Rural Health Care Services of PHC and Its Impact on Marginalized and Minority Communities

Rural Health Care Services of PHC and Its Impact on Marginalized and Minority Communities L. Dinesh Ph.D., Research Scholar, Research Department of Commerce, V.O.C. College, Thoothukudi, India Dr. S. Ramesh Kumar Associate Professor and Head, Research Department of Commerce, V.O.C. College, Thoothukudi, India ABSTRACT The main objective of the study is to examine the rural health care services rendered by Primary Health Centre (PHC) among marginalized and minority communities. Home interviews were conducted from 776 randomly selected consumers representing two districts in Tamil Nadu. PHC is preferred by all the respondents irrespective of their demographic profile. Most of the respondents prefer PHC for getting treatment for all kind of diseases. It is concluded that all patients irrespective of their community get effective treatment. Proper infrastructure facilities should be maintained in PHC to render effective services to the patients. Government should allocate sufficient funds for the development of Primary Health Centres in the rural areas. Key words: Primary Health Centre, Natural light, sympathetic approach. 1. INTRODUCTION In India health has been a major policy issue since independence. Health is an important commodity not only at the individual level but also in terms of micro and macro economic scales of a country. The development of rural health infrastructure, immunization programmes and the extension of water supply and sanitation have led to health gains. Improvement of health status is therefore on the political agenda of every government. Developing nations have been focusing on relevant infrastructure, technology, disease control, and health outcomes in terms of deaths and disabilityadjusted life years, largely ignoring the service quality aspect from the patient s viewpoint (J K Sharma and Ritu Narang 2011) 1. Today, the availability of drugs is inadequate in all of the PHC, Sub Centres (SC) and hospitals that have been set up by the government over the years. There is thus an infrastructure lying unused merely because of the sharp cutback in public expenditure on health, and the focus on privatization of health services. This affects severely the poorest of the population (Ghosh A. 2006) 2. Poor infrastructure generally leads to poor quality of service, which in turn not only waste resources but is positively dangerous to the health and welfare of the patients and the community at large. The poor suffer more if government services are not functional or are of poor quality as they do not have any other choice. So the concept of primary health care led to a rapid expansion of outpatient service facilities in the form of Primary Health Centres, Dispensaries and Sub Centres, with a view to take health care to the community. Lack of proper infrastructure for purchase, storage, and distribution of essential drugs and medicines is another major concern in the delivery of health services in rural areas. The functionality and utilization of infrastructure is also affected by various factors such as non availability of skilled staff, supplies and proximity to the communities etc. (World Development Report 2004) 3. 2. MATERIALS AND METHODS 2.1 Sample Size The quantitative data for the study was collected from 776 respondents randomly selected from two districts of southern Tamil Nadu (Thoothukudi and Tirunelveli). In the field work, the data were collected through a well structured questionnaire after obtaining consent from the respondents. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 03, July 2014 Page 86

2.2 Research Design The survey analyses the rural health care services provided by the PHC during the period June 2011 to April 2014 as a part of Doctoral research work. The questionnaire was divided into three sections (1) Demographic factor (2) Attitude of doctors, nurses and support staff towards patients and (3) Infrastructure facilities available in PHC. 2.3 Pilot Study The questionnaire was pre-tested by collecting data from 75 respondents. The questionnaire were revised and restructured based on the results of the pilot study. The final draft was prepared after revising the questionnaire based on the feedback of the pilot study. 2.4 Data Analysis The collected data were analysed by using Statistical Package for the Social Science (SPSS) software package version 17. Scores for each test category were calculated by assigning correct responses. Chi-square test (5% significance level) was used to compare indicators across demographic characteristics (age, gender, education, occupation, income, religion, and community). The t test has been used to infer the association between friendliness of doctor and the demographic profile of the respondents. The one way analysis of variance has been used to find out the relationship between demographic characteristics of the respondents and effective & equitable treatment rendered in PHC. The correlation analysis has been used to find out the inter relationship between services, courteousness, kindness & sympathetic approach and friendliness of nurses. 3. RESULTS AND DISCUSSIONS * Significant at 5% level Table 1 Preference of Primary Health Centre Demographic profile Chi-square test df P value Age 10.373 a 9.321* Gender 3.443 a 3.328* Education 8.396 a 6.210* Occupation 15.600 a 12.210* Income 8.052 a 9.529* Religion 5.468 a 6.485* Community 6.418 a 9.698* Table 1 shows the relationship between the demographic profile of the respondents and their preference for PHC. In the different demographic variables of age, gender, education, occupation, income, religion and community, the P value is greater than 0.05. As per the acceptance of null hypothesis, the above said variables are not associated with the preference for PHC. PHC is preferred by all respondents irrespective of their age, gender, education, occupation, income, religion and community. Table 2 Main reason for using Primary Health Centres Respondents Percentage First aid 147 20.8 All diseases 532 75.4 Child s care 6.8 Delivery 21 3.0 Total 706 100.0 www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 03, July 2014 Page 87

Table 2 shows the main reason for using PHC by the respondents. About three-fourth of the respondents (75.4%) prefer PHC for all diseases, followed by first aid (20.8%) and delivery (3%). A least number of the respondents (0.8%) avail PHC services for child s care. Hence, it can be concluded that majority of the respondents use PHC for getting treatment for all diseases. Table 3 Association of Income and getting treatment Value df P value Pearson Chi-Square 5.138 a 6.526* Likelihood Ratio 4.497 6.610 Linear-by-Linear Association.208 1.648 N of Valid Cases 706 Table 3 shows the chi-square value of 5.138 (df 6, N=706), P>0.05 is not significant at 6 degree of freedom, showing that there is no significant difference between expected and observed frequencies. As such, the null hypothesis is accepted and the alternate hypothesis is rejected. All respondents, irrespective of their level of income, prefer to get medical treatment in Primary Health Centres. The income of the respondents does not influence in getting different treatment in PHC. Table 4 Association between religion and equitable treatment Hindu 509 4.33.794 Christian 112 4.38.829 Muslim 85 4.26.742 Total 706 4.33.793 * Significant at 5% level.519.595 Table 4 indicates that the `F` value of.519, P>0.05 is not significant by indicating that there is no significant difference between religion and equitable medical treatment. As such, the null hypothesis is accepted and the alternate hypothesis is rejected. It infers that religion does not influence the equitable treatment given in PHC. The respondents of any religion are treated with equality in PHC. Table 5 Association of respondents community and getting effective treatment OC 50 4.24.916 BC 407 4.15 1.042 MBC 88 4.16.908.561.681* SC 161 4.27 1.023 Total 706 4.19 1.012 Table 5 reveals the association between the community and getting effective treatment. As per the acceptance of null hypothesis (P>0.05), there is no significant difference between community and getting effective treatment. Hence, it can be concluded that getting effective treatment is not associated with the community of respondents. All patients irrespective of their community get effective treatment. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 03, July 2014 Page 88

Table 6 Association of respondents gender and friendliness of doctors Gender N Mean Std. Deviation t value P value Friendliness of Male 195 4.25.802 doctors Female 511 4.23.870 0.229 0.819* Table 6 reveals the relationship between the gender and friendliness of doctors. As per the acceptance of null hypothesis (P>0.05), there is no significant association of gender with the friendliness of doctor. It is concluded that gender of the respondents does not influence the friendliness of doctor. The doctors are friendly to both male and female patients. Table 7 Impact of respondent s religion on waiting time to consult doctors Hindu 509 3.92 1.115 Christian 112 3.88 1.202 0.201 0.818* Muslim 85 3.85.880 Total 706 3.90 1.103 Table 7 shows the association between religion of the respondents and waiting time to consult doctors. As per the acceptance of null hypothesis (P>0.05), there is no significant association between religion and waiting time to consult doctors. All the patients are treated equally in PHC. The waiting time to consult doctor is same for all religions. Religion does not influence the waiting time to consult doctors in PHCs. Table 8 Relationship among the role and attitude of nurses in PHC Correlations Services Courteousness Kind and sympathetic approach Friendliness Services 1.785 **.738 **.686 ** Courteousness 1.808 **.736 ** Kind and sympathetic 1.821 ** approach Friendliness 1 **. Correlation is significant at the 0.01 level (2-tailed). Table 8 shows the bivariate correlation between the variables of services, courteousness, kind and sympathetic approach and friendliness of nurses. In this analysis, there is a relationship among the variables of services, courteousness, kind and sympathetic approach and friendliness of nurses. All the factors have inter - correlation with positive value. 1. The attitude of kind and sympathetic approach is highly correlated with friendliness of nurses 0.821. 2. The courteousness of nurses is positively correlated with kind and sympathetic approach 0.808. 3. The service of nurses is positively correlated with courteousness of nurses 0.785. 4. The service of nurse is positively correlated with kind and sympathetic approach 0.738. The results shows that there exists a positive relationship between kind and sympathetic approach and friendliness of nurses (r =.821, P<0.01). The respondents give first preference to kind and sympathetic approach and friendliness of nurses. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 03, July 2014 Page 89

Table 9 Association between the respondents community and attitude of support staff Proper guidance OC 50 3.32 1.168 BC 407 3.57 1.155 MBC 88 3.63 1.107 1.259.287* SC 161 3.67 1.094 Total 706 3.58 1.137 Assistance of support staff OC 50 3.38 1.260 BC 407 3.58 1.190 MBC 88 3.67 1.111 SC 161 3.75 1.103 Total 706 3.62 1.168 1.520.208* Table 9 analyses the relationship between the community and attitude of support staff. As per the acceptance of null hypothesis (P>0.05), there is no significant relationship between community and the two variables of proper guidance and assistance of support staff. It is concluded that proper guidance and assistance of support staff are not influenced by the community of the respondents. All the respondents get proper guidance and assistance of support staff irrespective of their community. Table 10 Relationship among the physical environment in PHC Natural Clean Clean bathrooms Change of Water Consoling light wards & toilets bed sheet supply words Natural light 1.707 **.689 **.625 **.627 **.638 ** Clean wards 1.764 **.752 **.721 **.714 ** Clean bathrooms & toilets 1.787 **.730 **.730 ** Change of bed sheet 1.771 **.718 ** Water supply 1.773 ** Consoling words 1 **. Correlation is significant at the 0.01 level (2-tailed). Table 10 shows the bivariate correlation between the variables of natural light, clean wards, clean bathrooms and toilets, change of bed sheet, water supply and consoling words. In this analysis, there is a relationship among the variables of natural light, clean wards, clean bathrooms and toilets, change of bed sheet, water supply and consoling words. All the factors have inter-correlation with positive value. 1. Clean bathrooms and toilets is highly correlated with change of bed sheet 0.787. 2. Water supply is positively correlated with consoling words 0.773. 3. Change of bed sheet is positively correlated with water supply 0.771. 4. Clean ward is positively correlated with clean bathrooms and toilets 0.764. 5. Natural light is positively correlated with clean wards 0.707. 6. Natural light is positively correlated with clean bathrooms and toilets 0.689. The result shows that there is a positive relationship between the variables of clean bathrooms and toilets and change of bed sheet (r=.787, P<0.01). The respondents give first preference to clean bathrooms and toilets and change of bed sheet. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 03, July 2014 Page 90

CONCLUSION The present study indicates that PHC extend its services to all patients irrespective of their demographic profile. It provides equitable treatment to all patients regardless their religion. The doctors treat their patient in a friendly manner. The nurses of PHC are courteous, kind and have sympathetic approach towards patients. The support staff also guides and assists the patients irrespective of their community. Patients prefer clean bathrooms and toilets and they also expect that the bed sheet should be changed daily. Hence, necessary steps should be taken to maintain cleanliness in bathrooms and the bed sheet should be changed regularly. Sufficient infrastructure facilities should be laid down and it should be maintained properly. The NGO may join their hands with the government in maintaining the infrastructure. The government should allocate huge funds for the construction and maintenance of PHC in all regions of the country. REFERENCES 1. J K Sharma and Ritu Narang, (2011). Quality of Healthcare Services in Rural India: The User Perspective includes research articles that focus on the analysis and resolution of managerial and academic issues based on analytical and empirical or case research VIKALPA VOLUME 36 NO 1 JANUARY - MARCH 2011. 2. Ghosh A. Health Care and Globalization Case for Selective Approach. Economic and Political Weekly 24 February 2006. 3. World Bank. World Development Report 2004 - Making Services Work for Poor People; Washington; 2003; 256-57. www.theinternationaljournal.org > RJSSM: Volume: 04, Number: 03, July 2014 Page 91