Quality of Healthcare Services in Rural India: The User Perspective

Developing nations have been focusing on relevant infrastructure, technology, disease control, and health outcomes in terms of deaths and disability-adjusted life years, largely ignoring the service quality aspect from the patient's viewpoint. However, researchers opine that real improvement in quality of care cannot occur if the user perception is not involved. Patients' perception is significant as it impacts their ‘health-seeking behaviour’ including utilization of services, seeks involvement in issues directly related to them, enables the service provider to meet their expectations better, and provides relevant information to the policy makers to improve the quality. Some studies conducted in the recent years have made attempts to develop multi-dimensional scales and measure quality of healthcare services in the developing nations. The current study seeks to assess the perception of patients towards quality of healthcare services in rural areas of seven districts of Uttar Pradesh based on the scale developed by Haddad et al (1988) after making adjustment for Indian culture and language. 500 patients were contacted at the healthcare centres. A response rate of 79.2 per cent was obtained resulting in 396 complete questionnaires. The 23-item scale employed in the study comprised five homogeneous sub-scales and tested well for reliability. The findings illustrated some interesting differences in user perception regarding service quality and how they varied between different healthcare centres and according to the demographic status of patients. It was observed that: ‘Healthcare delivery’ and ‘financial and physical access to care’ significantly impacted the perception among men while among women it was ‘healthcare delivery’ and ‘health personnel conduct and drug availability’. With improved income and education, the expectations of the respondents also increased. It was not merely the financial and physical access that was important but the manner of delivery, the availability of various facilities and the interpersonal and diagnostic aspect of care as well that mattered to the people with enhanced economic earnings. What was most astonishing was the finding that the overall quality of healthcare services is perceived to be higher in Primary Healthcare Centres than in Community Healthcare Centres (CHCs). Inadequate availability of doctors and medical equipments, poor clinical examination and poor quality of drugs were the important drawbacks reported at CHCs. The current study demonstrates that the instrument employed was reliable and possessed the power to discern differences in the opinion of people on the basis of demographic factors and point out the quality differences in different healthcare centres. It could be employed to evaluate healthcare quality perception in other rural and urban regions of the country and to assess the perception of users towards private healthcare centres. Further, research could be conducted on price-quality relationship. The government and policy makers are urged to consider the perceptions of patients as well in order to affect improvement in the quality of services and subsequently increase their utilization.