Citizen orientation in delivering government primary health services in rural Maharashtra

Abstract

The government plays an important role in providing reliable and good quality primary health care especially to the poorer and weaker sections of the population. Any effort to improve the quality must take into account the perceptions of citizens as the perceived quality has a strong impact on utilisation of health care. Three districts in Maharashtra covering 20 villages were studied. The perceived quality of health care was measured using SERVQUAL instrument. SERVQUAL instrument was further integrated with Kano's model and Importance - Satisfaction model to identify areas for improvement. The study has found that people are highly dissatisfied with lack of accessible distance of primary health centres, availability of medicines and cleanliness. Further, perceptions of health officials were significantly different from those of the people on many attributes. Improving the quality of health care needs additional financial resources. Con joint analysis was carried out to find out the preferences of the people on agency and their willingness to pay for improved services. One of the important findings of the study is that the people have strong a preference for improved services and they have indicated willingness to pay for improved health care. Analysis has also shown that the primary health centre is the preferred agency to private clinic even at higher user charges as compared to private clinic. People belonging to the low-income group have shown limited willingness to pay whereas the high-income group has shown significantly high willingness to pay. One of the initiatives of cost recovery in a district of Madhya Pradesh,Rogi Kalyan Samiti, was studied. The study has shown that citizens perceive noticeable improvement in health care services out of fee revenue and have shown willingness to pay for further improved services indicating receptive attitude towards user charge. A user charge with perceptible improvements in quality is critical for user charge policy to succeed. Price discrimination giving protection to the poor by charging them at low rates would be the appropriate strategy.