiting time. Efforts should be made to improve the social status of mother so that they would be more independent for their health-seeking behavior.

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