Quality of Health Care in PHC: Understanding from Patient Perspective

 

Suby Elizabeth Oommen

Assistant Professor and Research Guide, Department of Economics, Christian College, Chengannur,

Alappuzha District, Affliated to Kerala University, Thiruvananthapuram.

*Corresponding Author E-mail: suby.elizabeth@gmail.com

 

ABSTRACT:

Primary health care through Primary health care system has been recognized as the effective strategy for improved health services across the world. In the present scenario where there is a steep rise in the health expenses, it is difficult for the poor to meet this rising health expenses. Most of them fall in debt trap and become bankrupt. It is the PHCs which is accessible to poor and can meet the health needs of the rural and marginalized section of the community. But the PHCs also have many deficits in facilities and services. This has to be evaluated so as to make necessary actions for improving the PHCs in the State. The study is a micro level analysis in understanding the quality of health care provided by PHCs through assessing the satisfaction of patients for the facilities and services they receive from PHCs. The study evaluates the satisfaction of patients towards the determinants of PHCs and analyzes the relationship between determinants of Patient satisfaction and Quality of health care. The result of the study shows that the determinants of patient satisfaction have a significant positive influence on the Quality of health care of PHC. The scope of the study is limited to Pathanamthitta district of Kerala. The insights from this article   calls for more collaborative works in various facets of PHCs.

 

KEYWORDS: Primary Health Care, Primary health Centres, Patient Satisfaction, Quality of health care, Community Orientation, Tangible.

 

 


1. INTRODUCTION:

In a globalized economy, all sectors are facing stiff competition to meet the demands of the society. This is greatly reflected in the health care system also in terms of its performance. It appears that the motivating force towards success in health care system is the delivery of high quality service (Thompson et.al. 1985). In the era of increased competition, improvement of service quality and its measurement is one of the significant issues for developing efficiency and the growth of the system. Therefore, the study attempts to analyse the quality of health care in Primary Health Centres through patient satisfaction.  

 

2. BACKGROUND OF THE STUDY:

Primary health care is defined as “essential care based on practically and scientifically sound, socially acceptable methods and technologically made universally accessible to individuals and families in the community by means acceptable through full participation at a cost that the community and the country can afford to maintain at every stage of their development in a spirit of self-reliance and self-determination” (WHO, 1978). It forms an important part of the country’s health system. It addresses the foremost health problems usually faced by the community, by providing promotive, preventive, curative and rehabilitative services. Primary health care through Primary health care system has been recognized as the effective strategy for improved health services across the world. The Primary health care system consists of the Community Health Centres, Primary Health Centres and Sub Centres. Unfortunately, now this system which is affordable to the people has many deficits in facilities and services. As the system is not equipped to provide all types of services to all the patients suffering from communicable, non-communicable and life style diseases, it causes rise in the health expenditure of the poor in the community as they have to depend on private specialist hospitals which demand high cost leading them to financial crisis. Due to steep rise in expenses, in the private health care sector, the poor and marginalized groups fall into debt trap and become bankrupt. The poor have to spend 40 percent of their income towards health care in contrast to the rich who spend a mere 2.4 percent (Kunhikannan et.al 2000). Latest National Sample Survey Organization (2015) reports states that, spending by hospitalized males is over 35 percent higher in rural Kerala than rural India and total expenditure is higher than India average, even though non-medical expenses in Kerala is lower than Indian average. In an article in Times of India (September 22, 2015), “Kerala spends maximum ‘out of pocket’ expenditure on healthcare” reported that people in rural Kerala spend Rs.244 per month on health care and in urban areas, spend Rs.275. According to the Kerala Development Report 2008, exorbitant levels of health care expenditure nearly pushed four percent of people below poverty line. The consequence of low levels of public spending coupled with poor access to public facilities compel the poorer sections of the household to bear the cost of services in the private sector which increases the out of pocket expenses. Some people do not have the capability to access health care services while others fall into poverty as a result of health spending.

 

Rising price of medicine has also become a big burden. Rising drug prices aggravate the inequitable distribution of the Kerala health system. This is obvious because of what has come to be widely referred to as mediflation. Mediflation affect mostly the lower- strata of society pushing them to BPL and into deep indebtedness (Aravindan, 2001). Presently, it is found that the poor cannot afford to have health care services at lower cost. In this situation the PHCs which are affordable and accessible has to be strengthen so that the poor community can also improve the health care through the low cost and this will result in bringing equity in health services. However most of the studies on PHCs are based on functioning mechanisms, performance of PHCs and utilization of services by PHCs. Eventhough the PHCs has many deficits in facilities and services, this has to be assessed. Therefore this study is a micro level analysis in understanding the quality of health care provided by PHCs through the facilities and services.

 

The following are the objectives of the study-

·       To evaluate the satisfaction of patients towards the determinants of PHCs

·       To analyze the relationship between determinants of Patient satisfaction and Quality of health care.

 

 

3. RATIONALE FOR SELECTING THE STUDY AREA:

For the detailed study about the quality of health care in PHC, Pathanamthitta district in Kerala was selected based on purposive sampling method. Pathanamthitta district is selected for the study since Othera Primary Health Centre that got the first ISO-9001 certification for its Primary Health Centre in the state of Kerala belongs to this district. Further it is the district having the lowest population growth rate and lowest growth rate of child population in Kerala (Census, 2011). It is the first polio free district in India. According to DLHS 2013-14, the district has the highest achievement in the utilization of antenatal care by the government health services. As per 2011 census, Pathanamthitta is in the second position in the state that showed most favorable sex ratio (1132 female per thousand males). The district consists of both urban area, rural areas and remote rural areas that suffer from inadequate accessibility due to poor road connectivity. The district covers also remote rural area in the hilly and forest terrains. These are the rationale for selecting Pathanamthitta district for the study.

 

4. METHODOLOGY:

4.1 Survey Design:

The study mainly used primary data. Primary data has been collected from the sample patients in the selected PHCs of the district.

 

On basis of geographical areas, the PHCs are classified into urban, rural and remote PHCs. Sample PHCs are selected from the different geographical areas, and patients were selected from the area of the sample PHCs. There are 43 PHCs in the district consisting of one in an urban area; 25 in ordinary rural areas and 17 in remote rural areas. From these, five PHCs were selected to cover the three distinct areas referred to above through stratified random sampling method. From the three strata identified, PHCs are selected through purposive sampling.

a)       Primary Health Center from urban area- Chumathra PHCs the only one in the urban area was selected for the study. This PHC is located in an area where there are one medical college and two multi specialty hospitals within the radius of three kilometers.

b)       Primary Health Center from rural area-From among 25 PHCs, in the rural areas, Othera and Cheneerkera PHC are selected. Othera was selected as it was the first PHCs in the state that got State Government’s quality control certification of ISO-9001.Chenerkara PHCs was selected as it got Arogya Keralam award during the year 2015 for its performance in palliative care and infrastructure development.

c)       Primary Health Center from rural remote area- From among 17 PHCs in the remote rural areas, Anicadu and Kokkathodu PHCs were selected. Anicadu PHC is selected as it is located in an area where the health care services as per reports are scarcely provided and received. Kokkathodu PHC is selected, as it is located in a tribal area consisting 85 percent of the area under the forest.

 

The five sample PHCs represents all the different geographical areas. As there is only one urban PHC, the study has taken that PHC. And the size of the sample PHCs from rural and remote rural area constitute more than 10 percent of the total PHCs from the respective areas.

 

4.2 Selection of Patients:

The actual beneficiaries of the PHCs are the patients. To know the real experience of patients with the PHCs, patient satisfaction survey was conducted separately in the selected PHCs. From the five PHCs, a total of 220 patients (10 percent of patients during the survey period of one week) were identified. Thus 46 from urban Chumathra PHC, 42 from rural Othera PHC, 42 from rural Chenerkara, 50 from remote rural Anicadu and 40 from remote rural Kokkathodu PHCs. The patients were selected from the outpatients present at the time of interview.

 

Patient satisfaction was the indicator used in the study for measuring health care as it affects the outcomes of PHC. Qualitative research technique is used to explore the level of satisfaction of the patients on various determinants of PHCs. The interview schedule for patient satisfaction was prepared with questions regarding the satisfaction of patients on eleven determinants. The five determinants of patient satisfaction included in the interview schedule was taken from the SERVQUAL model. The responses of patients were taken by using a five point likert scale (See appendix II). Patients’ satisfaction in getting care is the central component for evaluating healthcare quality. The five derterminants taken from SERVQUAL model (Parasuraman, et al (1988)) are Tangible, Assurance, Responsiveness, Empathy and Reliability. Along with these, Staff behaviour, Accessibility, Availability, Communication, Accountability and Community orientation are also included to get a complete level of patient satisfaction. The patient satisfaction received from these determinants depicts the overall quality of health care provided by PHC. The patients were asked to mark their satisfaction level on a five point Likert Scale towards the eleven determinants. A multiple regression analysis was also used to show the relationship between the determinants of patient satisfaction and quality of health care.

 

5. ANALYSIS AND FINDINGS OF PATIENT SATISFACTION TOWARDS PHC:

5.1 Staff Behaviour:

Staff behaviour is an important factor in influencing the patients while taking care of. Patients should feel that their dignity is encouraged and well care is given. Staff must see that privacy within the environment of Primary Health Centre be provided and they must be in a position to take appropriate action if they consider a patient’s dignity is at risk.

 

Mean±SE and one sample t-test is used to check whether the patients are satisfied about the staff at Primary Health Centres.

 

Table 1 Patient satisfaction and staff behaviour

Staff

Mean±SE

Test value = 3

(Moderate satisfaction)

t-value

P-value

M.O

3.82±0.04

19.694

0.000*

Nurses

3.26±0.04

5.946

0.000*

Health Inspector

2.70±0.05

-6.578

0.000*

ASHA

3.08±0.05

1.622

0.106

Peons/ Security

2.85±0.04

-3.270

0.001*

Pharmacist

3.24±0.04

6.043

0.000*

Other Staff

3.11±0.04

2.978

0.003*

Source : Survey Data,* Significant at 1% level of significance

 

It is clear from the table 1 that, patients are satisfied with the Medical Officers, Nurses, ASHA workers, Pharmacist and other staff (mean Score is >3). But in this survey, patients shows dissatisfaction with the services of Health Inspectors and Peons/Security (mean Score <3). The very small SE of mean (.04-.05) indicates the opinions are consistent. This shows that the services rendered by the staff towards the patients within the PHC seem to be effective, whereas, the services towards the community found to be not satisfactory.

 

5.2 Patient satisfaction and Tangible factors:

The tangible factors such as infrastructure and facilities of Primary Health Centre play a pivotal role in evaluating the quality of health care. Good appearance (tangibility) of the physical facilities and infrastructure definitely create a positive impression on the patients, which could be definitely considered a main criteria in assessing the quality of health care. Health care infrastructure constitutes a major component of the structural quality of a health system.

 

Table 2 Patient satisfaction and Tangible factors

 

Mean±SE

Test value =3

t-value

P-value

Inside of PHC

3.03±0.06

0.490

0.624

Primary Health Centre as a whole

3.01±0.06

0.142

0.887

Consultation Rooms

2.88±0.07

-1.606

0.110

Waiting Room

2.92±0.06

-1.281

0.202

Pharmacy

3.22±0.05

4.418

0.000*

Other medical facilities

2.93±0.06

-1.141

0.255

Casualty

1.37±0.12

-13.584

0.000*

Communication facilities

2.54±0.07

-6.977

0.000*

Drinking water

2.47±0.08

-6.438

0.000*

Electricity

3.30±0.05

5.771

0.000*

Toilet facility

2.36±0.09

-7.449

0.000*

Parking Space

3.12±0.10

1.145

0.253

Other Services MCH, FP, FM

3.25±0.03

7.767

0.000*

Government insurance Sub Centre Schemes and policy

3.23±0.03

7.744

0.000*

Source: Survey Data * Significant at 1% level of significance ** Significant at 5% level of significance

 

From the table 2, it is observed that the patients are satisfied with the inside of PHC, PHC as a whole, Pharmacy, electricity, Parking space, MCH, Government schemes (mean score is >3) but expressed dissatisfaction with Consultation Rooms, Waiting Room, Other medical facilities, Casualty, Communication facilities, Drinking water and Toilet facility (mean Score <3).

 

All PHC in the districts have a Pharmacy, electricity and at least a small Parking space. But some PHC especially the rural and remote rural PHC lack the least provision of a casualty, waiting room, toilet facilities, drinking water facility, referral facility and laboratory facility. This shows that there is the absence of necessities in the PHC.

 

5.3 Patient satisfaction and Accessibility:

Accessibility of care includes convenience of geographical location, convenience of appointment system, waiting time, and extended office hours. This is an important component to know whether the PHC are situated in an area which is easily accessible to the community.

 

Table 3 Patient satisfaction and Accessibility

 

Mean±SE

Test value =3

t-value

P-value

Travel time to PHC

3.15±.061

2.467

0.014**

Convenient hours

2.87±.049

-2.673

0.008*

Source: Survey Data

*Significant at 1% level of significance ** Significant at 5% level of significance

 

From the table 3 it is evident that, the mean Scores shows that patients are satisfied with the travel time to PHC (mean Score is >3) but expressed dissatisfaction with the convenient working hours of Primary Health Centre (mean Score <3). This shows that, there is difficulty with transportation facility and the short duration of working hours in rendering medical care.

 

5.4 Patient satisfaction and Availability:

Availability of doctors, nurses and hospital beds round the clock is of concern to patients in defining the level of access.

 

Table 4 Patient satisfaction and Availability

 

Mean±SE

Test value =3

t-value

P-value

M O and all other staffs are always available

2.81±.066

-2.892

0.004*

Medicines are always available

3.20±.053

3.804

0.000*

Source: Survey Data

* Significant at 1% level of significance ** Significant at 5% level of significance

 

The mean SE shows that respondents are satisfied with the availability of medicines (mean score is >3) but expressed dissatisfaction with availability of doctors (mean score <3)

 

 

This shows the need for the availability of more than one doctor in each PHC so that medical care is made available to all the patients undisrupted.

 

5.5 Patient satisfaction and Assurance:

Knowledge, skill and courtesy of the doctors and nurses can provide a sense of assurance that they repose on the patients.

 

Table 5 Patient satisfaction and Assurance

 

Mean±SE

Test value =3

t-value

P-value

Qualified and competent doctors

3.46±.040

11.471

0.000*

Nurses are skillful

3.25±.046

5.400

0.000*

Source: Survey Data

* Significant at 1% level of significance ** Significant at 5% level of significance

 

The mean in the table 5 shows that patients are satisfied with the qualifications and competency of doctors and also with the skill of nurses (mean Score is >3).

 

This shows that the qualification, ability and skillness of doctors and nurses are the main yardstick in providing medical care. It is reported from the survey that every PHC should see that well qualified and well-trained doctors and nurses are appointed wherever it deemed to be necessary.

 

5.6 Patient satisfaction and Communication:

Communication is a vital factor for patient satisfaction. A person should always feel satisfied with the communication and rapport created by the doctors and nurses help in passing on essential information, which in turn influence patients’ satisfaction.

 

Table 6 Patient satisfaction and Communication

 

Mean±SE

Test value =3

t-value

P-value

Doctors explain clearly to patient

3.57±0.04

13.118

0.000*

Nurses explain clearly to patient

2.94±0.05

-1.120

0.264

Doctors have Good knowledge to answer patients questions

3.38±0.04

8.556

0.000*

Nurses have Good knowledge to answer patients questions

2.73±0.05

-5.473

0.000*

Source : Survey Data

* Significant at 1% level of significance ** Significant at 5% level of significance

 

The mean scores from table 6 shows that patients are satisfied with the doctors explanations and knowledge of diseases to the patient (mean score is >3) but expressed dissatisfaction with the nurses explanation and knowledge regarding diseases (mean score<3)

 

Patient satisfaction increased when members of the healthcare team take the problem seriously, explained information clearly, and tried to understand the patient’s experience, and provides viable options.

 

 

5.7 Patient satisfaction and Responsiveness:

Patients always expect hospital staff be responsive whenever needed. They also expect the required equipment be made available, functional and able to provide quick diagnoses of diseases.

 

Table 7 Patient satisfaction and Responsiveness

 

Mean±SE

Test value =3

t-value

P-value

Waiting time

3.20±0.06

3.386

0.001*

Doctors immediately respond to patient.

3.37±.04

10.168

0.000*

Source: Survey Data

* Significant at 1% level of significance ** Significant at 5% level of significance

 

The patients expressed that, they are more concerned about the doctors and services, most of the patients were least bothered about the waiting time.

 

5.8 Patient satisfaction and Empathy:

Health care providers should have“empathy on patients’ problems and needs which in turn satisfy the patients a lot. Patients also expect nurses to provide personal care and mental support to them.

 

Table 8 Patient satisfaction and Empathy

 

Mean±SE

Test value =3

t-value

P-value

Doctors are helpful and respectful to patients

3.56±

0.04

14.439

0.000*

Nurses are helpful and respectful to patients

3.23±

0.05

4.831

0.000*

Source: Survey Data

* Significant at 1% level of significance ** Significant at 5% level of significance

 

The mean scores shows that patients are satisfied with the helping and respecting mentality of Doctors and nurses to patients (mean Score is >3) In this context, Doctors have a great position in their minds.

 

5.9 Patient satisfaction and Reliability:

Reliability refers to providers’ ability to perform the promised service dependably and accurately. Reliability will be great when doctors recommend necessary medical tests, there is regular supply of drugs at the hospital premises, supervision of patients by care providers is regular, and specialists are made available to patients

 

Table 9 Patient satisfaction and Reliability

 

Mean±SE

Test value =3

t-value

P-value

Doctors spent enough time inconsultation

3.11±0.04

2.478

0.014**

Doctors have sincere interest on the patient

3.39±0.04

10.272

0.000*

Source : Survey Data

*Significant at 1% level of significance ** Significant at 5% level of significance

 

 

The mean Scores from table 9 shows that patients are satisfied about the time spent by doctors for consultation and their interest on the patients (mean scores is >3)

 

5.10 Patient satisfaction and Accountability:

Table 10 Patient satisfaction and Accountability

 

Mean±SE

Test value =3

t-value

P-value

Privacy during treatment

2.93±0.08

-0.879

0.380

Patient feel confident when receive care

3.48±0.04

11.476

0.000*

Source: Survey Data * Significant at 1% level of significance

** Significant at 5% level of significance

 

The mean scores shows that customers are satisfied about confidence of care that are received by the doctors of PHC (mean Scores is >3) but expressed dissatisfaction about the privacy they receive during treatment (mean Scores <3). This shows that privacy is lacking in many of the PHC due to the lack of a well organized consultation room. A good consultation room will provide confidentiality which helps the patient to open up their health care problems and will make the services more effective.

 

5.11 Patient satisfaction and community orientation

Community orientation is the extent to which PHC recognize the health needs of the community,

 

Table 11 Patient satisfaction and Community orientation

 

Mean±SE

Test value =3

t-value

P-value

Sanitation Promotion

3.05±0.05

1.189

0.236

Health awareness Programme

2.96±0.05

-0.839

0.403

Immunisation and MCH programmes

3.09±0.05

1.830

0.069

Visit of ASHA

2.78±0.05

-4.461

0.000*

Visit of health inspectors

2.58±0.05

-9.388

0.000*

Source: Survey Data * Significant at 1% level of significance

** Significant at 5% level of significance

 

The table 11 shows that patients are satisfied with sanitation promotion and immunization, MCH programmes (mean score is >3) but expressed dissatisfaction with health awareness programme, visit of ASHA and health inspectors (mean score <3). This shows that, frequent visit of Health Inspector (HI) and ASHA workers are not done. Moreover, sufficient number of HI are lacking in almost all the PHC. The only way in preventing epidemics in our society is to make sure that, frequent visits of health workers and ASHAs workers are effectively done which seems to be more congenial.

 

After having an evaluation about the patients satisfaction towards the said determinants of PHCs in the community, it is indispensible to analyze whether the above said determinants have any relation on the quality of health care in PHC. A Hypothesis has been formulated and step wise regression analysis is carried out.

 

Ho There is no significant relation between the quality of health care of PHC with the determinants

H1 There is significant relation between the quality of health care of PHC with determinants

 

Table 12 Multiple regression Analysis -Descriptive Statistics

Variables

Mean

Std. Deviation

Patient Satisfaction

3.04

0.53

Staff behavior

3.15

0.52

Tangible

2.83

0.81

Accessibility

3.01

0.76

Availability

3.00

0.82

Assurance

3.36

0.60

Communication

3.15

0.60

Responsiveness

3.29

0.46

Empathy

3.39

0.58

Reliability

3.25

0.51

Accountability

3.21

0.81

Community orientation

2.89

0.52

Source: Survey Data

 

The table 12 shows the mean and SD. It is clear from the table that the SD of tangible, Accessibility, Availability, Assurance and Accountability are 0.81, 0.76, 0.82, 0.60 and 0.81 respectively which shows that there is difference in the satisfaction level of patients towards these determinants.

 

Multiple regression analysis has been carried out to study the relation between patient satisfaction and the independent variables such as staff behavior, tangible Accessibility Availability, Assurance, Communication, Responsiveness, Empathy Reliability, Accountability and community orientation.

 

Table 13 Model Summary

R

R Square

Adjusted R Square

.990

0.980

0.978

The R square value is obtained 0.98 and the adjusted R square is 0.978. It shows 97.8% of variation of patient satisfaction is explained by the independent variables.---

 

Table 14 ANOVA

Model

Sum of Squares

Df

Mean Square

F

Sig.

Regression

61.183

11

5.562

327098.9

0.000a

Residual

0.004

208

0.000

 

 

Total

61.186

219

 

 

 

 

The Analysis of Variance (ANOVA) table shows the regression model is significant at 1% level of significance. The following tables gives the regression coefficients and test of significance.


 

Table 15 Coefficients

Model

Unstandardized Coefficients

Standardized Coefficients

T

Sig.

Collinearity Statistics

B

Std. Error

Beta

Tolerance

VIF

(Constant)

-0.001

0.003

 

-0.43

0.666

 

 

Staff behavior

0.158

0.001

0.155

167.20

0.000

0.32

3.08

Tangible

0.319

0.001

0.489

405.53

0.000

0.19

5.24

Accessibility

0.045

0.000

0.064

98.85

0.000

0.65

1.53

Availability

0.046

0.001

0.071

61.11

0.000

0.21

4.86

Assurance

0.045

0.001

0.051

56.12

0.000

0.34

2.96

Communication

0.090

0.001

0.102

125.74

0.000

0.42

2.36

Responsiveness

0.046

0.001

0.040

64.73

0.000

0.74

1.36

Empathy

0.046

0.001

0.051

60.10

0.000

0.39

2.55

Reliability

0.047

0.001

0.045

58.83

0.000

0.48

2.09

Accountability

0.045

0.001

0.069

52.56

0.000

0.16

6.12

Community Orientation

0.114

0.001

0.113

141.20

0.000

0.43

2.31

 


The table 15 shows that, all the independent variable have significant positive effect on patient satisfaction at 1% level of significance. The Variance Inflation Factor (VIF) and tolerance shows there are no serious multicollinearity. The Beta values can be used to compare the effects of independent variables on the dependent variable. It is shown in the table that, The structure variable that is tangible factors having a Beta value of 0.489 have the greatest influence on the outcome of PHC. When PHC have better tangible factors, the patient will have greater satisfaction towards the PHC, which contribute to greater quality of health care. Staff behavior having 0.155, showing that PHC with better staff and their good behavior contributes to an increase in Quality of health care. The determinant Community Orientation having 0.113 which explains that the services of PHC does in the community has a great influence on quality of health care. The determinants such as reliability and responsiveness have least influence on the promotion of quality of health care. This clinches on to the fact that the all the above said determinants have a great influence on determining the Quality of health care provided by PHC. Therefore, there is significant relation between the quality of health care of PHC with determinants.

 

As quality of services is the key factor that attract patients, it is a need to improve infrastructure of the PHCs, physical facilities especially laboratory, human and financial resources. A better consultation room will help the patients in opening up their health problems to doctors. Immediate steps will have to be taken in filling up the existing posts wherever it is lying vacant so that sufficient numbers of staff are appointed on a war time footing especially in those PHCs situated in the remote rural localities where the PHCs have a vital role to play. As the policy of decentralization entrusts the governance of the PHCs to the Grama Panchayats, they have to take up this responsibility seriously. Panchayats should strengthen and supervise their functioning.

 

6. CONCLUSION:

The study has made an attempt to evaluate the satisfaction level of patients in the PHC of Pathanamthitta District. The analysis in the study found that patients are seen to be dissatisfied with the services of health Inspectors, peons /securities, casualty, waiting room, consultation room, communication facility, drinking water, toilet facility, convenient working hours, availability of doctors, nurses explanation of diseases and their knowledge, Convenient hours, privacy and health awareness programmes, communication factor of nurses and the visit of ASHAS and Health Workers but satisfied with the services of Medical officers, nurses and Pharmacists. They are satisfied with the electricity, parking space provided, Government schemes, travel time to PHC, availability of medicines, qualification and skill of doctors and nurses, the communication factor of doctors, responsiveness, empathy, reliability factors, confidence the patients receive from the medical care, sanitation promotion, immunization and MCH programmes of PHC. The test of multiple regression analysis in the study shows that the determinants of patient satisfaction have a significant positive influence on the Quality of health care of PHC. The scope of the study is limited to the Pathanamthitta district only. Interdistrict studies and inter state studies are needed for wide comparison. The insights from this article calls for more collaborative works regarding the problems and level of satisfaction of the doctors and health staffs. As they are the main promoters of health care through the PHC, this area needs to be further explored.

 

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Received on 25.06.2023         Modified on 19.07.2023

Accepted on 21.08.2023      ©AandV Publications All right reserved

Res.  J. Humanities and Social Sciences. 2023;14(3):137-143.

DOI: 10.52711/2321-5828.2023.00028