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Vol. 34. Issue 4.
Pages 167-175 (July - August 2019)
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Vol. 34. Issue 4.
Pages 167-175 (July - August 2019)
Original Article
DOI: 10.1016/j.jhqr.2019.04.003
Patient experiences and health system responsiveness among internal migrants: A nationwide study in 13 Indian cities
Experiencias de pacientes y capacidad de respuesta del sistema sanitario entre los migrantes internos: un estudio a nivel nacional en 13 ciudades de la India
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B.V. Babua,
Corresponding author
babubontha@gmail.com

Corresponding author.
, Y. Sharmaa, Y.S. Kusumab,, M. Sivakamic,, D.K. Lald,, P. Marimuthue,, J.B. Geddamf,, A. Khannag,, M. Agarwalh,, G. Sudhakari,, P. Senguptaj,, A. Borhadek,, Z. Khanl,, A.S. Kerkettam,, A. Brogenn,
a Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
b Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
c Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
d International Institute of Health Management Research, New Delhi, India
e Department of Biostatistics, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
f National Institute of Nutrition of Indian Council of Medical Research, Hyderabad, India
g Indian Institute of Health Management Research, Jaipur, India
h Department of Community Medicine & Public Health, KG Medical University, Lucknow, India
i Department of Human Genetics, Andhra University, Visakhapatnam, India
j Department of Community Medicine, Christian Medical College, Ludhiana, India
k Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, India
l Department of Community Medicine, JN Medical College, Aligarh Muslim University, Aligarh, India
m Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
n Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, India
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Tables (8)
Table 1. Responses of participants pertained to the domain ‘autonomy’.
Table 2. Responses of participants pertained to the domain ‘clarity of communication’.
Table 3. Responses of participants pertained to the domain ‘confidentiality’.
Table 4. Responses of participants pertained to the domain of ‘dignity’ – ‘respect’.
Table 5. Responses of participants pertained to domain of ‘dignity’ – ‘privacy’.
Table 6. Responses of participants pertained to domain of ‘quality of basic amenities’.
Table 7. Responses of participants pertained to domain of ‘prompt attention’.
Table 8. Responses of participants pertained to domain of ‘Access to family/community’.
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Additional material (1)
Abstract
Objective

To report various components of health system responsiveness among poor internal migrants who availed the government health facilities in 13 Indian cities.

Materials and methods

Cluster random sampling was used to select 50,806 migrant households, of which 14,263 households avail the government health facility in last six months. In addition, 5072 women, who sought antenatal care and 3946 women who had delivery in government health facility during last six months were also included. Data on different domains of health system responsiveness were collected using an interviewer-administered questionnaire, developed based on the World Health Survey of WHO.

Results

Of the eight domains of responsiveness, namely, autonomy, communication, confidentiality, dignity, choice, quality of basic facilities, prompt attention and access to family and community, seven domains, except the ‘choice’, are assessed, and they are moderate. Only about 30% of participants said that doctor discussed on treatment options (autonomy). And 50–60% of participants said positively for questions of clarity of communication. About 59% of participants acknowledged the confidentiality. Not more than 40% of participants said they were treated with dignity, and privacy is respected (dignity). The responses to quality basic amenities, prompt attention and access to family and community domains are fairly satisfactory.

Conclusions

This study has implications as many urban poor, including migrants do not utilize the services of public healthcare facilities. Hence, a responsive health system is required. There should be a policy in place to train and orient healthcare workers on some of the domains of health system responsiveness.

Keywords:
Quality of health care
Health services accessibility
Human migration
Migrant workers
Resumen
Objetivo

Informar sobre los diferentes componentes de la capacidad de respuesta del sistema sanitario entre migrantes internos pobres que utilizaron los servicios sanitarios del gobierno en 13 ciudades de la India.

Materiales y métodos

El muestreo aleatorio en grupos se utilizó para seleccionar 50.806 hogares de migrantes, 14.263 de los cuales han utilizado los centros sanitarios del gobierno en los últimos 6 meses. Además, se incluyó a 5.072 mujeres que solicitaron asistencia prenatal y a 3.946 mujeres que dieron a luz en centros sanitarios del gobierno durante los últimos 6 meses. Los datos sobre los diferentes ámbitos de la capacidad de respuesta del sistema de salud se recopilaron mediante un cuestionario administrado por un entrevistador, elaborado de acuerdo con la Encuesta Mundial de Salud de la OMS.

Resultados

De los ocho ámbitos de capacidad de respuesta, es decir, autonomía, comunicación, confidencialidad, dignidad, elección, calidad de los centros básicos, asistencia rápida y acceso a la familia y la comunidad, se evalúan siete ámbitos, excepto la «elección», y son moderados. Solo alrededor del 30% de los participantes afirmó que el médico habló sobre las opciones de tratamiento (autonomía). Y el 50-60% de los participantes respondieron positivamente a las preguntas de claridad de la comunicación. Alrededor del 59% de los participantes reconoció la confidencialidad. No más del 40% de los participantes comunicaron que fueron tratados con dignidad y que se respetó su privacidad (dignidad). Las respuestas a los servicios básicos de calidad, la asistencia inmediata y el acceso a los ámbitos de la familia y la comunidad son bastante satisfactorias.

Conclusiones

Este estudio tiene implicaciones ya que muchos ciudadanos pobres, incluidos los migrantes, no utilizan los servicios de los centros sanitarios públicos. Por tanto, se requiere un sistema sanitario receptivo. Debe existir una política para formar y orientar a los profesionales sanitarios en algunos de los ámbitos de la capacidad de respuesta del sistema sanitario.

Palabras clave:
Calidad de la asistencia sanitaria
Accesibilidad a los servicios sanitarios
Migración humana
Trabajadores migrantes

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