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A self-sustaining vicious circle of low utilisation and poor confidence can then be generated.
This is why a lack of knowledge of glycaemic status because of low utilisation of SMBG was raised as a reason for poor glycaemic control.
Moreover the fees generated are not retained in municipal and rural district-run facilities, thus creating a vicious cycle of low utilisation and low investment in the services.
We found that both sites show similar trends of low utilisation of formal healthcare services, a high prevalence of NCDs, as well as the presence of multiple healthcare beliefs.
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This could be one of the possible reasons for low utilisation of claims by the beneficiaries in the private sector, unlike in majority of the states in India where almost half of the TB patients are accessing treatment in the private sector [42].
Further research is needed to identify the underlying factors leading to low utilisation of PPE despite the welders of eastern Nepal being knowledgeable of it.
Numerous reasons for low utilisation of skilled birth attendance in Kenya exist, including cost of service (perceived or real), the distance to the health facility, and quality of care [ 7].
There are significant demand and supply-side barriers contributing to low utilisation of SRH services by adolescents in Vanuatu.
A study in Tanzania found that households headed by men were associated with more home based deliveries [ 4], while in Pakistan high decision making power by men was linked to low utilisation of ANC and delivery care services [ 5].
The lack of studies on perceived quality of HATCS and low utilisation of HATCS, and the need for evidence to improve healthcare performance motivated the selection of this zone for the study.
Regardless of the reasons, low utilisation of services, in turn, affects health staff motivation in at least two ways.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com