Service quality in contracted facilities

Fauziah Rabbani, Nousheen Akber Pradhan, Shehla Zaidi, Syed Iqbal Azam, Farheen Yousuf

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Purpose – 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. Design/methodology/approach – 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. Findings – 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, p¼0.006). Practical implications – The study shows that contracting out initiatives have the potential to improve MNH care. Originality/value – This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.

Original languageEnglish
Pages (from-to)520-531
Number of pages12
JournalInternational Journal of Health Care Quality Assurance
Issue number5
Publication statusPublished - 8 Jun 2015


  • Balanced scorecard
  • Contracting
  • Maternal and neonatal health
  • Pakistan
  • Quality care
  • Rural health centres


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