Accessibility of Primary Health Care Services

Handiness of Primary Health Care Services: A Case Study of Kadakola Primary Health Centre in Mysore District

Abstraction

Primary Health Care Centres are established with the purpose to supply accessible, low-cost and available primary wellness attention to the common people at their door measure, with specific focal point on the rural and vulnerable subdivisions. The success of PHC lies in the maximal use of its services by the people. But many studies ( NFHS-2, NSSO ) and surveies have pointed out that use of PHC services is low both in rural and urban countries, as it is influenced by legion factors.

Unless these factors are identified and the steps taken, the end of “Universal Health Care and Health for All” may non be achieved.

In this background the present paper efforts to analyze the degree of use of PHC services in rural countries and attempts to track the factors act uponing the handiness of PHC services. For this intent a Case Study of Kadakola PHC has been undertaken.

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For the interest of analysis, techniques like Dummy arrested development, Correlation and Chi-square have been employed. It is found that merely 82 % of people have entree to PHC. The major ground for non accessing PHC services are income degree, distance and instruction degree. The distance to the PHC is the major determiner to the entree of wellness attention services as it is found to be important at 10 % degree.

Cardinal words:Primary Health Care Centre, Health Care Services, Accessibility

Introduction

Primary Health Care defined as an indispensable wellness attention which should be based on practical, scientifically sound and socially acceptable method and engineering ( WHO & A ; UNICEF 1978 ) .

It should be universally accessible by the persons and the household in the community through full engagement. It is to be made available at a cost which the community and the state can afford to keep at every phase of its development in a spirit of autonomy and self-government ( Roy, Somnath 1985 ) .

The World Bank Organisation Alma-Ata Declaration defined Primary Health Care as integrating healing intervention given by the first contact supplier along with promotional, preventative and rehabilitative services provided by multi-disciplinary squads of health-care professionals working collaboratively ( hypertext transfer protocol: //ama.com.au/position-statement/primary-health-care-2010 ) .

PHC is the first degree of contact of the persons, the household and the community with the National Health System, conveying wellness attention every bit near as possible to where the common people live and work.

Entree to Medical services has historically been used as a step of a just distribution. The construct of equality of entree to wellness attention is a cardinal aim of many wellness systems. It implies that persons should be given equal chance to utilize wellness services without respect to other features such as their income, ability to pay, ethnicity, or country of abode ( Sundar, 2009 ) .

“Access” word itself created much perplexity about its significance and measuring ; In this respect many treatments were held and legion definitions were proposed such every bit Access as Utilization of health care, Access as Maximum Attainable Consumption of Healthcare and Access as Foregone Utility Cost of obtaining Healthcare and so on. But it was found that entree in footings of a use of health care is the most often used definition of equal entree in empirical surveies ( Ibid ) .

Reappraisal of literature

Polluste, Kallikorm(2011 ) in their cross-sectional survey titled“Satisfaction with Access to Health Services: The Perspective of Estonian Patients with Rheumatoid Arthritis”explained the possible determiners of satisfaction with entree to wellness services in patients with arthritic arthritis ( RA ) . The consequences demonstrated that Estonian RA patients are satisfied with their entree to wellness services. Factors that had a negative impact on satisfaction included hurting strength, longer waiting times to see the physicians, every bit good as low satisfaction with the physicians. Transportation system costs to see a rheumatologist and higher rehabilitation disbursals besides affected the grade of satisfaction. Patients who could take the day of the month and clip at which they could see the rheumatologist or who could see their “own” physician were more likely to be satisfied than patients whose appointment times were appointed by a health care supplier. In add-on, the satisfaction with one’s Family Doctor and rheumatologist played a important function in people’s satisfaction with their entree to wellness services.

The survey byNteta, et.al, . (2010 ) investigated the handiness and use of the primary wellness attention services in three community wellness attention Centres in the Tshwane of the Gauteng state, South Africa. It showed that in footings of distance, the clinics were accessible as most of the participants lived within 5km of such a installation, and the Tuberculosis ( TB ) clinic was the most often visited service. Further it stated that long waiting line, deficiency of equipments, staff deficit, slow service bringing and negative attitude of wellness attention staff were major restraints in use of Community Health Centres.

Krajewski,Hameed, et.al. ,( 2009 )in their paper “Access to exigency operative attention: A comparative survey between the Canadian and American wellness attention systems” tried to find the differences in entree to exigency operative attention between Canada and the United States. The consequences suggested that entree to exigency operative attention is related to Socio Economic Status ( income ) in the United States, but non in Canada. This difference could ensue from the concern over the ability to pay medical measures or the deficiency of a stable relationship with a primary attention supplier that can happen outside a cosmopolitan wellness attention system.

DeVoe, Baez’s( 2007 ) survey “Health Care: Typology of Barriers to wellness attention entree for low-income families” was designed to place the barriers faced by low-income parents when accessing wellness attention for their kids and how insurance position affects their coverage of these barriers. Consequence showed that households reported 3 major barriers i.e. , deficiency of insurance coverage, hapless entree to services, and unaffordable costs.

Nair, Thankappan, Vasan( 2004 ) in their paper “Community Utilisation of Subcentres in Primary Health Care -- An Analysis of Determinants in Kerala” tried to place the determiners of use of subcentre services. It found that about 30 per cent of the donees utilized services of the subcentres during the mention period. And the territory in which a subcentre was physically present had extremely correlated with its use.

The survey on “Distance and Health Care Utilization among the Rural Elderly”by Nemet, Bailey( 2000 ),explored the relationship between distance and the use of wellness attention by a group of aged occupants in rural Vermont. The consequences confirm the thought that increased distance from supplier does cut down use ; they strongly suggest that distance to supplier is a alternate for location in a richer web of dealingss between occupants and their local communities.

The above literature reappraisal confirmed that the use of wellness attention services is influenced by a figure of factors such as income degree, distance, location of Centre, high cost, medical staff, substructure, insurance coverage and so on. In this respect the present paper efforts to analyze utilisation form of PHC services and the factors act uponing the handiness of PHC services in rural country.

Aims of the Study

1. To look into the handiness and use Pattern of Primary Health Care services in Study country.
2. To place the factors act uponing the handiness of Primary Health Care centres in rural country.

Hypothesiss

1. There is a important Use of PHC services in the topographic point where it is situated or physically found.
2. Education degree is negatively correlated with entree to PHC.
3. There is a important association between handiness of PHC services and Socio Economic Status ( Income degree ) .
4. Distance is a important factor act uponing use of PHC.

Sampling

By utilizing Simple random trying method 50 persons were interviewed severally in four subcentres of Kadakola PHC. Besides informal treatment was made with the Medical officer and Auxiliary Nurse Midwives and other staff of the PHC to cognize the current position of PHC and its history.

Data Collection

The present survey is strictly based on primary informations. The information is collected from good structured questionnaire semen agendas, where inquiries were asked about Age, Average income, Education, Awareness about PHC and authorities services, distance to PHC and other issues. In order to do the survey more representative, an effort was made to interview the persons indiscriminately from all the four subcentre countries, viz. Kadakola, Mandakalli, Sindhuvalli and Byathalli which come under Kadakola PHC.

Tools for Analysis

Along with Cross check, Custom tabular arraies, Bar and Pie chart, Correlation, Chi-Square for independency and Dummy arrested development techniques have been used to analyze the collected information.

Scope of the Study

Kadakola is a small town in Jayapura hobli of Mysore taluk in Mysore territory of Karnataka province. It is about 15 kilometers off from Mysore ) . It is besides recognised as an of import Industrial Development country ( hypertext transfer protocol: //www.onefivenine.com/india/villages/Mysore/Mysore/Kadakola ) .

The present survey is related to Kadakola PHC, which is physically found in Kadakola small town. It has a history of 20 old ages. It was upgraded to 24*7 PHC in the twelvemonth 2010 and recognised as figure 1 PHC in Mysore Taluk.

Note:**Approximate figure

*As on 2001 nose count

( )Figures in brackets indicates population

Restriction of the present survey

The information was collected in the month of February 2013 ; the response of the persons may change harmonizing to the clip and topographic point. Responses from the persons have a clip edge of one twelvemonth. Sample size is merely 50 which may non be sufficient to universe to measure the accurate and existent consequences.

Consequences and Findingss

Table 1: Demographic Profile of Respondents

Beginning: Primary Survey

The table1 reveals that out of 50 respondents studied 23 i.e. , 46 % are Female and 27 i.e. , 54 % are Male. There is greater fluctuation in the composing of age of respondents with, 24 ( 48 % ) belonging to 18-37 age group, highest among the three group. 16 ( 32 % ) belonging to 38-57 age group and a few i.e. , 10 between 58 to 77 age group. Sing the educational degree the tabular array reveals that 36 % i.e. , 18 of respondents are Illiterate and 64 % ( 32 ) are literate. It found that bulk of the literate respondents i.e. , 17 have completed their schooling between 7^Thursdayto 10^Thursdaycategory and a really few ( 3 ) completed Degree and Masters ( 1 ) besides.

Beginning: Primary Survey

The pie chart shows that 25 ( 50 % ) out of 50 respondents belong to below 4000 income group class. 36 % and 10 % of the respondents were under 4001-8000 and 8001-12000 income group class severally. The 12001-16000 and above 16000 income class had merely 1 respondent in each of them.

Table 2:Awareness on Primary Health Centre

Beginning: Primary Survey

Table 2 shows that out of 23 male respondents 7 i.e. , 31.8 % and 15 i.e. , 68.2 % out of 27 female respondents were non cognizant of the word PHC, with 16 of males and 12 of the females being cognizant of the word PHC. The aggregative figure reveals that 28 respondents out of 50 i.e. , 56 % were cognizant about PHC word. And besides found that 44 % i.e. , 22 of the respondents non even heard the word Primary Health Centre and they use to place them as Government Hospital.

Table 3:Awareness on Government Health Programmes

Beginning: Primary Survey

In the Table 3, a different form was observed associating to the consciousness about the authorities wellness programmes when compared to PHC consciousness between gender. It was found that out of 35 respondents 19 ( 54.3 % ) belong to female who have an information ( Aware of ) on Government wellness programmes such as 108 services, Madilu Kit, Janani Suraksha Yojana and Prasuthi Haaraike. This was observed because most of the adult females in the survey country benefited from the above programmes.

Table 4: Entree to Primary Health Centre

Beginning: Primary Survey

The above tabular array 4 indicates that major users of PHC are females, which comprises 23 respondents ( 56 % ) out of 41 users. It was found that most of them visited PHC for Maternity or Pregnancy check-ups.

Chart2 shows that out of 25 interviewed from & lt ; 4000 income group 20 ( 80 % ) are reported as a users of PHC for intervention other intent, followed by 88 % in 4001-8000 and 80 % in 8001-12000 income group. It was found that major users of PHC were the people whose income is between 4001-8000.

The above chart3 reveals that out of 18 nonreaders 15 ( 83 % ) are using PHC services, on the other manus literates histories merely 81 % ( 26 out of 32 ) .

Chart 4 shows that per centum of use of PHC was high in & lt ; 1km i.e. , really near ( 76 % ) and & gt ; 1 & lt ; 5km i.e. , small far ( 100 % ) class compared to & gt ; 5km i.e. , far group ( 66.7 % ) .

Hypothesiss proving

Hydrogen₁:“There is a important Use of PHC services in the topographic point where it was situated or physically found.”

Dummy Regression

Yttrium_I=b₁+b₂Calciferol_1i

Yttrium_I= No. of clip Visited to PHC

Calciferol₁= 1 for Kadakola, 0 otherwise

Yttrium_I= 8.956521739 +1.0805152298D₁

T = 3.850941747+0.341393592

( 0.000348097 ) * ( 0.734297329 ) *

Where * Indicates the P values.

The arrested development consequence shows that, the average visit to PHC in Kadakola is approximately 10 times ( 8.95+1.08 ) in a twelvemonth which is 1time greater than other part. The estimated coefficient of Dummy is non statistically important, as its P value is 73 per centum. Therefore we do non reject the Null hypothesis which states that the Utilisation of PHC services in other part is every bit same as PHC located topographic point.

Hydrogen₂:“There is a important negative correlativity between instruction degree and use of PHC.

The correlativity consequences indicate expected mark ( - ) in the instance of Visit to PHC and Total Number of Visits in the last one twelvemonth. It shows that Utilisation of PHC both in footings of Visit and Total figure of visits negatively associated with Education degree. But in the instance of Awareness on authorities programme unexpected negative mark was observed i.e. , negative association between instruction degree and aware of govt programmes. It was found that the correlativity between the variables was non found important.

Hydrogen₃:There is a important association between entree to PHC services and Socio-Economic Status of persons.

The correlativity consequences showed that entree to PHC is negatively correlated with income i.e. , -0.030 bespeaking negative association between entree to PHC and income. But the association between variables did non happen important with 0.835 P value. The Chi-square trial for independency besides provided the similar consequences i.e. , no important association exists between entree to PHC and ( SES ) Income ( entree to PHC and Income are independent ) .

Hydrogen₄:Distance is significantly act uponing on the use of PHC.

The Pearson Chi-square value 5.556 with 0.062 P ( P & lt ; 0.1 ) value indicated that use of PHC is significantly influenced by distance ( entree to PHC and distance are dependent ) . The dummy arrested development for distance ( really nigh, small far, far ) besides provided the similar consequence that use of PHC differs between distances and besides it revealed that the average visits to PHC significantly differ between really near and far group ( P & lt ; 0.1 ) i.e.,12 and 5mean visit per twelvemonth severally. It supported the earlier consequences that negative association between use of PHC and Distance.

Decision

Use of wellness attention services has become one of the great concerns in the country of just distribution of wellness services. In this respect the present paper made an effort to analyze the use form of Primary Health Centre services in rural country in signifier of gender, instruction, income and distance. It was found that in the survey country 82 % people are using PHC services. The consequences support earlier findings on relationship between Utilisation of PHC service and Education degree, Income and Distance ( NFHS-2, NSSO, Ghosh.BN and others ) .

The survey identified negative correlativity between instruction degree and consciousness on authorities programmes. It was found that use of PHC is negatively associated with instruction degree, income and distance. The distance was found to be the lone statistically important determiner. Thus the survey found that even though the Kadakola PHC is situated merely beside the main road many respondents find longer distance, hapless route and conveyance installations as major restraints in their handiness.

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Mention:

DeVoe, J. E. , Baez, A. , Angier, H. , Krois, L. , Edlund, C. , & A ; Carney, P. A. ( 2007 ) . Insurance+ access? wellness attention: typology of barriers to wellness attention entree for low-income households.The Annals of Family Medicine,5( 6 ) , 511-518.

Gujarati, D.N. , Sangeetha. ,Basic Econometricss, New Delhi: Tata McGraw-Hill, 2007.

Ghosh, B.N, Mukherjee, A.B. ( 1989 ) . An Analysis of wellness services coverage of a primary wellness Centre in West Bengal.Indian Journal of Public Health, 33, 26-3.

hypertext transfer protocol: //ama.com.au/position-statement/primary-health-care-2010

Krajewski, S. A. , Hameed, S. M. , Smink, D. S. , & A ; Rogers Jr, S. O. ( 2009 ) . Access to exigency operative attention: a comparative survey between the Canadian and American wellness attention systems.Surgery,146( 2 ) , 300.

Nteta, T. P. , Mokgatle-Nthabu, M. , & A ; Oguntibeju, O. O. ( 2010 ) . Use of the primary wellness attention services in the Tshwane Region of Gauteng Province, South Africa.PloS one,5( 11 ) , e13909.

Nair, V. M. , Thankappan, K. R. , Vasan, R. S. , & A ; Sarma, P. S. ( 2004 ) . Community use of subcentres in primary wellness attention -- an analysis of determiners in Kerala.Indian diary of public wellness,48( 1 ) , 17.

Nemet, G. F. , & A ; Bailey, A. J. ( 2000 ) . Distance and wellness attention use among the rural aged.Social Science & A ; Medicine,50( 9 ) , 1197-1208.

Polluste, K. , Kallikorm, R. , Meiesaar, K. , & A ; Lember, M. ( 2012 ) . Satisfaction with Access to Health Services: The Perspective of Estonian Patients with Rheumatoid Arthritis.The Scientific World Journal,2012.

Roy, Somnath ( 1985 ) : Primary Health Care in India. Technical Paper 5. National Institute of Health and Family Welfare, New Delhi.Health and Population: Perspective and Issues, 8, 135-167.

Sundar I. ,Principles of Health Economics, New Delhi: Sarup Book Publishers, 2009, p. 3.

Ibid. , pp 191-192.

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