Service Readiness; A Key and A Challenge for Better Utilization of Primary Healthcare Systems in Pakistan

Abstract

Background: The Government of Pakistan attempted numerous efforts to revive primary healthcare systems but its meagre utilization is still questionable. "Service Readiness" which is now a gold standard for the services that should be present in healthcare facilities in functional form can help to improve utilization of primary healthcare facilities especially in developing countries. This study aimed to assess service readiness at primary health care level of Pakistan. Methods: A cross-sectional study of all basic health units was carried out in tehsil (administrative unit) Rawalpindi, Pakistan with the help of structured questionnaire. The Cronbach"s alpha was used to assess reliability of tool which was 0.756. The outcome was normally distributed (Kolmogorov-Smirnov test= 0.091, p=0.20 and Shapiro-Wilk= 0.967, p=0.616). Data were analyzed in SPSS 21, by using descriptive and parametric tests (T-test and One way ANOVA). Cohen"s criteria were used to calculate effect size. The data were collected from face to face interviews with administrative staff of basic health units and researcher"s observations for a checklist as a part of a questionnaire. Results: A total of 23 health facilities were included, service readiness (1.86± 0.15) was statistically significant for locality of health facility (p=0.000), distance to district health office (p=0.007), political support (p=0.001), health official visits (p=0.022), availability of staff (p=0.001) and availability of residence for staff (p=0.001). Among all blocks of services readiness basic amenities, standard precautions and laboratory capacity showed worst results. Conclusion: Our results highlight weak service readiness at primary health level of Rawalpindi and advocate for urgent remedial measures to overhaul the primary health care system. Finances should be allocated on these highlighted issues on immediate basis to revive this most important tier of primary healthcare systems of Pakistan.