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*Based on 229 exit interviews of caretakers at facilities; 60 respondents for low utilization facilities, 128 respondents for middle utilization facilities, and 41 respondents for high utilization facilities.
Difference between low utilization and high utilization facilities is statistically significant (p<0.05) in logit regression when controlling for district (data not shown).
Table 6 shows that high utilization facilities spent 20% of their total budget, on average, for vehicle operation and field visits.
We also find, based on exit interviews, that a greater proportion of caretakers reported traveling over 1 hour to receive care among low-utilization facilities compared with high utilization facilities.
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Because high-utilization facilities are more likely to have vehicles than other facilities, the upward slope of marginal costs at high utilization levels indicated by the regression probably reflects the cost of vehicle operation rather than diseconomies of scale with respect to staff or other fixed costs.
Within these traditional financing and payment mechanisms, individual health workers had two primary sources of income: (i) a monthly salary, and (ii) the abovementioned quarterly bonus, which had the potential to be a considerable source of income for health workers stationed in facilities with high utilization rates.
Studies conducted elsewhere in Africa have reported poor partograph utilization in lower health facilities [ 30, 31] and a high utilization rate in a tertiary hospital [ 32].
The norms might be appropriate for some places (e.g. urban dispensaries with a high utilization rate) but for others not (e.g. rural remote facilities covering a relatively small population).
In such a production facility capacity planning is of vital importance as scarce resources need to be cleverly managed in order to obtain a high utilization.
"It's more or less designed for high utilization in a commercial setting," he said.
There is high utilization of antenatal care services with more than 94% of pregnant women attending at least once but on the other hand only 47% of deliveries take place in health facilities [ 6].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com