Reasons for Visiting Non-Governmental Health Care Providers - Results from Exit Interviews in Two Districts in Zambia

Background: Several studies have shown that non-governmental health care constitutes a large and important source of health care - not least for the poor and those in hard to reach areas. Yet, the private health care sector in low-income countries remains largely unexplored. This study reports the findings of exit interviews conducted with consumers of non-governmental health care providers in Lundazi and Chingola districts Zambia. The study was conducted as a part of the work within the 'Private Sector Programme in Health (PSP)'; an international network involving eight research institutions in six low-and middle-income countries. The project is coordinated jointly by the Division of International Health (IHCAR) at Karolinska Institutet, Sweden and the Harvard School of Public Health, USA. Methods: The study was conducted using structured questionnaires, administered by trained research assistants. The questionnaires used were the generic Health Care Assessment Tools developed by the PSP research members. Adjustments were, however, made to make the questionnaires applicable to the Zambian context. Consumers of private clinics (25), pharmacists and drug vendors (63) and traditional healers and traditional birth attendants (214) were interviewed. In total, 302 clients were interviewed. Results: The study revealed that consumers in private clinics visited that particular clinic because of 'proximity' (72%) followed by 'availability of diagnostic facilities' (32%) and 'cost'(20%). Clients of pharmacies/drug vendors rated 'cost' (86%) and 'proximity' together with 'availability of drugs' as the most important factor (82.5%) for visiting that particular drug store/pharmacy followed by 'attitude' (70%) and 'attitude of provider' (65%) Finally, the main reason for clients of traditional healers to go to that particular provider was 'experience of the provider' (72%) followed by 'proximity' (35%) and 'familiarity with provider' (25%). Conclusions: The findings indicate that proximity is a very important factors for clients of private clinics and drug stores/pharmacies while for clients of traditional healers, the experience of the provider is more important. Cost is important for customers of private drug stores/pharmacies, but does not seem important for clients of private clinics and traditional healers. The low consideration given to cost in private clinics can probably be explained by the fact that many of the clients of private clinics were under the mining corporations' health insurance schemes. Similarly, consumers of traditional healers commonly pay in-kind and thus low consideration is given to cost