Quality of health and family planning services in rural Uttar Pradesh: The client's view

Abstract

Aim: To gain in-depth understanding of how villagers in Uttar Pradesh view both government and private health services, and how they think about the available family planning services.

Methodology: A special unit of the Indian Market Bureau carried out a set of 20 small, in-depth, focus group interviews with married, 15-34 year old males and females. The selection was made at the level of districts and villages. Districts were selected from each of the five socio-cultural regions. Villages with access to government health care services were selected. In each of the socio-cultural regions, four group discussions were held – three with women and one with men. Each FGD lasted for about hour and a half and was moderated by a trained group leader who followed a structured discussion guide. Discussions were tape-recorded, then translated into English. The transcripts were content-analysed.

Discussions on general health issues helped in establishing a rapport with the people before proceeding to the sensitive topic of contraceptive use.

The reports states the advantages and disadvantages of FGD and its implications for generalisation of the findings.

Findings: Important determinants of treatment-seeking behaviour fall into the categories of physical or financial access. In the Indian context, indicators of quality of care include experiences with effectiveness of treatment, thoroughness of examination, care by a doctor (as opposed to paramedical personnel), waiting time, timings of the facilities, provision of medication, provider-patient communication, and doctors' qualifications. The respondents evaluated the private sector positively on almost all the indicators except one, that is, qualification of the providers. The public sector was evaluated negatively on all the indicators, except two – treatment experience and qualification of providers.

There was a fairly high level of awareness of family planning methods among both men and women. Respondents reported that government health personnel do not involve them in the choice of a particular contraceptive method. Some also doubted the reliability or efficacy of the method. Respondents elaborated on the kind of family planning services they wanted.

The author provides a list of recommendations based on this data to overcome the existing constraints and shortcomings of the programme.