'First we go to the small doctor': first contact for curative health care sought by rural communities in Andhra Pradesh & Orissa, India.
'First we go to the small doctor': first contact for curative health care sought by rural communities in Andhra Pradesh & Orissa, India.
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“我们首先去小型医生”：第一次接触印度安得拉邦和奥里萨邦农村社区寻求的治疗卫生保健。
DOI：
10.4103/0971-5916.90987
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发表时间：
2011-11
期刊：
影响因子：
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通讯作者：
Dror DM
中科院分区：
文献类型：
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作者：
Gautham M;Binnendijk E;Koren R;Dror DM
在初级保健的公共供应不足和非正式提供者的报告的背景下，本研究试图收集描述性证据的第一次接触治疗性卫生保健寻求在印度的两个邦-安得拉邦（美联社）和奥里萨邦的农村社区之间的选择。横断面研究设计结合了家庭调查（AP 1，810户;奥里萨邦5，342户），48个焦点小组讨论（AP 19个;奥里萨邦29个）和61个与医疗保健提供者的关键知情人访谈（AP 22个;奥里萨邦39个）。在AP，69.5%的受访者在他们的村庄或附近寻求非学位对抗疗法从业者的帮助;在奥里萨邦，40.2%的受访者选择与非学位对抗疗法从业者进行第一次治疗接触，36.2%的受访者选择与传统治疗师进行第一次治疗接触。在AP，所有NDAP都是私人执业医生，在奥里萨邦，一些在卫生设施雇用的药剂师和护士也是私人执业。受访者解释说，他们的选择是因为距离近，而且服务提供者愿意在需要时上门服务。不到四分之一的受访者选择合格的医生作为他们的第一个电话点：主要是AP的私人医生和奥里萨邦的公共医生。在选择合格医生的人中，最常见的原因是医生的质量而不是距离。这项研究的结果表明，大多数农村人寻求离家近的第一级医疗保健，并支付咨询和配药的综合便利服务。国家发展援助计划满足了公共系统无法满足的对初级治疗保健的巨大需求，在大多数情况下，国家发展援助计划实际上是第一级服务。
Against the backdrop of insufficient public supply of primary care and reports of informal providers, the present study sought to collect descriptive evidence on 1st contact curative health care seeking choices among rural communities in two States of India - Andhra Pradesh (AP) and Orissa. The cross-sectional study design combined a Household Survey (1,810 households in AP; 5,342 in Orissa), 48 Focus Group Discussions (19 in AP; 29 in Orissa), and 61 Key Informant Interviews with healthcare providers (22 in AP; 39 in Orissa). In AP, 69.5 per cent of respondents accessed non-degree allopathic practitioners (NDAPs) practicing in or near their village; in Orissa, 40.2 per cent chose first curative contact with NDAPs and 36.2 per cent with traditional healers. In AP, all NDAPs were private practitioners, in Orissa some pharmacists and nurses employed in health facilities, also practiced privately. Respondents explained their choice by proximity and providers’ readiness to make house-calls when needed. Less than a quarter of respondents chose qualified doctors as their first point of call: mostly private practitioners in AP, and public practitioners in Orissa. Amongst those who chose a qualified practitioner, the most frequent reason was doctors’ quality rather than proximity. The results of this study show that most rural persons seek first level of curative healthcare close to home, and pay for a composite convenient service of consulting-cum-dispensing of medicines. NDAPs fill a huge demand for primary curative care which the public system does not satisfy, and are the de facto first level access in most cases.