Strengthening of primary health care: Key to deliver inclusive health care

Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in ′Right to Life.′ It is imperative to define ′essential health care,′ which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of ′family physician′ in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery

Barriers and facilitators to seek treatment for gynecological morbidity among women from urban slums in Pune, India

Background: The high burden of gynecological morbidity along with poor treatment seeking practices indicate the need to identify barriers and facilitators for treatment seeking. Methods: A community based study using mixed methodology was conducted among women in reproductive age group in slums of Pune city. A pretested semi open ended questionnaire was used to record data on sociodemographic variables, symptoms of gynecological morbidity, domestic violence, autonomy and treatment seeking. Data were analysed using logistic regression analysis. Reponses to in-depth interviews were analysed using grounded theory. Results: Out of the 202 women recruited in the study, 116 (57%) reported symptoms of gynecological morbidity of which 64 (55%) reported to have sought treatment. The factors significantly associated with treatment seeking were: discussing symptoms with husband [p=0.001, OR=6.99 (2.11 - 23.12)]; having a role in decision making for major household purchase [p=0.005; OR=4.36 (1.54-12.32)] and reporting four or more symptoms [p=0.015; OR=4.57 (1.34-15.61)]. In-depth interviews identified barriers and facilitators at individual, family, community and health service levels. Conclusion: There was a high prevalence of self-reported gynaecological morbidity amongst women in urban slums and only half of symptomatic women reported to have sought treatment for their symptoms. Women empowerment, health education and initiatives planned under National Urban Health Mission such as linkages with health care set up through ASHAs and community based groups and appointment of lady medical officers and gynecologists at Urban PHCs will facilitate treatment seeking