′First we go to the small doctor′: First contact for curative health care sought by rural communities in Andhra Pradesh & Orissa, India

Abstract

Background & objectives: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.Methods: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).Results: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.Interpretation & conclusions: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.

Informal rural healthcare providers in North and South India

“…Our study confirmed the findings of several other studies (Rohde and Vishwanathan 1995; Gautham et al 2011; George and Iyer 2013; Das et al 2012) that IPs are a significant source of basic health care for rural residents. A study of IPs in two other Andhra districts, Warangal and Karimnagar, located in the state’s Telengana region, also reported ‘doorstep’ services (Gautham et al 2011) by mobile IPs who travelled from house to house and village to village on their daily service delivery rounds.…”

“…These providers tend to be viewed as a homogenous group, but studies in different settings suggest that they differ, in terms of education and training, the contents of their practice and their business model (Gautham et al 2011; George and Iyer 2013). They work in complex health markets and are influenced by many factors, which include consumer expectations, relationships with other providers and formal and informal rules (George and Iyer 2013; Bloom et al 2013).…”

Examining Delay Intervals in the Diagnosis and Treatment of Primary Open Angle Glaucoma in an Egyptian Population and Its Impact on Lifestyle

“…Patients tend to move from one provider to another before they are finally properly diagnosed by a specialist and given proper treatment [6, 15, 16]. This was also true with our patients, who spent some time looking for the right eye specialist and/or whose diagnosis was sometimes delayed due to controversial doctors' opinions from different healthcare providers.…”

Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review

“…Private and informal HCPs are often the first source of care for any illness 6-8 and also TB. 9 There is evidence, albeit limited, that patients with TB symptoms often begin seeking advice in the informal private sector (chemists and unqualified practitioners), then seek care from qualified practitioners, and eventually end up in the public sector for free treatment.…”