Wenjuan Wang, Rebecca Winter, Lindsay Mallick, Lia Florey, Clara Burgert-Brucker, and Emily Carter.
2015. The Relationship between the Health Service Environment and Service Utilization: Linking
Population Data to Health Facilities Data in Haiti and Malawi. DHS Analytical Studies No. 51. Rockville,
Maryland, USA: ICF International.
Access to and quality of health services are key determinants in utilization of health services and consequently, health outcomes. By linking DHS household data and health facility survey data, this paper explores the relationship between the service environment (service availability and readiness to provide a service) and utilization and quality of health care obtained in several health areas in Haiti and Malawi. The health areas included are family planning, maternal health care, child care, and HIV testing services in Haiti, and malaria-related health care services in Malawi. Geographically appropriate buffer zones around each cluster were determined based on area of residence—metropolitan, other urban, and rural areas in Haiti and urban and rural areas in Malawi. For each health area, data from the facilities within the buffer were summarized to cluster level to measure the cluster’s service environment relative to the health area included in the buffer zone. These cluster-level data were then linked to individual women in the household surveys. As expected, for all the health services examined in Haiti, clusters in the metropolitan area were linked to a much greater number of health facilities than clusters in other urban and rural areas. For most health areas, a significant association was found in rural areas (and other urban areas in Haiti) between access to or readiness of service provision and utilization of health services. The relationship does not hold however in the metropolitan area in Haiti; more precise measurements of the health service environment would be needed for areas with both high density of health facilities and population.