Utilization and perceptions of neonatal healthcare providers in rural Uttar Pradesh, India

• Published in: International journal for quality in health care Vol. 23; no. 4; pp. 487 - 494
• Main Authors: WILLIS, JEFFREY R., KUMAR, VISHWAJEET, MOHANTY, SAROJ, KUMAR, AARTI, SINGH, JAI V., AHUJA, RAMESH C., MISRA, RAJENDRA P., SINGH, PRAMOD, SINGH, VIVEK, BAQUI, ABDULLAH H., SIDHU, SHARLEEN, SANTOSHAM, MATHURAM, DARMSTADT, GARY L.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-08-2011
• Subjects: Cost; Female; Health Care Surveys; Health Personnel; Health policy; Humans; India; Infant Care - economics; Infant Care - utilization; Infant, Newborn; Male; Medical service; Prospective Studies; Quality control; Quality of Health Care; Rural Population; Young Adult; India; patient satisfaction; quality of health care; newborn; health expenditures; health services
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzr030

Objective. To describe the utilization and perceptions of existing neonatal health services in rural Uttar Pradesh, India. Design. A prospective observational study. Setting. The study was located in Shivgarh, a rural block of Uttar Pradesh, India. Participants. One hundred and fifty-three households that utilized a healthcare provider for their sick neonates. Intervention(s). None. Main Outcome Measure. Perceived neonatal health improvement after utilization of neonatal health services; satisfaction with aspects of neonatal health services: 'overall care', 'interaction with provider', 'waiting time' and 'explanations of immediate care and follow-up care'. Results. Unqualified allopathically oriented providers (UAOPs) were utilized by 110 households (71.8%), while qualified allopathically oriented providers (QAOPs) by 43 households (28.2%). The odds of perceived neonatal health improvement were significantly higher among households utilizing UAOPs (n=88/110, 80.0%) than those using QAOPs (n = 23/43, 53.5%) [adjusted odds ratio (OR): 3.3, 95% confidence interval (CI): 1.5-7.5]. The median healthcare fee charged was higher for UAOPs (Rs. 25) than those for QAOPs (Rs. 1). Household satisfaction with 'overall care' of neonatal health service was significantly higher among households that utilized UAOPs compared with those that used QAOPs (OR: 2.4, 95% CI: 1.2-5.0). Conclusion. Households that utilized UAOPs reported better perceived neonatal health outcomes and higher satisfaction levels than those that used QAOPs, despite higher costs for the former. Future research should assess what dimensions of neonatal care are important to households and identify incentive structures that promote healthcare providers to deliver better perceived care in high-mortality settings such as rural Uttar Pradesh, India.