Primary health centres fail to deliver the goods in rural areas

Syed Akbar
Hyderabad:  The State government’s constant promotion of
Primary Health Centres (PHCs) in the State notwithstanding, about 70
per cent of people in rural areas continue to visit quacks and
unqualified medical practitioners. The use of these centres is largely
limited to immunization, and people prefer unqualified medical
practitioners even for important health issues like newborn/child
illnesses, malaria/febrile illnesses, TB and women’s health.

An international study on the utilization of medical facilities by
rural people in Andhra Pradesh revealed that although intended for the
poor and cheaper than private, PHCs are nonetheless not perceived as
poor-friendly by poor patients. Researchers from Erasmus University
Rotterdam, Netherlands, Tel Aviv University, Israel, and Micro
Insurance Academy, New Delhi, covered hundreds of households for a
first-hand assessment of people’s choice of health care providers.

The study published by the Indian Council of Medical Research shows
that 69.5 per cent of respondents accessed unqualified medical
practitioners or non-degree allopathic practitioners (NDAPs)
practicing in or near their village. “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. There is low
utilization of primary outpatient care in public facilities (PHCs)
because of long distances, inconvenient opening hours, lengthy
waiting, staff absenteeism, poor availability of medicines, and poor
quality of care,” the researchers pointed out.

Each PHC is supposed to serve on average 30,000 persons. It should be
managed by a medical doctor. Only 25 per cent of people approached
qualified doctors in the first instance. As many as 77.5 per cent of
respondents named proximity as the most important reason for their
choice of first contact provider when asked why they were approaching
unqualified practitioners.

The quacks used mostly four classes of drugs:
analgesics/antipyretics/antimalarial, vitamin and iron supplements,
antibacterial and non-steroidal anti-inflammatory drugs (NSAIDs).