Strengthening Primary Health Care Services: Insights from Qualitative Research in West India

Objectives: To understand reasons for nonuse of Government health services and identify ways to address them. Design and Setting: Indepth interviews of 371 married women of reproductive age were conducted in village of two Primary Health Centres (PHC), of north Gujarat. Five focus group interviews in each of the PHC areas were also conducted. Results and Implications: 1. Acceptance of immunization is high, but needs institutionalization, through community preparation. Women are aware of vaccines(90%), but unaware of diseases, dosage, schedule(69%), therefore do not know the importance of completing vaccine schedule(32%). Vaccines are given at home, but there is substantial dropout in coverage, as women report irregularity of worker(26%), and lack of time(15%). 2. Distributing Iron & Folic Acid tablets may not reduce anemia because, of 60% women served, only 12% consumed for more than 3 months due to side effects and treatment form private sources. 3. There was low demand for antenatal care (46% use) as women do not perceive any benefit unless there is a problem. Delivery care needs improvement, as majority are at home(81%), attended by traditional birth attendants (46%), relatives(18%), private practitioners(24%) and only 3% by ANMs. 4. Sterilization is well accepted but fears remain. Tubectomy was perceived to have least side effects but laparoscopy was preferred as less post operative rest required. Major fears were; laparoscopy causes burning of blood(41%), and vasectomy causes weakness(56%). 5. Low knowledge, demand and use of spacing methods was observed. Knowledge of IUD, condoms and pills was 71%, 63% and 51%. Most women felt that since the natural interval between their children was 2 to 3 yrs, no spacing method was required. Trend was to accept sterilization after the desired family size. 6. People used and preferred private care for major and minor illnesses because private care was thought to be more effective(50%), quick(35%), and more accessible(95). The extension work was restricted to three programs: family planning, immunisation and malaria and the working pattern of the workers does not allow time for counselling and education. The role of primary health care in rural areas and the servering of link between preventive and curative care are discussed.