Introduction
Methodology
Research design
Study geography
Sampling of respondents
Survey quality
Data analysis
Results
Profile of respondents
Utilisation of primary healthcare facilities for OPD services
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Utilisation by type of facilitiesThe efficient utilisation of primary health facilities is critical to the improvement of service delivery of healthcare system as they will not only alleviate the burden on the secondary and tertiary health care facilities but also reduces beneficiaries’ out-of-pocket expenditure. In rural areas, however limited, but still there are options available to select the health facility for treatment. The analyzed data of respondents reveals that barring 29% of ‘no treatment’ cases, the share of public health facilities, namely PHC, Community Health Center (CHC), and District Hospital (DH) was 35%, and private1 36% (see Fig. 1). In a study conducted on the utilisation of rural PHCs in South India by Sivanandan et al., only 44.5% of individuals visited any health facility of which the proportion of people seeking care at rural PHCs was 70.4% [25]. According to our study, 70.86% of the total 460 patients had received treatment at any health facility, either public or private. Excluding the ‘no treatment’ cases, 14.72% had received treatment at primary health centers. However, within public health facilities this share of PHC was 29.81%, which shows a huge scope to shift the load of higher facilities towards primary health centers in rural Rajasthan.
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Utilisation of health facilities by type of diseasePHCs are the first point of contact to access the primary health services and continuum of care for both communicable and non-communicable diseases. Non-Communicable Diseases (NCDs) show a higher prevalence (64.1%) followed by Communicable Diseases (CDs) at 30.7% and injury at only about 5% in the studied PHCs. In context to facility utilisation, regardless of CD, NCD, or injury cases, a larger proportion of patients were going to private health facilities for treatment than public health facilities (see Fig. 2). In the 30 days before the survey, about 35% of those with CDs, 26.4% of those with NCDs, and 29% of those with injuries did not seek OPD treatment. The disease-wise distribution of public health facilities demonstrates that the share of PHCs is higher in CDs, even though the load is obvious in district hospitals. PHCs outnumber CHCs and DHs by a wide margin, but the data shows that they are currently bearing a disproportionate share of responsibility for treating patients.
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Utilisation of health facilities by socio-economic profilePrimary health facilities are meant for people of all segments of society. However, the variations are found in their utilisation based on different socio-economic characteristics. In the study the analysis in Table 1 reveals that people of age 45 and above were the most likely to seek treatment, while those below 29 were the least likely (56%). Patients aged 45 and older make up nearly half (47.9%) of PHC’s patient population. In contrast, PHC has the highest percentage of people between the ages of 30–45 (29.2%), more than any other facility category. Gender-wise analysis shows that females were less likely to seek treatment in comparison to males. However, among women the PHC uptake is highest among all the facilities. It suggest that women have easier access to PHCs but not to other higher facilities like their male counterparts. Married people reported higher rates of OPD utilisation than those who had never been married or were widowed. There was a higher rate of treatment-seeking behaviour among those educated up to middle and above (72.4%) and it declined as education level declined, with only 59% among non-literate individuals. But those who were going to PHC and to private healthcare facilities for OPD services, the majority were nonliterate. The social composition of respondents shows that the majority of patients taking treatment at district hospitals and private institutions were from the OBC (Other Backward Castes) group, whereas the shares of SC (43.8%) and ST (52.3%) was higher at PHCs and CHCs, respectively.The studies shows that poor people are benefited more from primary health care services [26]. Our research also shows that higher proportion of patients (42%) at PHCs belong to lowest wealth quintile, whereas the middle and upper wealth quintiles each account for 29% of patients. Private health facilities have a higher variance in the wealth quintile of patients, ranging from 26.7% in the lowest to 41.8% middle quintile, whereas CHC has a lower variation, ranging from 29.5% (middle) to 36% (highest). At district hospital it ranges from 27% in the richest quintile to 39% in the lowest quintile. The majority of those who did not seek treatment were in the 45+ age group, male (56.7%), and nonliterate but the proportion was almost equal in the lowest and highest quintiles .
PHC (%) | CHC (%) | DH (%) | Private facilities (%) | No treatment (%) | Total (N) | |
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Age in years (%)
| ||||||
Below 29 | 22.9 | 20.5 | 20.3 | 28.5 | 32.8 | 125 |
30–45 | 29.2 | 25.0 | 20.3 | 20.0 | 23.1 | 103 |
45+ | 47.9 | 54.5 | 59.4 | 51.5 | 44.0 | 232 |
Sex (%)
| ||||||
Male | 52.1 | 70.5 | 71.0 | 58.2 | 56.7 | 277 |
Female | 47.9 | 29.5 | 29.0 | 41.8 | 43.3 | 183 |
Marital Status (%)
| ||||||
Never Married | 18.8 | 15.9 | 11.6 | 18.8 | 27.6 | 92 |
Married | 66.7 | 77.3 | 84.1 | 72.1 | 67.2 | 333 |
Widow/Divorce | 14.6 | 6.8 | 4.3 | 9.1 | 5.2 | 35 |
Education (%)
| ||||||
Non-literate | 60.4 | 56.8 | 23.2 | 47.9 | 41.0 | 204 |
Primary | 18.8 | 22.7 | 43.5 | 25.5 | 31.3 | 133 |
Middle/Above | 20.8 | 20.5 | 33.3 | 26.7 | 27.6 | 123 |
Religion (%)
| ||||||
Hindu | 93.8 | 97.7 | 97.1 | 97.6 | 97.8 | 447 |
Muslim/Sikh/Bodh | 6.3 | 2.3 | 2.9 | 2.4 | 2.2 | 13 |
Caste (%)
| ||||||
SC | 43.8 | 25.0 | 13.0 | 20.6 | 27.6 | 112 |
ST | 31.3 | 52.3 | 13.0 | 28.5 | 24.6 | 127 |
OBC | 20.8 | 20.5 | 69.6 | 42.4 | 41.8 | 193 |
Other | 4.2 | 2.3 | 4.3 | 8.5 | 6.0 | 28 |
Wealth (%)
| ||||||
Lowest | 41.7 | 36.4 | 39.1 | 26.7 | 36.6 | 156 |
Middle | 29.2 | 29.5 | 33.3 | 41.8 | 27.6 | 156 |
Highest | 29.2 | 34.1 | 27.5 | 31.5 | 35.8 | 148 |
Total (N)
|
48
|
44
|
69
|
165
|
134
|
460
|
Reasons for taking treatment at different health facilities
Reasons | PHC (%) | CHC (%) | DH (%) | Private facilities (%) | Total |
---|---|---|---|---|---|
It is near to our homes | 66.7 | 20.5 | 5.8 | 5.5 | 16.6 |
Facility timings are convenient to visit | 25.0 | 27.3 | 31.9 | 19.4 | 23.9 |
Health personnel are often present | 18.8 | 29.6 | 37.7 | 22.4 | 26.1 |
Waiting time is within 15 minutes | 10.4 | 2.3 | 42.0 | 13.3 | 17.5 |
Health personnel are attentive and polite | 22.9 | 18.2 | 34.8 | 21.8 | 24.2 |
Quality of care is good | 20.8 | 36.4 | 71.0 | 59.4 | 53.1 |
Required services were available | 33.3 | 38.6 | 66.7 | 41.8 | 45.4 |
Availability of free medicine | 41.7 | 54.6 | 42.0 | 10.9 | 27.9 |
Total (N) | 48 | 44 | 69 | 165 | 326 |
Logistic regression
Background characteristics | Odds Ratio | [95% Conf. Interval] | |
---|---|---|---|
Age in years | |||
Below 29® | |||
30–45 | 1.770 | 0.495 | 6.326 |
45+ | 1.181 | 0.311 | 4.492 |
Sex | |||
Male® | |||
Female | 1.202 | 0.572 | 2.525 |
Marital Status | |||
Never Married® | |||
Married/other | 0.898 | 0.260 | 3.098 |
Widow/Divorce | 1.025 | 0.202 | 5.197 |
Education | |||
Non-literate® | |||
Primary | 0.418* | 0.163 | 1.072 |
Middle and above | 0.509 | 0.178 | 1.460 |
Caste | |||
SC® | |||
ST | 1.340 | 0.515 | 3.486 |
OBC | 0.363** | 0.150 | 0.880 |
Other | 0.478 | 0.081 | 2.807 |
Wealth | |||
Lowest® | |||
Middle | 0.364** | 0.145 | 0.915 |
Highest | 0.298** | 0.118 | 0.753 |
Disease | |||
Communicable® | |||
Non-communicable | 0.813 | 0.378 | 1.753 |
Injury | 0.261 | 0.028 | 2.407 |
Distance | |||
< 5 km® | |||
5–9 km. | 0.272** | 0.122 | 0.610 |
10+ km. | 0.203*** | 0.076 | 0.539 |
Facility Preparedness | |||
Low® | |||
Medium | 3.584** | 1.262 | 10.177 |
High | 9.740*** | 2.856 | 33.217 |
Ranking the reasons to visit PHCs
Suggestions of the respondents
Suggested Factors | (%) N = 217 | |
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Accessibility | The facility staff should increase its reach | 54.4 |
Facility should be near | 45.6 | |
The facility should have Ambulance services | 28.1 | |
Infrastructure | The facility should have more equipment / Medicine in the facility | 33.6 |
Hygienic environment in facility should be provided | 27.2 | |
Diagnosis through innovative and advance equipment | 41.5 | |
Service Delivery | The health workers should have more home visit | 31.8 |
Waiting time should be reduce | 38.2 | |
Quality of care should be improved | 36.4 | |
Free treatment and Medicine | 33.6 | |
Human Resource and capacity building | Availability of trained staff | 32.7 |
Facility should have more female staff/doctors | 27.6 | |
The staff needs to be more trained in soft skills | 27.2 |