Utilisation of rural primary health centers for outpatient services - a study based on Rajasthan, India

Abstract

Introduction Outpatient services are crucial for strengthening primary healthcare and reducing out-of-pocket spending, which has been one of the major causes of impoverishment. So it is also critical to comprehend the people’s preferences in accessing primary healthcare facilities, as government primary healthcare facilities in India are underutilized. The current paper explores the factors that construct the individual’s decision to seek outpatient care in primary healthcare facilities in India’s largest state Rajasthan. Methods It was a cross-sectional survey conducted in 72 primary sample units of 24 primary health centers in 11 districts of Rajasthan, India, from November 2019 to January 2020. The study selected 368 households through purposive sampling. Out of 368 households, 460 people reported any illness and 326 reported outpatient visit to any health facility in the last 30 days from the date of the survey. Analysis The focus was on analyzing the data in the context of public and private health facilities to understand the factors influencing people’s choice to access outpatient services. The principal component analysis is used to understand the relationship between facility preparedness and OPD uptake. Also, multivariate logistic regression is applied to assess the significant predictors in using primary health facility services. Result Except for the 29% of patients who received no care, the proportion of patients attended public health facilities was 35%, and the rest were utilizing private health facilities. Those who sought care at PHCs were mostly over 45 years age, non-literate, and from the lowest wealth quintile. Logistic regression suggests that people belong to upper wealth quintile (OR = 0.298; 95% 0.118–0.753) are less likely to visit PHCs for treatment. Also, increase in distance of PHC (OR = 0.203; 95% CI 0.076–0.539) reduces the likelihood of their visit outpatient care. People are 9.7 times (OR = 9.740; 95% CI 2.856–33.217) more likely to visit a PHCs that are better equipped in terms of human resources, equipment, and medicine. Conclusion The uptake of PHCs depends on several factors, which should be considered to ensure that all segments of society have equitable access to them. Through improved accessibility and quality of service, PHCs can be made more appealing to the larger population.

Can the Emergency Medical Service (EMS) System Help in Improving the Healthcare Access – Evidence from Maharashtra EMS

“…Care through OPD service is crucial for developing and strengthening primary healthcare and reducing the out-of-pocket (OOP) expenditure. [ 14 ] The role of PHCs is important as it can address 80% of the health needs of people and thus reduce the OPD care cost. [ 15 ] Therefore, the availability of doctors in PHCs will add a huge value in the health care system and also improve the accessibility to a greater extent.…”

How useful do communities find the health and wellness centres? A qualitative assessment of India’s new policy for primary health care

“…According to the community feedback received in our study, the different essential components of care such as medicines and tests were available in HWCs. Earlier studies have shown that availability of free medicines is important for government facilities to attract enough patients and to meet their treatment needs [ 23 ]. People appreciated that HWCs provided screening and follow-up and not just episodic care.…”

“…This represents a significant advancement as primary care delivered by public sector in India has often been criticised for offering selective primary care [ 10 , 24 , 25 ]. An earlier study had reported that people used the government primary facilities mainly for maternal and child care services [ 23 ]. This was because the PHCs and SHCs provided very few services other than those related to maternal and child health [ 23 – 25 ].…”

“…An earlier study had reported that people used the government primary facilities mainly for maternal and child care services [ 23 ]. This was because the PHCs and SHCs provided very few services other than those related to maternal and child health [ 23 – 25 ]. A study on evolution of the PHCs in India has shown that their services were shaped by vertical programmes which were selective, top-down and target driven in nature [ 26 ].…”

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“…Rural healthcare delivery and utilization form another significant area of study. Srivastava et al (2023) investigate the use of rural primary health centers, focusing on outpatient services in Rajasthan. This research is integral in assessing the effectiveness of primary healthcare infrastructure in rural areas, which is often the first point of contact for the rural populace.…”