Agha Sohail, Balal Asma, Ogojo-Okello Francis
Health Serv Res. 2004 Dec;39(6 Pt 2):2081-100. doi: 10.1111/j.1475-6773.2004.00333.x.
To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty.
A quasi-experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow-up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow-up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T-tests, the analysis of variance, and multivariate logistic regression analysis were conducted.
These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty.
The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services.
评估一项小额信贷项目的影响，该项目为私营部门的助产士提供商业技能培训和循环贷款，以了解其对服务感知质量和客户忠诚度的影响。
采用带有预测试和后测试设计的准实验研究来评估干预措施的影响。在接受干预的15家诊所和未接受干预的7家诊所进行了离职面谈。2000年11月至12月进行了基线离职面谈。为助产士提供了为期五天的商业技能培训，并在2001年1月和2月发放了贷款（平均454美元）。进行了一次后续诊所访问，以评估助产士是否在落实培训中强调的内容。贷款需在6至12个月内连本带息偿还，利率为当地商业市场的标准利率。对于偿还了第一笔贷款的人（11家诊所），在2001年6月之后提供了第二笔贷款（平均742美元）。2002年2月至3月在相同的诊所进行了后续离职面谈。我们在诊所和客户层面评估了干预措施的效果。进行了t检验、方差分析和多变量逻辑回归分析。
由于在研究期间观察到了长期趋势，这些发现应谨慎解读。该干预措施与客户对在干预诊所接受的护理质量的看法改善有关。该干预措施还与更高水平的客户忠诚度有关。
助产士的热情回应和高贷款偿还率表明，助产士对小额信贷项目非常接受。总体而言，这些发现表明，小额信贷可能通过提高私营医疗服务提供者的商业技能和客户对服务的满意度，在加强私营部门卫生服务方面发挥重要作用。
