Peery See Satisfaction From Primary Health Care Services: A Comparative Study of Two Taluks in Mysore District * Anitha C.V * Dr. Navitha Thimmaiah cr The utlisaion of any social services including health sorvices have never boon equitably distributed throughout society is proved by many studios (Ray SK etal, 2011). Along with uiisation, itis also important to check the satisfaction associated with ‘access fo social services especially heath services and its association with other variables. It would be interesting fo examine the relationship between utiisaion and satisfaction, Bocause the ulisation rates sol does not aisclose whether tho usors aro satisfied with public health services delivered through Primary Health Centres (PHCs) or not. In this context the present paper ‘made an attempt to study the utlisation of public health services along with satisfaction through a comparative study. The results indicated that higher utilisation is nota sign of highor satisacton in the context of Primary Health Centres. Further the study identified some variables like Doctor's availabilty, Qualfy of Service, Cleanliness otc, influencing satisfaction in study {area so that right decisions are taken in order to increase the satisfaction rates associated with PHCs. LO SR ee eC aCe Ce Ce ULE nae Ss Introduction The utlisation of any social services including health servic- es have never been equitably distibuted throughout socie- ty (Ray Sk, Basu SS, & Basu Ak 2011). The Government of Inca introduced the concept of Primary Health Centre with the intention fo provide accessible, afordable and available primary health care ta the eomman people at tier doorstep, With specific focus on the rural and vulnerable sections. But the studies by Ray & Mukhopadhyay (1984), Ray SK et a (2011), Gnosh & Mukherjee (1989) and Ram & Datta (1975) indicate lesser utlisation (i.., lass than 80 percent) of Gov- ‘emment health services especially Primary Health Centro (PHC) services in diferent states of India ‘An analysis of health services coverage of PHCs in wast Bengal indicated that PHC services declined significantly with distance from the primary health centre and it further report- ‘ed that uiiisation of PHC services is higher in lower income {group than the higher income groups (Ray, 2011). Diferent research works have deat with ulisation of pubic health care ‘vices and have came out with several factors influencing uillsaton such as distance, income, vansport cost, age, health condition and so on ‘Along with ulisaton, itis also important to check the satis- faction associated with access lo social services especially health services and its association with otner varables. It Would be interesting to examine the relationship between Uiilsation and satistacton. Because the utlisaton rates ise does not disclose whether the users are satisfied with public health services delivered through Primary Health Centres or not Very few research works have thrown light on ullsation as well a ealsfaction associated with PHCs, In this background the present paper made an attempt o study ullistion of PH services along with satisfaction rom PHC services through comparative study. Objectives ‘= To explore the utlisation rates of PHC services in the study area, + Tecompare the utlisation rates of PHC services between two taluke" + To explain the possible determinants of satisfaction with respect to PHC services in the study area Hypotheses + Ublsation of PHC services significantly differ botwoen two taluks. ‘+ There is a significant association between satisfaction from utlisaton of PHC services and its determinants tke Qually services, Doctors avallaally, Localty, Response from medical personnel and staff. Cleanliness, Inf structure, Drugs availability, Waiting time. Methodology ‘Study area “Two taluks in the Mysore district were selected for field work based on Health infrastructure Index®, Mysore taluk as devel- ‘oped taluk and H.D Kole faluk as underdeveloped or back: Ward lal. In each taluk two PHCs were selected such that they are located in hb 7 head quarters (HO), But in HD Kote (Kote) taluk, N. Belttur PHC was selected for eld work though its not located in Hobli but it includes Antharsante hob in its coverage area, Thus Varuna, Yelawala PHC in Mysore taluk and Hampapura, NBelihur PHC in H.D Kote taluk were finally selected for fla work, ‘Sample size and sampling Shy respondants living in the coverage areas of each PHC were selected randomly for interview, where 20 respondents ‘45 ® PARIPEX - INDIAN JOURNAL OF RESEARCHWore taken based on each clstance group such as <4 km, ~akm Bkm from each PHC. Thus a total of 240, responses were collected, where 120 are from Mysore taluk land 120 from Kote taluk. ‘Questionnaire ‘Awol! structured questionnaire was used for data collection, ‘The questionnaire was self administered, consisting of both close ended and open ended question. ‘Study variables and measurement “The variables included in this study were as folows: respond ‘ents socioeconomic characteristics - Age, Sex, Education ( Primary and below, High school, PU, Degree and above) , Employment status as employed or not employed (students, relied, house wife and unemployed), Monthly Income ( ‘tom all sources), Family Typat jint or nuclear), Distance to PHCinearedkm, ite far=>dkm 2kry), Health status of the Respondent (Goad, average, poor), Heath In- ‘suranco( Yes or No), Utlised PHC services in the last 12 months(Yes or No). Respondents self reported number of Visits to PHC in last one year, Awareness apout Government Health programmes(ves or No} and so an. “The variable Satisfaction from PHC Services and is determi- nants namely Doctors Avallabiliy, Drugs Availabilty, Locality, Infrastructure, Response of Medical Personnel, Cleanliness Waiting Time and Quality of Service (curable treatment) ware measufed using the folowing five point Likert Scale: 5=Hig ly Satisfied, 4=Satise, 3= Moderate, 2= Dissatisfied, 1 Fighly Dissatsiec. Statistical analysis, Descriptive staistics and frequencies were computed for ‘each item in the questionnaire, The study includes ordinal Variables (Likert scale), nominal variables (sex, education, laccessing PHC) as well as continuous variables (income, age, numberof visits) Inialy al 240 responses were taken forthe analysis, later for stsfacton from PHC services only 89 responses were con- Sidered (aut of 91 users of PHC services 2 were dranped due {anon responsiveness to some toms), Salisfaction rom PHC services was determined as a dependent variable. T-statis- tic was used fo compare the mean values of independent variables observed in ikert seale in two groups: respondents who ware satisfied wity PHC services and those who were not satisfied. Aor the preliminary analysis of dala, the items measured in iker scale were cichotomised from the original five levels into two categories 1=satistieg, O= not satisfied (1= highly salisfed and salsfied, O= moderate, cissalsfied and highly dissatisfied) Cross tabs were performed along with Chi-square test to ‘cheek the association between satisfaction from PHC ser- Vices and other independant variables. The determinants of satsfaction from PHC services were calculated using binary Togstic regression. The effect of independent variables. on people's satisfaction from PHC services was expressed 35 ‘odds ratios with 95% confidence intervals. The data was an- alysed using SPSS 16.0 and STATA 10.0 stastical sofware. Results and discussion ‘Socio-economic profile of the respondents ‘Out of 240 respondents (Tabla 1), 74 percent were females and 26 percent were males. In both the taluks number of fe- male respondents wore greater than the males. The age of the respondents ranged from 18 to 87 years. 26.25 percent ofthe respondents were reported in 27-37 age group. 89 per- Cent of the familes reported as nuciear and the remaining 11 percent as joint family. Less than haf of the respondents (40, percent) were employed and 60 percent were unemployed. 30, percent ofthe respondents wore inthe income group <=3000. More than hat of the respondents (62.5 perce!) ware iterate land 37-5 pereant were literate, where 38 percent had higher primary education and above (secondary school education). ‘Overall 90 percent of the respondents reported as having no health insurance coverage. This group holds majority In both ‘he areas, but the numer of people having heath insurance in Mysore taluk were 13 where as in Kote taluk it was 10. Utilisation of Primary Health Centro Services ‘Out of 240 respondents only 91(38percent) reported as the users of PHC services in the last one year, with 25 (22 per- cent) in Mysore taluk and 65 (54 percent) in Kote taluk. Thus, 2 significant aiference was found (ch-square value 26.82 significant at 0,001 level in the utilisation of primary heath Centre services between Mysore taluk and Kote taluk H.D Kote being underdeveloped with lesser Heath infrastruc ture Index (Hil) of 1.17" in whole of Mysore district reported significant uiiisation of PHC services. In particular, PHC lo- ‘cated in hobli HG i.e, Hampapura PHC in Kote taluk reported highest utlisation rate Le., 35 (60 percent) among the four PHCs. On the other hand, Yelawala and Varuna PHC in My sore taluk reported only 2Spercent and 18percent utilisation rate respectively even with a good Hil of 2.36" The N.Beltwur PHC whieh Is interior (remote) compared to other PHCs re ported a goed utilisation rate .e., 48percent even with worst oad conrectity lack of transport facity, bad infrastructure and long distance. The major hurdle in the utlisation ofthis PHC is reported as long aistance and lack of transport facil, [AS it 00 far from the hobli HO e., Antharsante, many ofthe respondents in HO find it ifiul to access the PHC services and due to this many of them switch to local clinics to fulfil their healin care needs in recent years. In other case, even ‘hough the two PHCs in Mysore taluk were just located beside the highways and have good transpor facity they reported lesser ullisation rates when compared to Kote PHCs, ‘The uilisation rates of PHC services, in all four PHCs showed a sharp decline with increase in distance to the PHC. Thus, distance was found to be the major determinant of utilisation Of PHC services, Figure 1: Utilisation of PHC Services in Two Taluks. ° Meyronetan ‘cote tahe Satisfaction from PHC Services Table 2: Descrintive Statistics [arabes Wirimun] Maximum [oar Boy tach ipatsfgction with IS [3.56 |.768 longeAvatoonty fp [sass [ron [Doccravaiasnty [1s [ase [700 [wating timings [is ‘fase fans Locatty [spss foot lavaiiyotSewce [1s _fase [asr Response. fon] mea personnel! IS 13.64 |. 787 [Geariness fps [a4 inrasivcure fps av [eas 46 & PARIPEX - INDIAN JOURNAL OF RESEARCH‘Table 2 indecates the maximum, minimum scores, mean scores along with Standard Deviation and variance of each item (independent variables), the highest and the lowest mean score ars taken by cleanliness (2.88) and drugs availa: billy (8.18) respectively. Table 3: Mean difference between two groups IMean] sat [N [Meer festauste [sig 7 [ee fast favre fooar™ Drugs Availabilty 5 |e Let Io 7a9 looose 1 [58 [378 [3787 Poctoravailabiity 5 Jat ists [s.399 1 [se faat_ [1.387 [Wetingimings gst fs.t8_|1.354 Local 1 [se fs40-fo.ose ny o_|er_fa.a9_ Joost 1 [58 [374 [5.158 0.002" lauaty ofSenice SP ete ease 00k IResponse from? [58 [379 [2583 loon | Iria PME Jar [aos [2827 foots Iceaninese 7 [ee [sas faaao foot " oer faz [2054 foosse Infrastructure 1 [58 [s-72 0334 _Jo-7a9 o_|s1 [a8 foses _Jorsa Note: Bold values in t-statistic and sig. column repre- ‘sents equal variance assumed results. Significant at the 0.001 level (2-taled),* *Significant at the 0.01 level (24alled). “Significant a the 0.05 evel tailed), [As per figure 2 and table 2, out of 89 users 65 percent (58) reported as satisfied from PHC services, with percent (21) in Mysore taluk and 59 percent (37) in Kole taluk. Remaining 35 percent (31) reported as not satsfied with access to PHC Service, out of which 19 percent (5) were from Mysore and ‘percent (26) in Kole taluk. Thus a significant diflerence is found (chi-square value 3.938 significant at 0.05 level) be- ‘oon two taluks in satisfaction from PHC services. Moreover, significant ference was found in the mean scores. (of Drugs Availabilty, Doctor Availabilty, Qualty of Services, Response from Medical Personnel and Siaff, Cleanliness be- ‘ween two groups ie, Group ‘=satisfied ftom PHC services ‘and Group 2= nat satisfied from PHC services. ‘Tho study obsorved that though the utilisation rates wore low in Mysore taluk the satisfaction from PHC health care servic~ {2 is high compared to H.D Kote taluk due to good transport Figure 2: Taluk wise Satisfaction from PHC services Determinants of Satisfaction from PHC Services None of tha independent variables namely Doctors Avail bilty, Orugs Availabilty, Localiy, Infastructure, Response of Medical Personnel, Cleanliness, Waling Time and Qually (of Service (curable treatment) was found to be signfeant in ‘explaining satisfaction in Mysore taluk, due to lesser num- bor of users of PHC services, But, n Kote taluka signifieant positive correlation and association was founé between salis- faction fom PHC services and four variables namely Doctors Availabilty Response of Medical Personnel, Cleanliness and ‘Quality of Service (able 4). Here none af the socioeconomic Variables of the respondents was associated independently With their satisfaction from PHC services. The results inicat- ‘ed that satisfaction from PHG services in Kote taluk was as- sociated with Doctor's Availabilty, Quality of service (Curable treatment), Response fram madical personnel and stalf ang Cleanliness Ifthe people ae satisied with above independ- ‘ent variables, then the overall satisfaction from PH services Resgacon wm POE, o gs © age sevare ase atau’ ° [atl Dosoramny [oro oat sever —[o0g —[o" emanate fos Gains a ‘Significant at the 0.04 level (tailed) * Significant at the 0.05 level (24ailed), Logit mode! Invorder to identity the significant determinants of satisfaction ‘om PHC services, al hase variables that were found to be signicantly associated witn the dependent variable were in- Cluded inthe logt model along with other variables Logit Model for Kote taluk: ‘Satisfaction feom PHC servis 1 +b2 Sex - bs Locality +03 QoS +b4 Doc -bS inc + b8 Resp - b7 Age + ba Clean = b9 Infta + b10 Drug - b11 Wait= 12 Insurance - 13 facility, road connectivity and good services Quali - 014 occup ~ ~() ‘Table 5: Logit model results lrocitors Joveral [Mysore taluk Kote talk [Coet. [oadsrato|P>it [Cost oddsrato[Poial [Cost [Ode rato[P>ral [Sex [92 [sao __looor [= = = Isa [208.20 [0.000 Lecaiy [189 ozo oor [= = : 349 [0.030 [0.000 laos. laa2 [1677 Jooor sei ___|as.ar__fo.ooz__[s.02___[zo6 [0.002 [Docavanaity | : I [ozs foot oor | LE LE income L = joor [roa _foos7 [= = [Response [ : lata [e290 foose [= lage: [ : [= [- = : a7 [asa [Cleantiness [= : : Ir71___[azaoe Infrastructure f= : : 535 [0.008 [wate enio(ta) —__[25.20" [2136 arar [Pseudo R2 joss loasr7 los106 ‘47 ® PARIPEX - INDIAN JOURNAL OF RESEARCHFrom the logit model a significant ference was identified in the lst of determinants between two taluks and also tee so- cio-economie variables found as determinants of satisfaction from PHC serves namely Age, Sex and Income. Due to less observation (.e., out of 120 respondents only 26 ‘of them reported as the Users of PHC services) the model of Mysore taluk was not foune significant. But other than that the independent variables like QOS, Doctor Availabilty and Income of the respondent family and Response of the med- cal staff wore found as significant predictors of satisfaction ftom PHC services in Mysore taluk. The income coefficient indicated that a unt{ 100 Rs) increase in weighted income, the weighted 1og of the odds in favour of satsly from PHC sorvices goes up by about 0.01 units suggesting a positive ‘effect, Tis means that fr a unitinerease in weighted income, the weighted odds in favour of satisfy from PHC services int creases by 1.02 or about 2%.An unexpected negative sign was observed in the case of Doctors availabilty ‘On the other hand the model of Kote taluk was found sig- nificant st 0.01 level inciating that all the regressors have 2 significant impact on the satisfaction from PHC services. ‘Si variables namely Sex, Locally, QoS, Age, Cleanliness and Infrastructure were found as significant predictors of sat- faction from PHC serves. Where Sex, Cleanliness and {QoS regressors have @ positive effect on the logit and the other 3 regressors namely Locally, Age and Infrastructure have a negative effec. Thus it showed that satisfaction from PHC services in Kote taluk depended on Quality of servic~ 9s, Cleanliness in the cenire, Age, Sex, Locality and Infra- Structure, Results ind-cated that lesser age group people are Salsfid from PHC services than the higher age group. This means that fr a year inorease in age, the weighted adds in favour of satisty from PHC services decreases by 0.934 o about 6.6%. It indicates that expectation of aged people from PHC services is high than the younger ane. Resulls futher indicated that if QoS is good and cleanliness 's maintained in health contre the users willbe satisfied from PHC services. The QoS odd indicates that the people who ‘sa stad with QoS are 20 limes likely to sais from PHC sor- Vices than the people who have not salisfed with GoS. The ‘sat sfacton ratos are better by 5 times if malos aro the users, PEE ‘Conclusion ‘he intention of establishing PHC in rural areas was found ntaken, because inthe study area not only a lower utilisation ‘of health services was found but also a signifeant dference ‘was found in the ulisaton af PHC services between two ta- Tks which are different in development, economic condition and Hil Not only a significant ifference was found in the mean scor- ings of the Independent variables but also a signfieant i ference was found in the mean score of Drugs Avalabily, Doctor Availabilty, Qualty of Services, Response from Medi- ‘cal Personnel and Staff and Cleantiness between two groups “salsfied with services and not satisfied with services, H.D Kole taluk whic is comparatvely underdeveloped taluk With least Health Infrastructure Indox of 1.17 in Mysore district ‘eparted higher utilisation rate (54 percent) of PHC services compared to Mysore taluk. Bul the interesting fact is, Kote taluk having lester satisfaction rate (59 percent) compared to Mysore taluk. The satisfaction from PHC services in Kote {aluk was found associated independently with Doctor's Avail- ablity, Quality of service (Curable treatment), Response from ‘medical personnel and staff and Cleanliness ‘The logit models also gave diferent results for both the ta- luks. In H.D Kote taluk, the variables Sex, Cleaniiness and {QoS have positive effect on the dependent variable Satistac- tion; the other three namely Localty, Age and Infrastructure hhad negative effect. The logit model for Mysore Taluk was foun to be insignificant because of few users. Itcan be inferred thatthe people in less developed taluk d pend more on Public heath Services because of poor income levels, lack of connectvty and transportation faclties and non affordability of private health care services and so on. Since the ullisation rates are better in H.D Kole taluk, the findings feom this study area would be more helpul towards better- ‘ment of public health care service delvery through PHCs, {As satisfaction is found to be significantly associated with Doctor's Availabilty, Quality of service (Curable treatment Response from medical personnel and staff and Cleanliness, importance should be given to them so as to improve salsfa tion levels of the users availing PHC services, N1Gwews ON. & sangre Bas Enema (st), eGrawl 5034972] Gosh BN ane Mare AB. (B80) nn Jour of uote eon, Hen 3, 203319 Ray SK Musdapacyay SB Gogy NM Mani. & Roy 8.00), Eero aan of Maral cr ens PC. fri of ‘tual a, rf Pai ecb 28 2 Ii} Ry 9, Bans 8. & Sanu AK (07) As sera ot Rl Mec Coe Deve Stem soe ‘Sear Weel Genuine nan ama fut Hay, a) 7-0 Ftv om pnin an Tharweay Maoh, 29% |] Ram Re, 8. Gues (re): Atay anh lean of Paar Holy Cones ard Su covers heal serves by heal people Ma Ta, Mahara. han Jura Pe Ream 20iae38 | 48 & PARIPEX - INDIAN JOURNAL OF RESEARCH