Quality Of Public and Private Healthcare Services in Bihar: Understanding Health System Capabilities and Responsiveness

This project, sponsored by IFPRI, aims to provide nuanced understanding of the complex dimensions determining the quality of primary health care services in Bihar, particularly in the rural areas. We extend recent work done under the MAQARI project by Das et al (), to conduct a systematic, and comparative assessment of quality of care of both public and private health care providers, involving the key domains of provider competence and capabilities, motivational factors, technical dimensions of quality such as infrastructure and availability of drugs and other medical procedures on the one hand, and combining with experiences of care by patients, or the population at large. We accord specific importance to maternal and child health care services as a key component of primary care, and link the results with our other ongoing study of the impact of health financing models on MCH outcomes; our empirical methods thus involve combination of psychometric exercise such as vignettes, and techniques such as direct clinical observations, exit-patient interviews and health facility surveys. The study will be largely based on the IHD longitudinal panel of households from rural Bihar, but would also supplement it with a sub-sample drawn from the urban populations in the city of Patna, Gaya, and Bhagalpur. All government health facilities in the population would be covered, along with a convenient sample of private providers using respondent-matching methods. About 150 physicians would be covered from an equal number of facilities/clinics and about 10 exit-patient interviews would be conducted at each facility. The results of the project is expected to shed important insights into the behavioural and technical dimensions of quality of primary health care, and serve as inputs in possible reforms of the heart system.