Case Study: Does training of private networks of Family Planning clinicians in urban Pakistan affect service utilization?

The study uses 2001 survey data consisting of interviews with 1113 clinical and non-clinical providers working in public and private hospitals/clinics. Data analysis excludes non-clinical providers reducing sample size to 822. Variables for the analysis are divided into client volume, and training in family planning. Regression models are used to compute the association between training and service use in franchise versus private non-franchise clinics.In franchise clinic networks, staff are 6.5 times more likely to receive family planning training (P = 0.00) relative to private non-franchises. Service use was significantly associated with training (P = 0.00), franchise affiliation (P = 0.01), providers' years of family planning experience (P = 0.02) and the number of trained staff working at government owned clinics (P = 0.00). In this setting, nurses are significantly less likely to receive training compared to doctors (P = 0.00).These findings suggest that franchises recruit and train various cadres of health workers and training maybe associated with increased service use through improvement in quality of services.Pakistan is one of six countries in South Asia that are facing a critical shortage of health workers [1] with an insufficient number of doctors and nurses [2] to meet Millennium Development Goals (MDG) for Health [3] [Table 1].There are also inequalities in distribution of health workers with approximately 80,000 doctors in urban areas, and about 36,000 in rural areas. In contrast, there are about 8,000 nurses in urban areas and about 15,000 nurses in rural areas [4]. The majority of physicians comprise male doctors, approximately 75,000 versus 41,000 female physicians [5]. Poor health managerial capacity and inadequate referral mechanisms have led to gross inefficiencies in the public sector; and too often, these referrals are not managed at the basic level because of lack of resources, lack of managerial training, lack of patient-centred care and staf