Health systemPrimary health centres viewed as a vehicle for programme and schemes, rather than as a provider of integrated care. There is little financial support and encouragement of activities—like the OPD—from the authorities. Primary health centres viewed with derision within the health system as a hospital that does not have many facilities. Primary health centres viewed (by doctors) as place where professional support from peers is absent. Doctors work gets reduced to administrative work. Few drugs available for curative care at these centres. The higher tiers better suited for curative care.
| Health systemNon-incentivised OPDs get less attention In coping with too many schemes and programme, health workers concentrate only on activities with targets There is focus on reporting activities rather than doing them There is no incentive for not referring/ treating at primary health centres Doctors hesitate to take risks due to fear of punitive action and lack of peer support (nurses are protected by doctors to some extent)
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CommunityPrimary health centres viewed as a small hospital that has nothing much in terms of facilities or drugs. Community finds very few services of primary health centres relevant to their basic curative care needs. Primary health centres sometimes treated as a pharmacy to obtain a stock of drugs or tonics. Mismatch on perceptions of what primary care entails—between community and the health system actors. Community often does not understand the logic behind having many tiers of care. Community views referral with suspicion (as staff shirking their duty).
Expectations from primary healthcentres: Guaranteed presence of the doctor, attention from the doctor and other staff, strong drugs and more ‘variety’; all laboratory reports must come on time. Instant relief must be obtained; and the patient must not be asked to come again and again. Even if primary health centres are geographically a little distance away, these can be visited if the trip is worth the effort. | CommunityHealing norms in the community are oriented towards instant relief—this is mismatch with the practices at primary health centres. However, the local private practitioners cater to these needs. There is wariness about public institutions and their employees in the community Doctors at primary health centres process people in the OPD mechanically. Community not satisfied with such processing Community dissatisfied with the experience at these centres nurse interaction; waiting time; staff’s way of speaking to them and delay in laboratory reports. (especially in contrast to private practitioners) Community members demand clinically irrational treatments at primary health centres.
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