Utilization of health services : delivery and health status study (pretest phase)

The project is implemented in cooperation of the Ministry of Health (MoH) over 5 years (September1999-September 2004). PHCI aims at improving primary health care and reproductive health. The evaluation follows quasi-experimental design. Users of UNRWA health centers served as the control (comparison) group while clients of MoH health centers served as the intervention group. A representative sample was selected using stratified two stage cluster sampling approach from users of MoH health centers and another sample was selected from UNRWA facilities. A set of utilization of services and proxy health status indicators were chosen for evaluation. The indicators were based on timeliness of vaccination, growth and development visits, antenatal postnatal visits, screening children and pregnant women for anemia, screening for hypertension, contraceptive use, anemia of children and pregnant women, status of control of diabetes and hypertension. Some variables were collected from records and others through crosssectional surveys. Data for pretest was collected during October-November of 2000, while posttest will be carried out during June 2004. The baseline findings of the pretest phase for MoH showed that 64.4% of 2-year old children received all their immunizations timely. Only 21.3% of 3-year old children did appropriate growth and monitoring visits (63.3% during the first year of life, 37% during the second year and 35.6% during the third year). Only 57.7% of pregnant women did 4 or more antenatal visits (risk pregnancies were excluded) while 29.6% attended the postnatal care at least once over the first 6 weeks of delivery. The prevalence of modern contraceptives was 51.6%. Screening adults aged 40 years and older for hypertension was practiced in about 37% of the cases. Children aged 6-24 months had their hemoglobin checked and documented only in 37.8% of the cases with 25.4% anemia prevalence. About 88% of pregnant women were tested for anemia during pregnancy with 24.7% anemia prevalence. The prevalence of poor control of diabetes as judged by glycosylated hemoglobin was 43.1%. Only 11% of the hypertensive patients were found to have controlled (normal) blood pressure with over 60% of the patients found in the second and third grade of hypertension. The above findings serve as guidance for various PHCI project activities as well as for MoH to improve quality of services provided to clients. (Author abstract)