title: Does use of a government service depend on distance from the health facility?
abstract: To reduce mortality from common childhood illnesses such as diarrhoea and upper respiratory infections, it is important that health services are available and used appropriately. Physical accessibility to a health facility may influence its use, particularly in rural areas. We assessed whether use of government services for treatment of the three most common acute childhood illnesses (fever, diarrhoea and upper respiratory infections) was influenced by the physical accessibility of the government primary health care centres. We analyzed data from a household survey which was collected between November 1992 and January 1993, from 139 randomly selected villages located around 14 government facilities in Thatta, a rural district of Pakistan. There were 691 children under 5 years of age who suffered from the three acute illnesses; 85% of these children used either a government or a private service. Children living at less than 4 km from a government facility made 22% less use of that facility than those living 4 km or more away. After controlling for the effects of distance from a private facility and treatment cost in a multiple logistic regression model, children living less than 4 km from a government facility were no more likely to use the facility than those living 4 km or more away (Adjusted Odds Ratio: 1.01, 95% Confidence Interval: 0.68-1.50). These results suggest that factors other than distance are the primary determinants of use of government services for treating children in the Thatta district. To increase the use of government health services, policymakers should assess carefully the factors determining the use of existing facilities, before they plan the building of more health facilities. Further studies are needed to examine the management of health facilities and the clients' perception of health-care providers.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. rozina.noorali@aku.edu
authors.forename: R
authors.initials: R
authors.lastname: NoorAli
authors.forename: S
authors.initials: S
authors.lastname: Luby
authors.forename: M H
authors.initials: MH
authors.lastname: Rahbar
mesh_terms: D002391:Catchment Area, Health; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003710:Demography; D003906:Developing Countries; D006297:Health Services Accessibility; D006302:Health Services Research; D006305:Health Status Indicators; D006801:Humans; D010154:Pakistan / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011635:Public Health Administration; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014195:Travel