Document Type : Original Article

Authors

Department of Preventive and Social Medicine, JIPMER, Puducherry, India

Abstract

BACKGROUND: First point‑of‑care (FPC) at the primary health care (PHC) level is an important public
health issue at the global level. Patients directly come to tertiary health centers without a referral.
AIMS AND OBJECTIVES: Hence, the current study was done to assess the proportion of individuals
availing health‑care services from rural health center (RHC) as FPC and reasons for not availing it.
METHODS: A community‑based cross‑sectional study was conducted in Puducherry, coastal South
India, among 367 households with 1510 individuals. Sociodemographic details, recent FPC during the
past 6 months, morbidity profile, and reasons for not seeking were collected from all the individuals.
RESULTS: About 44.5% (672/1510) of individuals used any health facilities, of which 70.4% (473/672)
used RHC as the FPC. About 33.2% of individuals had a respiratory illness, 22.3% had general
signs and symptoms. About 24.6% (32/130) mentioned the reasons for not seeking care as lack of
appropriate health facilities.
CONCLUSION: More than one‑fourth of the study population not utilized services at PHC level.
Improving the health facilities may help to increase these services.

Keywords

1. Khayyam KU, Somdatta P, Rohit S, Rupak S, Digamber B.
A study on overcrowding of out‑patient department of a tertiary
care tuberculosis institute in Delhi. Indian J Prev Soc Med
2014;45:19‑23.
2. Gautham M, Binnendijk E, Koren R, Dror DM. ‘First we go to the
small doctor’: First contact for curative health care sought by rural
communities in Andhra Pradesh, Orissa, India. Indian J Med Res
2011;134:627‑38.
3. Kumar V, Singh P. Access to healthcare among the Empowered
Action Group (EAG) States of India: Current status and impeding
factors. Natl Med J India 2016;29:267‑73.
4. Shrestha DR, Ittiravivongs A. Factors affecting utilization of health
centers in a rural area of Chon Buri Province, Thailand. Southeast
Asian J Trop Med Public Health 1994;25:361‑7.
5. Sustainable Development Goals. Sustainable Development Knowledge
Platform. Available from: https://sustainabledevelopment.
un.org/?menu=1300 [Last accessed on 2018 Jan 22].
6. Government of Puducherry, Department of Health and Family
Welfare Services, Health Report, Union Territory of Puducherry;
2011‑12. p. 1‑2.
7. ICD‑10 Version: 2010. Available from: http://apps.who.int/
classifications/icd10/browse/2010/en#/XVIII [Last accessed on
2017 Nov 29].
8. ChauhanRC, KandanM, PurtyAJ, SamuelA, SinghZ. Determinants
of health care seeking behavior among rural population of a coastal
area in South India. Int J Sci Rep 2015;1:118‑22.
9. Nteta TP, Mokgatle‑Nthabu M, Oguntibeju OO. Utilization of the
primary health care services in the Tshwane Region of Gauteng
Province, South Africa. PLoS One 2010;5:e13909.
10. Muhammed KA, Umeh KN, Nasir SM, Suleiman IH.
Understanding the barriers to the utilization of primary health
care in a low‑income setting: Implications for health policy and
planning. J Public Health Afr 2013;4:e13.
11. Hone T, Gurol‑Urganci I, Millett C, Başara B, Akdağ R, Atun R.
Effect of primary health care reforms in Turkey on health service
utilization and user satisfaction. Health Policy Plan 2017;32:57‑67.
12. Rutkove SB, Abdool SK, Loening WE. Patterns of care in an
overburdened tertiary hospital outpatients department. S Afr
Med J 1990;77:476-8
13. Aguwa EN, Arinze‑Onyia SU, Okeke T, Aniwada EC. Excessive
and inappropriate utilization of a tertiary health center in
South‑East Nigeria. TAF Prev Med Bull 2010;9:15‑22.
14. Khan ME, Prasad CV, Quaiser N. Reasons for under‑utilization of
health services – A case study of a PHC in a tribal area of Bihar.
Demogr India 1987;16:177‑95.
15. Prasad S. Preference of hospital usage in India. Ann Trop Med
Public Health 2013;6:472.
16. Umunna ZI. Exploring the factors that contribute to poor
utilization of primary health care services: A study of two
primary health care clinics in Nasarawa State, Nigeria (Doctoral
dissertation, University of the Western Cape); 2012.
17. Abrahamsson B, Berg ML, Jutengren G, Jonsson A. To recommend
the local primary health‑care centre or not: What importance
do patients attach to initial contact quality, staff continuity
and responsive staff encounters? Int J Qual Health Care
2015;27:196‑200.
18. Lahariya C. ‘Ayushman Bharat’ program and universal health
coverage in India. Indian Pediatr 2018;55:495‑506.