| Abstract | decades after the Alma Ata Cqnference, where the WHO f01warded its gender policy in 2002 which emphasized gender mainstreaming in health care through legislation on policy making and designing programs. This disse1iation attempts to contribute to the body of knowledge by assessing the gender differences in access to and utilization of PHC services in response to the PHC needs of men and women, and associated factors at the basic health unit (BHU) level in Pakistan. This study used a mix of quantitative and qualitative approaches. A cross-sectional survey was conducted for data collection. The Penchansky and Thomas model of access and Anderson's Behavioral Model of Health Services .Use were used to explore gerider differences in access to and utilization of PHC services and associated factors. To avoid development bias, out of 30 districts in Balochistan Province, the moderately developed Pishin district was selected as the study area. This dissertation uses both primary and secondary data. A structured questionnaire was used as the major tool along with semistructured interviews. Two-stage sampling technique was used for this research. In the first stage, ten BHUs were selected out of a total of 29 BHUs in four tehsils of Pishin District following the propo11ionate basis. In the second stage, following simple random sampling, 302 respondents (172 women and 130 men) were selected through random numbers table. For quantitative analysis, both descriptive and inferential statistics were used whereas, narrative statements and theoretical thematic analysis were used for analyzing qualitative data. The results indicate gender differences in access to PHC services as well as the associated factors. The women (56.94%) accessed PHC services more than the men (48.8%). Differences were also found in the non-utilization of PHC services, where 51.2% of men and 43.1 % of women had not accessed BHU services during their previous three instances of requiring health care. The findings revealed that women accessed PHC services more than men due to their greater health needs. However, a large proportion of both genders did not access any PHC services. Besides general weaknesses, gender-related barriers found in the factors of BHU locations, distance, transport, staff availability, income, service hours, and services organization confirm gender issues in access to PHC services. In the case of utilization of PHC services, findings indicate an underutilization of PHC services during the past 6-month period by both women and men. A majority of the men (66.2%) and women (62.2%) respondents were found to be low users of PHC services. Women were more likely to be high users (37.8%) of PHC services than men (33.8%). Logistic regression analysis revealed that utilization of PHC services among men was associated with age (Odds Ratio (OR)=0.734, P<0.05), education (OR=l.201, P<0.05), income (OR=0.165, P<0.05), distance (OR=0.105, P<0.05), doctor availability (OR=9.286, P<0.05), availability of medicine (OR=l.127, P<0.05), continuity of care (OR=6.857, P<0.5), satisfaction (OR=8.889, P<0.05), and chronic illness (OR=05.0l l , P<0.05). For women, utilization was related to age (OR=8.244, P<0.05), marital status (OR=9.589, P<0.05), income (OR=0.084, P<0.01), usual source of care (OR=0.702, P<0.01), doctor avail.ability (OR=0.654, P<0.05), continuity of care (OR=2.021, P<0.05), satisfaction (OR=22.977, P<0.05), chronic illness (OR=l0.061, P<0. 01 ), and health status (OR=0.407, P<0.05). The results also confomed that there were gender issues influencing utilization. From a cultural perspective, the women in the study area were found reluctant to consult male doctors, paiiicularly for gynecological and obstetrical care. The limited availability of transport for women also hindered their utilization, as their traveling unaccompanied is frowned upon or discouraged by local culture due to honor and safety concerns. The results for health status and client satisfaction reveal that the majority of respondents reported their health as poor and were found partially satisfied with PHC services. Women, making up 51. 7% of total respondents, rep01ted poor health as compared to 50% of their male counterpaits. This poor health status implies that the health needs of men and women were not met by the health system at the BHU level. The findings show gender differences in satisfaction with PHC services. Women and men both had indifferent satisfaction levels in the availability of medicines for common diseases, access to laboratory services, distance to BHU, economic status, responsiveness of BHU staff and perceptions about the quality of services. Contrary to the similarities, women and men had significant differences (P<0.05) in availability of medicines for chronic diseases, reproductive care, satisfaction with service hours, and trust in confidentiality of medical records. The findings of the present study suggest several policy implications. The general policy implications include improving the utilization and the quality of PHC services at BHUs through improving the convenience of BHU locations, ensuring the availability of adequate and appropriate staff, improving medicines quotas to BHUs and quality of diagnostic services in laboratories, and the organization of services. Similarly, the significant genderrelated policy implications consist of endangering of BHU staff, paiticularly ensuring the availability female doctors at BHUs and addressing gender-related baniers in access to PHC services. There is a dire need for assessing the PHC needs of both the men and women, paiticularly those of the less advantaged rural communities, in order to plan and disburse primary care to them at their doorsteps. This disse1tation has contributed to the body of knowledge by unveiling the gender-related issues in access to and utilization of PHC services. This study has explored the status of PHC services delivery in the rural context of Balochistan Province of Pakistan. The findings of this study are consistent with the findings of previous studies which have rep01ted an underutilization of primai·y health cai·e facilities in Pakistan. The findings have also revealed the causes of underntilization of PHC services at BHUs. This study has demonstrated that women utilize PHC services more than men do which is consistent with the existing literature. Moreover, the findings would help policy makers and health services managers in the development of gender-responsive policies and strategies to improve access to PHC services at BHUs for both genders. |