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Service quality in contracted facilities

Fauziah Rabbani (Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan)
Nousheen Akber Pradhan (Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan)
Shehla Zaidi (Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan)
Syed Iqbal Azam (Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan)
Farheen Yousuf (Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 8 June 2015



The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework.


Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher’s Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities.


Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients’ inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006).

Practical implications

The study shows that contracting out initiatives have the potential to improve MNH care.


This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.



The study was commissioned by the Research and Advocacy Fund (RAF/Fin/Grantee/AKU-1/2012/27), British Council, Islamabad, with funding provided by the Department for International Development, UK (DFID) and the Australian Agency for International Development (AusAID). Community Health Sciences Department staff, Aga Khan University (AKU), Karachi, executed the study. The authors are grateful for the input and fieldwork support provided by the Provincial Maternal Neonatal and Child Health (MNCH) Program, Department of Health, District Health Offices, Thatta and Chitral, Pakistan and Aga Khan Health Service, Pakistan (AKHS, P). The authors acknowledge Dr Aziz Jiwani; Assistant Professor Family Medicine at the Aga Khan University Hospital (AKUH) for reviewing the data collection instruments. The authors are also grateful to Mr Gul Nawaz; Social Scientist for providing close supervision and facilitation in the field. Finally, the authors appreciate the Women Medical Officers (WMO) and Lady Health Visitors (LHVs) for collecting the data.


Rabbani, F., Pradhan, N.A., Zaidi, S., Azam, S.I. and Yousuf, F. (2015), "Service quality in contracted facilities", International Journal of Health Care Quality Assurance, Vol. 28 No. 5, pp. 520-531.



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