Access to and quality of health services are key determinants in utilization of health services and
consequently, health outcomes. By linking DHS household data and health facility survey data, this paper
explores the relationship between the service environment (service availability and readiness to provide a
service) and utilization and quality of health care obtained in several health areas in Haiti and Malawi. The
health areas included are family planning, maternal health care, child care, and HIV testing services in
Haiti, and malaria-related health care services in Malawi. Geographically appropriate buffer zones around
each cluster were determined based on area of residence—metropolitan, other urban, and rural areas in
Haiti and urban and rural areas in Malawi. For each health area, data from the facilities within the buffer
were summarized to cluster level to measure the cluster’s service environment relative to the health area
included in the buffer zone. These cluster-level data were then linked to individual women in the household
surveys. As expected, for all the health services examined in Haiti, clusters in the metropolitan area were
linked to a much greater number of health facilities than clusters in other urban and rural areas. For most
health areas, a significant association was found in rural areas (and other urban areas in Haiti) between
access to or readiness of service provision and utilization of health services. The relationship does not hold
however in the metropolitan area in Haiti; more precise measurements of the health service environment
would be needed for areas with both high density of health facilities and population.