Awareness and client satisfaction of the services providedunder National Urban Health Mission in an Urban PrimaryHealth Center coming under Bruhath Bengaluru MahanagaraPalike - A cross sectional study

Introduction

India which was predominantly a rural nation at the time of independence presently has more than one third population in the urban area1 . The urban poor suffer from a variety of health problems. A poor environmental condition in the urban slums along with high population density makes them vulnerable to lung diseases like Asthma, Tuberculosis (TB) etc.2 Urban Slums also have a high-incidence of Vector Borne Diseases (VBDs) and cases of malaria among the urban poor are twice as high as other urban dwellers. Though there have been health care facilities at reachable distance, due to various reasons, people have not been utilizing the health care services provided by the facilities to the full extent. Considering all these, Government of India launched NUHM as a submission of NHM on 1st May 2013, providing the necessary Human Resources on contractual basis for betterment of health-care services in urban areas. As the health-care facility has been changing from time to time that is from Service oriented to Commodity oriented, the quality of service given matters the most. The technological improvement is very much necessary along with the improvement of quality of health care services. As it has been five years since the implementation of the NUHM, this study has been undertaken to assess the awareness about the programme in general public and also to assess the client satisfaction. Therefore the present study was conducted to assess the awareness about the services provided by the Urban Primary Health Centre under NUHM and to assess the Client satisfaction about the services provided by the Urban Primary Health Centre under NUHM

Materials & methods

A Community based Cross-sectional study was conducted among the households in the Urban Field Practice Area of BMCRI, Bengaluru in the month of September to November 2019. One adult member of the household was interviewed after taking consent. Information regarding awareness of services under NUHM and their satisfaction about services was collected& confidentiality was assured with regards to their participation.

After calculating the required number of study households from each sector, a random number was generated and the corresponding household was visited for the interview. The next household was visited by adding the sample interval to the randomly generated number and the interview was continued till we reached the required target.

A face validated semi-structured questionnaire was administered by interview method.Ethical approval was obtained from the Institutional ethical committee of Bengaluru Medical College & Research Institute.

Inclusion criteria:

Randomly selected household having a responsible adult person to answer the questionnaire.

Exclusion Criteria:

Locked households.

Absence of responsible adult member at the time of visit to household.

Refusal to answer by the members of the family.

Sampling: Systematic Random sampling Method. 

Data analysis

Data was entered in MS Excel sheet & appropriate coding was done. Analysis was done using the statistical software SPSS version 20.0. Results were expressed in terms of percentages, tables and graphs using appropriate statistical tests. Appropriate parametric and non-parametric tests were applied wherever necessary.

Results

Total 347 households had participated in our study on assessing the awareness and client satisfaction about the health care services provided by our UPHC under NUHM. The majority of the respondents in the study households were females (269, 77.53%) (Figure 1). The study showed that 167(48%) study households were availing the services from UPHC Siddaiah Road (Figure 2). 36% (128/347) of the households were aware of all the facilities provided under NUHM, though they were aware about individual components to different extents . 56.77 % of the households were aware of Mahila Arogya Samiti (MAS) meetings(197). Around 58.21 % of the population were aware of the evening clinic facilities (202) by UPHC. 60.51% of the population were aware of the Urban Health Nutrition Day programs (210). 61.95 % of the population were having awareness about the Special Out Reach Clinics being conducted in the field (215). 72.62 % of population were aware of the availability of Community Health Workers i.e., ASHA (252). 74.92 % of population were aware of the availability of lab-facilities (260). 89.91 % were aware that Free drug facilities are available in the centre (312) (Figure 3).

70% (118) of the population were satisfied about the overall health care facilities provided by UPHC. Among the remaining 30%(49), they were unhappy about; Waiting time for OPD consultation, lack of awareness of various Government entitlements, the behaviour of the staff towards the patients and the distance at which health-care facilities are available (Table 1). Among 52% (180) of the households who were not availing the services from our Health Care facility, the main reasons given for not availing the services was distance between the place of staying and the health care center (28.8%) and long waiting time for OPD consultation or the Pharmacy and lab services (26.11%). Other reasons include the difference in the quality of care provided by private and public health facilities, lack of awareness about many services provided and few others (Table 2).

Discussion

National Urban Health Mission was launched in a view to improve the pitfalls in the Health Sector and to attract more and more patients to the Public Sector. To achieve this, the basic awareness among the general public is very much necessary to get the public towards the Urban Health Centers. Especially in India, we have a notion to turn towards the private sector when it comes about Primary Health Care.

In the present study, 78% of the study participants were females, whereas the study done by Ray SK3 had 46.6% females and study conducted by Aldana JM et al5 had 88% of the female study participants. This majority corresponds to the occupation pattern as most of the participants in our study were housewives, who were present at home at the time of interview.

In our study, only 36% (128/347) of the households were aware of all the facilities provided under NUHM, though they were aware about individual components to different extents ranging from 55- 85%. Similar study conducted by Ray SK3 showed that about 63% of the population were not aware of the services provided under NHM in the rural area and the decisions and the programmes used to remain at the higher officials rather than reaching the general population. Thus it is very important that the information gap has to be bridged between the government and the beneficiaries.

In the study conducted by us, among the patients availing facilities, 70% (118) of the population were satisfied about the health care facilities provided by UPHC. Among the remaining 30%(49) of the population, they were unhappy about waiting time for OPD consultation 46% (23) and also about distance at which health-care facilities are available 29% (14). The study conducted by Aldana JM et al showed that a significant proportion of users (34.2%) were not satisfied with the length of time that the facilities were open to the public. About 30% of all users were not satisfied with the time they waited to receive care. And patients presenting for maternal care were significantly more dissatisfied (37.6%) than clients presenting for other types of services.

To overcome the barriers and to cater to more and more population, the public were asked to suggest the improvements needed in the Centre which are as follows; need of Direction signage to the UPHC, information on various Government entitlements to be provided to the beneficiaries and a lot of scope for improvement of cleanliness in and around the hospital which was stressed. The need to increase the number of drugs available in pharmacy, the lack of information regarding the Special Out Reach Clinics (SORC) available to the public and need of the General OPDs during evening hours was also given as suggestion.

Conclusion and recommendations:

It has been five years since the implementation of NUHM. Even though the people have fair idea about few individual components and health care services available under NUHM, it has not reached the general public to the full extent. Hence there is need of wider publicity through various platforms such as mass media and by the aadequate display boards and hoardings. For this purpose, Mahila Arogya Samithis to be strengthened across all the facilities. UHND programs have to be conducted on a regular basis which helps in reaching the population in the community.

Due to the longer distance between the health care facilities and the place of staying, many are not utilizing the services, for which there is a need of improvement in the field clinics in the form of SORC. The waiting time for OPD Consultation and at the dispensary to be reduced to the minimum possible. Specialist facilities in the evening clinics to be made aware to the public. The quality of care provided by the health facility to be improved, thereby attracting the community towards the health care facility.

There is a need to improve the behaviour of health care staff towards patients, by conducting training regarding soft skills to improve on their communication skills, counselling skills, interpersonal relations & empathy etc. The cleanliness in and around the hospital premises is being improved by the programs like Swach Bharath Abhiyan, Kayakalpa and others. Special consideration can be made about running general evening OPDs from 4pm to 9pm along with Speciality OPDs during evening time.  

Source of funding: None.

Conflict of interest: None.