Choice and Voice: People's Perspectives of Health Services in Pakistan
This report presents the main findings from RCA study conducted in April and May 2017. The study was designed to gather insights from people living in poverty on how they perceive, understand and engage with health services. It was commissioned by Palladium Pakistan’s Empowerment, Voice and Accountability for Better Health and Nutrition (EVA-BHN), a DFID-funded programme which aims to empower and facilitate people to hold two provincial governments in Pakistan (Punjab and Khyber Pakhtunkhwa) to account for the delivery of quality reproductive, maternal, new-born, child health and nutrition (RMNCH-N) services.
Researchers having informal conversations with people in the villages and joining in people’s daily activities.
Women described limitations on their mobility and, in all except the Sahiwal locations, shared that they rarely left their homes. The restrictions were higher for women in the Khyber Pakhtunkhwa locations than in Punjab.
People often referred to common indicators to describe their poor economic situation and choices, including: i) not owning farming land and house; ii) depending on ‘hard work’ like farming; iii) not having a reliable monthly income; iv) having no or less cash income; v) having few people in the family that can earn money; vi) depending on a single livelihood source; vi) having debt; vii) having no political networks or connections; and viii) having less access to transport and public facilities like BHU, hospitals, schools (in terms of cost, distance, service availability).
In addition to illness, people frequently related ‘not being healthy’ to what they eat, the medicine they use and working habits. Being able to work as usual was another thing people said that keeps them healthy.
Women, across locations, shared that they went about their routine as usual when pregnant. Most women shared that they had eaten ‘anything that was available’ during their pregnancies and ‘special’ food was only eaten after the baby was born.
Deciding where to go to in case of an illness depends much on the perceived seriousness of the ailment. People usually went to service providers with ‘facilities’, using the term to refer to all kinds of diagnostic services, and preferably where these were ‘under one roof’.
People trust what is perceived as ‘modern medicine’, injections in particular. They preferred going to chota doctors over the BHUs because there they would be given injections for almost all complaints. People prefer the chota doctors or the medical shops in the village also because these are close-by and make house- calls when needed.
People felt that the services at the BHU are for ‘poor people’. People in all locations frequently compared the cost of being treated at the BHU to costs elsewhere to indicate that the services at the BHU were not satisfactory.
In every village, there were certain people or groups who people said they go to in case of personal or communal disputes. While some of these are men who are traditionally considered politically ‘influential’. However, people would rarely complain to these individuals or others about poor quality services in the BHU.