Provider networks and quality of care for reproductive health services in Nepal

Dominic Montagu, University of California, San Francisco
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. Surveys of member providers, nearby non-member providers, clients of both groups, and randomly selected women living in households nearby were undertaken in 22 of Nepal’s 75 districts. Mystery clients were used to evaluate the quality of care in nurse-midwife, doctor, and specialist clinics using two reproductive health scenarios. A total of 1,282 providers, 1,374 client exit-interviews, 1069 household interviews, and 511 mystery client surveys were conducted. Findings: 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