Effects of outreach workers' visits on perceived quality of care in two rural areas of Bangladesh

Abstract

Objective: Provide information on rural women's perceptions of the regularity and the quality of care provided by the government family planning programme, especially by the female field workers. Methods: Working within the government system, the MCH-FP Extension Project of ICDDR,B conducts operations research at Sirajgonj and Abhoynagar in Bangladesh to improve health and family planning service-delivery. The Project has been maintaining a surveillance system in these field sites since 1982. In the spring of 1989, a special survey was conducted among married women of reproductive age. Using previous longitudinal data on field workers' visits to rural women, the impact of this programmatic factor on perceived quality of care was evaluated. Additional information on the socioeconomic, behavioural and attitudinal characteristics was obtained from previous surveys. Five different indicators of the quality of service-delivery were studied, based upon each client's assessments of her worker's responsiveness, helpfulness, concern for privacy, sympathetic manner, and ability to provide enough information. Results: Descriptive statistics of the population under study showed that their characteristics were similar to married women in national surveys. Three multiple regression models of the determinants of quality of care by selected programmatic and client characteristics were evaluated. Results showed that visit by one additional worker significantly increased the quality of care index. Rural women's perceptions of the standards of care provided to them by family planning field workers were significantly related to routine home visits by outreach workers. This indicates that if a woman is exposed to a household visit in a 90-day period by a female family planning worker, it is likely that the woman scores her as a better worker, irrespective of other factors or client characteristics. Conclusions: This study provides some of the first empirical evidences from a developing country on the importance of workers' visits on quality of care.