Accessibility and Quality of Government Primary Health Care: Achievement and Constraints

The paper deals with accessibility and qu ality issues of pr imary health care after the initiation of health sector reforms since 1998 using data from an exit survey of a nationally representative sa mple of service users of government primary health care facilities. It anal yses opinions of service users on a relevant set of structure and process dimensions of care within a framework of assessment of quality of care. The results indicate that the majority of the service users are dissatisfied with the existing level of quality of care at the public health care institutions. They are found to be dissatisfied with such aspects of care as waiting time, cleanliness and privacy of treatment, and expressed serious concern about the quality of inpatient food, availability of prescribed drugs and medical supplies at the health centers. Significant variation in quality of care has been identified by age, distance to the health center, facility type, medical expenditure, type of service and by region in out patient care; and gender, facility type, medical expenditure and by region in inpatient care. In terms of ranking of relative importance of different dimensions of care, the service users attached foremost importance to the responsiveness of doctors/service providers and secondly the availability of prescribed medicine at the health centers.