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2252
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t
s
i
s
t
h
e
mi
l
e
s
t
o
n
e
to
r
e
a
c
h
c
l
i
e
n
t
s
’
s
a
t
i
s
f
a
c
t
i
o
n
a
n
d
c
o
n
t
i
n
uo
us
im
pr
o
v
e
m
e
n
t
o
f
qua
li
t
y
o
f
c
a
r
e
”
[
13]
.
I
n
t
hi
s
s
t
ud
y
,
t
h
e
r
e
s
u
l
t
s
r
e
ga
r
d
i
ng
h
e
a
l
t
h
e
duc
a
t
i
o
n
pr
o
vi
s
i
o
n
by
s
t
a
f
f
a
n
d
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
l
e
v
e
l
s
h
o
we
d
t
h
a
t
m
a
j
o
r
i
t
y
o
f
t
h
e
c
li
e
n
t
s
we
r
e
n
o
t
s
a
t
i
s
f
i
e
d
w
i
t
h
t
h
e
c
o
m
muni
c
a
t
i
o
n
s
k
i
ll
s
a
n
d
e
duc
a
t
i
o
n
o
r
i
nf
o
r
m
a
t
i
o
n
g
i
v
e
n
by
t
he
h
e
a
l
t
h
c
a
r
e
s
t
a
f
f
.
T
h
e
m
a
j
o
r
i
t
y
o
f
t
h
e
c
li
e
n
t
s
i
n
t
e
r
vi
e
w
e
d
a
gr
e
e
d
t
ha
t
t
h
e
y
o
b
t
a
i
n
e
d
a
l
l
t
he
dr
ugs
t
h
a
t
pr
e
s
c
r
i
b
e
d
f
o
r
t
h
e
m
.
Ho
we
v
e
r
,
s
o
m
e
d
i
s
a
gr
e
e
d
a
n
d
c
l
a
im
e
d
to
p
ur
c
h
a
s
e
f
r
o
m
o
ut
s
i
d
e
t
h
e
h
o
s
p
i
t
a
l
.
Ava
i
l
a
bil
i
t
y
o
f
e
s
s
e
n
t
i
a
l
dr
ugs
i
s
a
n
im
po
r
t
a
n
t
f
a
c
t
o
r
i
nf
l
u
e
n
c
i
ng
pa
t
i
e
n
t
s
’
lev
e
l
o
f
s
a
t
i
s
f
a
c
t
i
o
n
o
bs
e
r
ve
d
i
n
s
e
v
e
r
a
l
s
t
ud
i
e
s
i
n
d
i
f
f
e
r
e
n
t
s
e
tt
i
n
g
s
[
7
]
,
[
14
]
-
[
16
]
.
I
n
t
hi
s
s
t
ud
y
t
h
e
r
a
n
ke
d
a
r
e
a
s
f
o
r
a
s
s
e
s
s
i
ng
t
h
e
c
l
i
e
n
t
s
l
e
ve
l
o
f
s
a
t
i
s
f
a
c
t
i
o
n
wa
s
a
c
c
e
s
s
i
b
il
i
t
y
o
f
s
e
r
vi
c
e
s
,
b
e
h
a
vi
o
r
o
f
s
t
a
f
f
,
he
a
l
t
h
e
duc
a
t
i
o
n
,
c
l
e
a
nli
ne
s
s
,
a
n
d
dr
ug
a
v
a
il
a
bil
i
t
y
.
“
No
t
a
s
i
n
g
l
e
r
a
n
ke
d
a
r
e
a
o
f
s
a
t
i
s
f
a
c
t
i
o
n
wa
s
n
o
t
i
c
e
d.
T
a
n
z
a
ni
a
,
pa
t
i
e
n
t
s
’
a
l
s
o
s
h
o
we
d
o
v
e
r
a
ll
d
i
s
s
a
t
i
s
f
a
c
t
i
o
n
w
i
t
h
t
h
e
qua
li
t
y
o
f
c
a
r
e
.
T
h
e
r
a
n
ke
d
a
r
e
a
s
i
n
t
hi
s
s
t
ud
y
we
r
e
a
s
s
ur
a
nc
e
,
r
e
l
i
a
bi
li
t
y
,
t
a
n
g
i
bl
e
,
e
m
p
a
t
hy
,
a
n
d
r
e
s
po
n
s
i
ve
ne
s
s
[
17]
.
Ac
c
o
r
di
n
g
to
I
n
d
i
a
n
s
t
ud
y
,
t
h
e
m
a
i
n
f
a
c
t
o
r
s
n
ot
i
c
e
d
to
a
f
f
e
c
t
i
n
g
t
h
e
ut
i
li
z
a
t
i
o
n
o
f
pr
i
m
a
r
y
h
e
a
l
t
h
c
a
r
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r
vi
c
e
s
we
r
e
e
a
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y
a
c
c
e
s
s
i
bil
i
t
y
,
l
o
w
c
o
s
t
,
l
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s
s
wa
i
t
i
ng
t
i
m
e
,
a
n
d
pr
e
s
e
n
c
e
o
f
c
oo
pe
r
a
t
i
v
e
s
t
a
f
f
[
11]
.
5.
CONC
L
USI
ON
OF
T
HE
S
T
UD
Y
I
t
c
o
n
c
l
ud
e
d
t
h
a
t
41
.
3%
o
f
t
h
e
c
l
i
e
n
t
s
we
r
e
s
a
t
i
s
f
ied
w
i
t
h
t
h
e
s
e
r
vi
c
e
s
pr
o
vi
de
d
by
t
h
e
B
HU
s
.
T
h
e
f
a
c
t
o
r
s
i
de
n
t
i
f
i
e
d
t
o
de
t
e
r
m
i
ne
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
we
r
e
a
c
c
e
s
s
i
b
il
i
t
y
o
f
s
e
r
vi
c
e
s
,
b
e
ha
vi
o
r
o
f
s
t
a
f
f
,
h
e
a
l
t
h
e
duc
a
t
i
o
n
,
l
e
v
e
l
o
f
c
l
e
a
nl
i
ne
s
s
,
dr
ug
a
v
a
il
a
bil
i
t
y
a
n
d
mi
s
c
e
ll
a
n
e
o
us
s
e
r
vi
c
e
s
.
Not
a
s
i
n
g
l
e
r
a
n
k
e
d
a
r
e
a
o
f
s
a
t
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f
a
c
t
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o
n
n
o
t
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c
e
d.
C
l
i
e
n
t
’
s
o
c
c
upa
t
i
o
n
a
n
d
i
nc
o
m
e
h
a
d
s
i
g
ni
f
i
c
a
n
t
r
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l
a
t
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n
s
hi
p
w
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t
h
t
h
e
pa
t
i
e
n
t
s
a
t
i
s
f
a
c
t
i
o
n
l
e
v
e
l
.
Ge
n
de
r
,
a
ge
,
a
n
d
e
duc
a
t
i
o
n
o
f
c
l
i
e
n
t
s
we
r
e
not
c
o
n
tr
i
b
ut
i
n
g
f
a
c
to
r
s
;
t
h
e
y
n
o
t
a
f
f
e
c
t
t
h
e
s
a
t
i
s
f
a
c
t
i
o
n
l
e
v
e
l
o
f
t
h
e
c
l
i
e
n
t
s
.
I
t
r
e
c
o
m
m
e
n
de
d
t
h
a
t
Ho
s
pi
t
a
l
m
a
n
a
ge
m
e
n
t
s
h
o
u
l
d
f
o
c
us
o
n
t
h
e
qua
l
i
t
y
,
r
e
s
po
n
s
i
v
e
n
e
s
s
o
f
s
e
r
vi
c
e
s
.
T
h
e
r
e
s
h
o
u
l
d
b
e
a
f
o
c
us
o
n
i
m
pr
o
vi
ng
t
h
e
c
o
m
m
u
ni
c
a
t
i
o
n
s
k
il
l
s
o
f
s
t
a
f
f
i
n
t
e
r
m
s
o
f
c
o
m
pa
s
s
i
o
n
,
po
l
i
t
e
n
e
s
s
a
n
d
a
c
t
i
v
e
li
s
t
e
ni
ng
by
t
a
nni
ngs
.
I
n
a
dd
i
t
i
o
n
,
t
h
e
h
o
s
p
i
t
a
l
m
a
n
a
ge
m
e
n
t
s
h
o
u
l
d
f
o
c
us
o
n
t
h
e
c
l
e
a
nli
ne
s
s
o
f
t
h
e
h
e
a
l
t
h
f
a
c
il
i
t
y
.
AC
K
NOWL
E
DGE
M
E
NT
T
h
e
a
ut
h
o
r
s
w
o
ul
d
li
ke
to
s
i
n
c
e
r
e
l
y
t
h
a
n
k
da
t
a
c
o
l
l
e
c
t
o
r
s
a
n
d
s
t
udy
pa
r
t
i
c
i
pa
n
t
s
wh
o
e
v
e
r
c
o
n
t
r
i
b
ut
e
d
f
o
r
t
hi
s
wo
r
k.
RE
F
E
R
E
NC
E
S
[1
]
D
e
Si
l
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a
A
.
an
d
V
a
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N
.
,
“
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fra
mew
o
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k
fo
r
me
as
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p
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n
s
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v
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s
,”
W
o
r
l
d
H
e
al
t
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O
rg
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o
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e
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[2
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g
ar
w
a
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.
,
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ec
t
o
r
r
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s
:
R
el
e
v
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a
,”
In
d
i
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Jo
u
r
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Co
m
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,”
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u
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r
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[4
]
Bab
a
I
.
,
“
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x
p
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e
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ce
s
i
n
q
u
a
l
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t
y
as
s
u
ran
ce
at
b
a
w
k
u
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o
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p
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d
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p
art
men
t
,
G
h
an
a
,”
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m
m
u
n
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a
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[5
]
A
n
j
u
m
J
.
,
“
Pat
i
e
n
t
Sat
i
s
fa
c
t
i
o
n
t
o
w
ard
s
O
u
t
Pat
i
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n
t
D
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p
art
m
en
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e
rv
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Pa
k
i
s
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an
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f
M
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c
al
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c
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en
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s
,
”
I
s
l
a
m
ab
ad
,
Ma
h
i
d
o
l
U
n
i
v
e
rs
i
t
y
,
2005.
[6
]
K
u
z
m
a
J
.
,
et
a
l
.
,
“
A
s
s
e
s
s
m
en
t
o
f
p
at
i
e
n
t
s
'
s
at
i
s
fac
t
i
o
n
w
i
t
h
ru
ral
h
e
al
t
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s
e
r
v
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ce
s
,
”
2012.
[7
]
A
s
s
e
fa
F
.
an
d
M
o
s
s
e
A
.
,
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s
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en
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o
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s
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t
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[8
]
Man
d
o
k
h
a
i
l
A
.
K.
,
“
Pat
i
e
n
t
s
at
i
s
fac
t
i
o
n
t
o
w
ard
s
O
u
t
p
at
i
en
t
D
e
p
art
m
en
t
(O
PD
)
Se
rv
i
ce
s
o
f
me
d
i
c
i
n
e
i
n
Ban
p
h
ae
o
A
u
t
o
n
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mo
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s
H
o
s
p
i
t
al
Sa
m
u
t
Sak
h
o
n
Pr
o
v
i
n
ce
,
”
T
h
a
i
l
a
n
d
,
Mah
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d
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v
e
rs
i
t
y
,
2007.
[9
]
V
ad
h
a
n
a
M.
,
“
A
s
s
e
s
s
m
en
t
o
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p
at
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art
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n
P
h
n
o
m
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h
,
”
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m
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d
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a
,
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t
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me
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s
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a
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ci
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U
n
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t
y
,
2
0
1
2
.
[1
0
]
U
p
re
t
i
S.
,
“
Co
n
s
u
me
r
Sat
i
s
fac
t
i
o
n
t
o
w
ard
s
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e
al
t
h
ce
n
t
e
rs
i
n
Su
p
h
a
n
b
u
ri
p
ro
v
i
n
ce
,
T
h
ai
l
an
d
,”
MPH
M
T
h
e
s
i
s
i
n
Pri
m
ar
y
H
e
al
t
h
Car
e
Man
a
g
eme
n
t
,
Ba
n
k
o
k
,
Facu
l
t
y
o
f
G
rad
u
at
e
s
t
u
d
i
e
s
,
Mah
i
d
o
l
U
n
i
v
e
rs
i
t
y
,
1994.
[1
1
]
Ras
h
ee
d
N
.
,
et
a
l
.
,
“
Cl
i
en
t
Sat
i
s
fac
t
i
o
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p
t
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ar
y
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e
al
t
h
Cen
t
re
o
f
D
el
h
i
,
In
d
i
a
,”
In
d
i
a
n
Jo
u
r
n
a
l
o
f
Co
m
m
u
n
i
t
y
H
ea
l
t
h
,
v
o
l
/
i
s
s
u
e:
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4
(3
)
,
p
p
.
2
3
7
-
42
,
2
0
1
2
.
[1
2
]
Sh
re
s
h
t
a
A
.
,
et
a
l
.
,
“
Pat
i
e
n
t
s
at
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fac
t
i
o
n
at
ru
ra
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o
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a
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en
t
al
c
a
m
p
s
-
a
o
n
e
y
ear
r
e
p
o
rt
,”
Th
e
In
t
er
n
a
t
i
o
n
a
l
E
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r
o
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i
c
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u
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em
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e
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ea
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t
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R
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,
E
d
u
ca
t
i
o
n
.
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r
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ce
a
n
d
P
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cy
,
p
p
.
1
-
6
,
2
0
0
8
.
[1
3
]
L
i
k
u
n
P.
,
“
St
ra
t
e
g
i
c
i
s
s
u
e
s
fo
r
r
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d
u
c
i
n
g
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at
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t
w
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d
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ro
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at
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t
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w
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e
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at
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e
n
t
d
e
p
art
men
t
o
f
fi
rs
t
affi
l
i
at
ed
,”
K
u
n
m
i
n
g
M
e
d
i
c
a
l
co
l
l
e
g
e,
PRC
A
,
MS
T
h
e
s
i
s
i
n
H
e
al
t
h
D
ev
e
l
o
p
men
t
Pro
g
r
am
,
Ban
g
k
o
k
,
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c
u
l
t
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f
G
rad
u
at
e
St
u
d
i
e
s
,
C
h
u
l
al
o
n
g
k
o
rn
U
n
i
v
e
rs
i
t
y
,
1996.
[1
4
]
J
ac
k
s
o
n
J
.
L
.
,
et
a
l
.
,
“
Pre
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c
t
o
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p
at
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fac
t
i
o
n
,”
S
o
c
i
a
l
s
ci
e
n
ce
&
m
ed
i
ci
n
e
,
v
o
l
/
i
s
s
u
e
:
5
2
(4
)
,
p
p
.
6
0
9
-
20
,
2
0
0
1
.
[1
5
]
L
e
s
h
ab
ari
M
.
T
.
,
et
a
l
.
,
“
Mo
t
i
v
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i
o
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o
f
h
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al
t
h
c
ar
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o
rk
e
rs
i
n
T
an
za
n
i
a
:
a
c
as
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s
t
u
d
y
o
f
Mu
h
i
m
b
i
l
i
N
at
i
o
n
al
H
o
s
p
i
t
al
,”
2008.
[1
6
]
Q
u
i
n
t
an
a
J
.
M
.
,
et
a
l
.
,
“
Pre
d
i
c
t
o
rs
o
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p
at
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s
at
i
s
fa
c
t
i
o
n
w
i
t
h
h
o
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p
i
t
al
h
e
a
l
t
h
c
ar
e.
BMC
h
e
al
t
h
s
e
rv
i
ce
s
re
s
e
ar
c
h
,”
v
o
l
/
i
s
s
u
e:
6
(1
)
,
p
p
.
1
0
2
,
2
0
0
6
.
[1
7
]
K
h
a
m
i
s
K
.
an
d
N
j
a
u
B.
,
“
Pat
i
e
n
t
s
'
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ar
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D
ar
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s
Sal
aa
m
,
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an
zan
i
a
,”
B
M
C
h
ea
l
t
h
s
er
v
i
ces
r
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s
e
a
r
ch
,
v
o
l
/
i
s
s
u
e:
1
4
(1
)
,
p
p
.
4
0
0
,
2
0
1
4
.
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