Poor healthcare delivery system in rural areas Doctors found absent during official timings
HYDERABAD: How good is the healthcare delivery at the grassroots level in the State?
A pilot project to assess the performance of two Primary Health Centres (PHCs) in two mandals of Visakhapatnam applying Community Scorecard (CSC) method has found "quality of service poor, besides systemic and support level weaknesses".
An evaluation of the scores given to various indicators by the community brought to light fundamental issues plaguing the healthcare delivery system in rural areas. The results were presented at the South Asia Regional Workshop on Social Accountability held here recently. Vivek Misra and P. Ramasankar of Centre for Good Governance (CGG) piloted the study.
Mr. Misra said staff behaviour and its working style was the most important indicator to communities in both the mandals, Devarapalle and Golugonda. It clearly demonstrated the importance of "human touch" in service delivery. The community felt that neither medicine prescribed by the doctor was distributed nor was there transparency on their availability.
As for timings/ availability of doctor and staff, the assessment found two dimensions -- their presence during official timings and the suitability of these timings to the community needs.
Both mandals fared poorly in these three indicators. Lack of basic infrastructure like waiting facilities, irregular water supply, unclean toilets, shortage of beds and absence of a scientific medical waste disposal process added to the patients' woes.
Weak support services like poor condition of village roads, lack of information about Government schemes and the inability of PHCs to provide emergency services further raised the discontent within the community. Overall, the quality of service delivery was quite poor -- the average score across all indicators reflecting the same.
Across the mandals, there were clear differences in the rating of indicators. In Devarapalle, the doctor's availability was a relatively bigger issue than in Golugonda, while doctor's diagnosis was more important in Golugonda. Gender wise, women gave higher rating to the PHCs than men.
Expectedly, the differences in perceptions of the community and the service providers were quite stark, with the former giving low ratings to all indicators while the latter high ones.
"The Community Scorecard is a powerful tool of civic engagement, a channel through which communities could articulate their concerns," Mr. Misra added. It could be scaled up to study 1,570 PHCs in the State.