|Author(s):||A. K. Aggarwal1|
|Affiliation(s):||1School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India|
|Keywords:||Reproductive health, access, quality of care, community survey|
Better access to healthcare is a global challenge. Increased amounts of funds are allocated nationally and internationally to improve access. Therefore, understanding access at local levels helps to focus the policies and strategies.
To study utilization of pubic health facilities for reproductive healthcare. 2) To identify important access issues from community’s perspectives.
Women tend to consult government and private doctors for the problems associated with use of family planning method. For reproductive tract problems, however, private doctors are preferred over govt. doctors. For institutional deliveries and emergency obstetric care this gap was much more pronounced, with private practitioners taking the lead over govt. health institutions. The major reasons for these as elicited through various focused group discussions were uncaring attitude of health service provider, resulting in delayed initiation of treatment. Other important reasons from community’s perspective were lack of availability of govt. doctors, and insufficient medicines. Lack of faith in public health services drives them to private practitioners that are costlier. Treatment often gets delayed in the process of arranging money. Such delays become fatal for maternal complications, as was evident from maternal mortality enquiry. Health centres were observed for availability of health facilities. Only 56% sub-centres are located in govt. buildings. Approachability of most of the sub-centres was poor especially in rainy season. At community health centre (CHC): first level of health centre where specialists in medicine, surgery, paediatrics and obstetrics should be available, money is charged for routine investigations. This is an important deterrent for many women. Unorganized antenatal care set-up, interpersonal conflicts between service providers, poor management and, co-ordination of services and vested interests reduce access of services to the clients. Only normal vaginal deliveries are conducted at this CHC and for all complications women are referred to district hospital. Ambulance for referral is available but is not accessible to all due to lack of awareness on the part of users, and lack of proactive approach and supervised referral on part of health providers. Treatment at government health facilities consumes more time, and people have to pay money to avail these services. Although cash expenditure is more in private hospitals, but time was considered as more precious than money by most people in this area. For others, even small amount levied upon at government facilities was deterrent. Service environment was found to be very poor at all levels. Our observations indicate that technical incompetence was an important contributor for mismanagement of reproductive problems and maternal complications. Lack of inventory management skills and human resource management skills resulted in frequent vaccine stock-outs and non delivery of services. Technical gaps were also observed through prescription audit. Emergency obstetric care services are practically not available at CHC. All such complicated cases arriving here should have gone directly to district hospital. The information gap exists because of stereotyped thinking in community and among health providers that referral chain from sub-centre to PHC, CHC, and district hospital should be followed irrespective of type of complication and availability of facilities to tackle the complication.
Investment on improving management skills, financing mechanisms to cut treatment delay due to immediate non availability of money, putting in place better maintenance structures for building, equipment and supplies, and technical strengthening of health staff may help build faith of community in public health services and improve access.