Provider Networks and Quality of Care for Reproductive Health Services in Nepal

Dominic Montagu, University of California, San Francisco
Ndola Prata, University of California, Berkeley
Robert McPherson, Independant Consultant
Anand Tamang, Center for Research on Environment Health and Population Activities, Kathmandu

In order to determine current practices and client expectations for reproductive health services we conducted a study of the activities of three health networks in Nepal between February and June 2003. A total of 1,282 providers, 1,374 client exit-interviews, 1069 household interviews, and 511 mystery client surveys were conducted. All provider surveyed were also located using Geographic Positioning System (GPS) instruments. Quality of care varies by both the training level of provider and the status of providers, with networked providers giving more appropriate care and consultation in a number of critical factors. Prices are aligned with provider level of training, but are not linked to quality of care within provider levels. Clients are not price sensitive, and report provider selection primarily upon perceived or expected quality of care.