Screening for Unmet Needs in Primary Health Care Clinics

 Funded by: USAID

Many clients attending primary health care (PHC) facilities in developing countries are unaware of the services available and of their own needs. Clients tend to visit for one particular service and the provider concentrates on that. Other needs remain undetected unless clients are asked about them and an opportunity can be missed to provide services needed. From a programmatic point of view, it should be more efficient and cost effective to provide multiple services on a single client visit, rather than providing services on separate visits. Physical integration of health and family planning services at PHC level can contribute to this, but attendance does not ensure that all the needs of a client will be met. Studies in Latin America have shown that unmet needs among clients can be identified using simple screening tools, resulting in more services per visit. This study developed a screening tool and evaluated its use by comparing changes in selected intervention and comparison clinics in Bangladesh.

The study was conducted from April 2002 to March 2003, in collaboration with the Ministry of Health and Family Welfare and the NGO Service Delivery Programme (NSDP), at union level government clinics in Mirsarai Union of Chittagong district and non-governmental organisation (NGO) clinics in Sherpur district.

A screening tool was developed and used to identify additional service needs among clients and their families, other than those requested. The study found that systematic screening was acceptable to providers and clients; it significantly increased the amount of checking for additional needs, the number of additional needs identified, and the proportion of those needs that were met. Checking for two or more additional needs increased from 7% to 17% in the Government intervention area, and from 67.4% to 90.7% in NGO intervention area. Overall, 13% more needs were identified in the Government area and 30% more in the NGO area. The proportion of additional needs met improved from 4.6% to 14.0%, and from 24.3% to 80.3%, respectively.

Overall, following introduction of the screening tool, the number of additional services provided per hundred requested increased from 4 to 10 in the government area and from 12 to 28 in the NGO area. These improvements were statistically significant and significantly greater than in the respective comparison areas. On follow up more than 80% of referred cases were found to have received services.

The results suggest that introducing a screening tool more widely in PHC clinics is feasible in Bangladesh and could significantly increase coverage of reproductive and child health services.