Patterns of health service utilization and perceptions of needs and services in rural Orissa
Patterns of health service utilization and perceptions of needs and services in rural Orissa
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DOI：
10.1093/heapol/czi021
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发表时间：
2005-05-01
影响因子：
3.2
通讯作者：
Pepper, K
中科院分区：
文献类型：
--
作者：
Ager, A;Pepper, K
尽管强调加强地方保健服务，但奥里萨邦内国家提供服务的使用率仍然令人关切。报告的研究审查了奥里萨邦四个县农村人口的服务利用模式，特别提到了对初级保健一级国家服务的可得性和质量的看法。在选定的地区，在66个村庄进行了219次访谈。据报告，家庭利用了各种各样的保健服务提供者，但医院是使用频率最高的，初级保健中心是使用频率最低的服务。私人从业员（合格和不合格）是提供医疗服务的主要部门。这包括在册部落和种姓获得医疗服务的比率很高（获得当地医疗服务和初级保健服务的比率大约是前者的两倍）。指导使用模式的关键因素是供应商的声誉、成本和物理可达性。人们普遍认为，通过助理护士、助产士和男性保健工作者提供的地方保健服务质量较差，在所有服务提供者中解决保健问题的比率最低。助理护士助产士分中心基地在一个村庄的位置对获得服务没有明显的影响。委员会承认在更广泛推广方面存在一些限制，但注意到调查结果对奥里萨邦卫生政策和方案拟订的影响。这包括支持目前加强初级保健和国家次级中心一级提供能力的努力，并承认有效管理的私人提供在满足农村穷人的需要方面可能发挥越来越大的作用。
Despite emphasis on strengthening local health care provision, concern remains regarding the rates of utilization of state-provided services within Orissa. The reported study examined patterns of service utilization across the rural population of four districts of Orissa, with special reference to perceptions of the availability and quality of state services at the primary care level. Within the selected districts, 219 interviews were conducted across 66 villages. Households reported utilizing a wide range of health care providers, although hospitals constituted the most frequently-and primary health care centres (PHCs) the least frequently-accessed services. Private practitioners (qualified and unqualified) represented a major sector of provision. This included high rates of access by scheduled tribes and castes (running at approximately twice the rate of access to both local and PHC provision). Key factors guiding patterns of utilization were reputation of the provider, cost and physical accessibility. Local health provision through assistant nurse midwives and male health workers was generally perceived of poor quality, with the lowest rates of resolution of health problems of all service providers. The location of a sub-centre base for assistant nurse midwives within a village had no demonstrable impact on access to services. Acknowledging constraints on broader generalization, the implications of the findings for informing health policy and programming within Orissa are noted. This includes support for current efforts to strengthen the capacity of PHC and sub-centre level provision within the state, and acknowledgement of the potentially growing role of effectively regulated private provision in meeting the needs of the rural poor.