title: Mobile clinic services to serve rural populations in Katsina State, Nigeria: perceptions of services and patterns of utilization.
abstract: BACKGROUND
  Topographical, cultural, socio-economic and developmental factors combine to create significant barriers to health services delivery in areas of Northern Nigeria, resulting in poor health outcomes in states such as Katsina. The Katsina State Ministry of Health has introduced a mobile clinic service to provide primary health care to particularly inaccessible communities. This study reports early evidence of beneficiary and provider perceptions of the service, and indicators of initial coverage.
  
  
  METHODS
  Key informant interviews were held with community leaders and service providers from communities receiving mobile clinic services from across six local government areas (LGAs), selected to represent diversity of conditions across the state. Exit interviews were conducted with 455 service users across three sites. Data on utilization were collated from routine service records and from a survey of a representative sample of households across the six LGAs.
  
  
  RESULTS
  Beneficiaries reported high levels of satisfaction with respect to most aspects of the mobile clinic service. However, there was significant variation in ratings of service quality. Concerns for beneficiaries included the lack of privacy provided, waiting times and lack of guidance on follow-up care. Providers of the service reported high levels of satisfaction with the work, highlighting the reach of services and the teamwork involved. Antenatal care (ANC) coverage of 30% of pregnant women-well above the average for the northern states-was achieved in one LGA, though much lower rates were secured elsewhere.
  
  
  CONCLUSIONS
  Data indicate that while services are generally well-received there are clear opportunities for strengthening quality of service provision. Improved service supervision and monitoring-potentially linked to performance-based financing mechanisms-promise to raise general quality of care to that demonstrated as attainable in the best performing LGAs. Provider reports suggesting high levels of motivation are notable in a general healthcare work environment with high rates of absenteeism.
authors.affiliation: Program for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Peters
authors.affiliation: Program for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USAProgram for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Doctor
authors.affiliation: Program for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
authors.forename: Godwin
authors.initials: G
authors.lastname: Afenyadu
authors.affiliation: Program for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Findley
authors.affiliation: Program for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA aa2468@columbia.edu.
authors.forename: Alastair
authors.initials: A
authors.lastname: Ager
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000706:statistics & numerical data*; D009549:Nigeria; D017060:Patient Satisfaction; D011247:Pregnancy; D011295:Prenatal Care; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Nigeria; perceptions; quality; rural; satisfaction; utilization