Does quality influence utilization of primary health care? Evidence from Haiti

• Published in: Globalization and health Vol. 14; no. 1; p. 59
• Main Authors: Gage, Anna D, Leslie, Hannah H, Bitton, Asaf, Jerome, J Gregory, Joseph, Jean Paul, Thermidor, Roody, Kruk, Margaret E
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20-06-2018; BioMed Central; BMC
• Subjects: Analysis; Child care; Cross-Sectional Studies; Demography; Developing countries; Dosage and administration; Global health; Haiti; Health aspects; Health care; Health care facilities; Health care policy; Health care reform; Health facilities; Health services; Health systems; primary health care; quality of care; service readiness; utilization; patient perception; Haiti; HIV; Hospital facilities; Human immunodeficiency virus; Humans; Immunization; Infrastructure; LDCs; Management; Medical care; National security; Obstetrics; Patient satisfaction; Perceptions; Population; Postpartum period; Prenatal care; Primary care; Primary Health Care - statistics & numerical data; Quality of care; Quality of Health Care - statistics & numerical data; Quality of service; Rural areas; Rural Population - statistics & numerical data; Surveys; Systematic review; Vaccination; Haiti; Health systems; primary health care; quality of care; service readiness; utilization; patient perception; Haiti
• ISSN: 1744-8603; 1744-8603
• DOI: 10.1186/s12992-018-0379-0

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti.
We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery.
Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure.
Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.