What drives utilization of primary care facilities?: Evidence from a national facility survey

ABSTRACT

This analysis aims to assess the association between commune health station (CHS) service availability/readiness and health service utilization. Data from the 2015 Vietnam District and Commune Health Facility Survey was used to build a series of multivariate negative binomial regressions to measure the association between domains of service availability/readiness and CHS's average number of visits per capita. Three domains of service availability/readiness are significantly associated with higher utilization rates: health infrastructure, basic equipment availability, and capacity to deliver services for non-communicable diseases. If all three modifiable CHS characteristics were to be improved from their current level, the predicted utilization rate of the CHS would be 3.3–3.7 times as high as current levels. Investments in improving facility infrastructure, making available essential equipment items, and enabling the CHS to provide hypertension and diabetes services would all likely increase health service utilization at CHS level.

KEYWORDS:

• Commune health stations
• health service utilization
• non-communicable diseases
• service readiness
• service availability

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Patient care and facility administration rooms include rooms for clinical examination, first aid, immunization, post-immunization observation, traditional medicine services, delivery/family planning services, pharmaceutical dispensing, administrative activities, IEC, etc. However, rooms such as the toilet or storage shed would not be included.

2 The 70% threshold is the benchmark in Decision 4667. The list of equipment in the survey includes: adult, child and newborn weighing scales, a thermometer, stethoscope, pinard horn to hear fetal heartbeat, blood pressure cuff, oxygen tank, bulb syringe, gastric lavage instrument set, gynecology/obstetrics table, mucus suction machine, instrument sterilization equipment, refrigerator, cold chain box, and microscope.

3 The 70% threshold is the benchmark in Decision 4667. The list of drugs in the survey includes: antibiotics (7), hypertensive drugs (6), diabetes drugs (4), NSAIDS and pain meds (4), cholesterol control (2), sedative/anti-depressant/epilepsy (3), diarrhea or parasite (2), acid reflux (1), and asthma/COPD (1).

4 Ministry of Health Decision 4667 categorizes facilities into three zones, largely based on geography and distance as follows: Zone 1 for urban locations, or rural delta and midland communes with the distance between the CHS and higher-level care less than 3 km; Zone 2 for communes in mountainous, remote, isolated, border and maritime areas with distance between the CHS and higher-level care less than 5 km and delta and midland communes with distance between the CHS and higher-level care from 3 km to below 15 km; Zone 3 for communes in remote areas with distance between the CHS and higher-level care of 5 or more kilometers or delta and midland communes with distance between the CHS and higher-level care of 15 or more km.

5 MOH Decision 1020/2004/QĐ-BYT issuing CHS design standards.

Additional information

Notes on contributors

Lan T. H. Vu

Lan T. H. Vu is an Associate Professor at Hanoi University of Public health. Her main research topic are applied biostatistics and epidemiology.

Sarah Bales

Sarah Bales is an Adjunct Professor at Hanoi University of Public Health. She specialized in health economics and social policy.

Caryn Bredenkamp

Caryn Bredenkamp is a Senior Economist in the World Bank Group and is based in Vietnam. Her main research interests including in health care financing, and the promotion and measurement of health system equity.