title: Service quality in contracted facilities.
abstract: OBJECTIVE
  The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework.
  
  
  METHODS
  Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher's Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities.
  
  
  RESULTS
  Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients' inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006).
  
  
  CONCLUSIONS
  The study shows that contracting out initiatives have the potential to improve MNH care.
  
  
  CONCLUSIONS
  This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Fauziah
authors.initials: F
authors.lastname: Rabbani
authors.forename: Nousheen Akber
authors.initials: NA
authors.lastname: Pradhan
authors.forename: Shehla
authors.initials: S
authors.lastname: Zaidi
authors.forename: Syed Iqbal
authors.initials: SI
authors.lastname: Azam
authors.forename: Farheen
authors.initials: F
authors.lastname: Yousuf
mesh_terms: D003284:Contract Services / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D010154:Pakistan; D011247:Pregnancy; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards*
keywords: Balanced scorecard; Contracting; Maternal and neonatal health; Pakistan; Quality care; Rural health centres