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Assessment of patient satisfaction of services in primary healthcare centers of Shivamogga: a cross-sectional study

India is the second most populous country in the world. Primary health care (PHC) plays an important role in providing health care facilities in India. With exponential growth of population in India, upholding the standards of primary health care becomes important. According to World Bank data India falls in the group of low-middleincome countries. Studies have shown that quality of primary health care in low to middle income countries is very poor due to high rates of wrong diagnosis, incorrect treatment and long waiting time to see a healthcare provider. Sustainable development goal (SDG) 3 clearly calls for successful implementation of universal health coverage with access to safe and quality health services, medicines, vaccines for all.3 With this goal in mind the need to access the current primary health care services in India to improve the services and achieve the goals of SDG becomes crucial.


INTRODUCTION
India is the second most populous country in the world. Primary health care (PHC) plays an important role in providing health care facilities in India. With exponential growth of population in India, upholding the standards of primary health care becomes important. According to World Bank data India falls in the group of low-middleincome countries. 1 Studies have shown that quality of primary health care in low to middle income countries is very poor due to high rates of wrong diagnosis, incorrect treatment and long waiting time to see a healthcare provider. 2 Sustainable development goal (SDG) 3 clearly calls for successful implementation of universal health coverage with access to safe and quality health services, medicines, vaccines for all. 3 With this goal in mind the need to access the current primary health care services in India to improve the services and achieve the goals of SDG becomes crucial.
India will soon achieve the Wold Health Organization (WHO) target of doctor to patient ratio in about 5 years. 4 With this development in mind it is also important to know the utilization of the services provided at the primary health care levels. The data will help improve the quality services provided and also help the community be benefited from the achievement of the required doctor patient ratio.
Patient's perception of quality of health care service provided has strong relation with the utilization the services. Studies done in Bangladesh, China, Nepal, Sri Lanka and Vietnam conclusively prove that the patient's perception of the health care services provided impacts the utilization of the same. [5][6][7][8][9] Most of the studies on performance of primary health care facilities has been done in high-income countries. 10 India being a developing country, it's important to monitor the health care delivery systems in the country to gain more knowledge about the health care delivery systems and to promote well-being for all ages.

METHODS
A cross-sectional study was conducted in selected PHCs in Shimoga town from July 2019-September 2019.
Purposive sampling technique was used in this study. As per the information obtained from the district health officer of Shivamogga, there are 11 PHCs in the city. 5 PHCs were selected by simple random sampling. 30 patients attending the facility were randomly chosen for exit interview from each of the PHCs to reach the total sample to 150 patients. Permission of the medical officer of the respective PHCs was obtained before conducting the study in each of the facility. Data was collected with the help of a pre-tested questionnaires given to each of the participant willing to participate in the study. The questionnaire contained items to collect socio demographic details, and their perception of quality of health care provided by the facility.
The data were entered into the excel sheet and analysed using statistical package for the social sciences (SPSS) software. The frequencies and percentages were calculated and represented in tables.

RESULTS
In the current study the urban and rural population was both equally represented with 50% of each of the population. Age groups were divided into adults (18-34 years), middle age (35-59 years) and elderly (60 years and above). Majority of the participants belonged to middle age (47.3%). The average age of the participants was 45.1 years. Majority of the participants were females (54%). Among the participants majority of the participants were Hindus 75.3% and Muslims and Christians were 19.3% and 5.3% respectively (Table 1).
Among the participants about 62% said that they travelled to the facility on foot. About 10% reached the facility via own vehicle. 62% of the participants said that, it took them less than half an hour to reach the facility and 76.7% of the population showed satisfaction towards the distance of the facility from their residence. About half the participants said that they waited only five to 10 minutes to see the doctor all the other participants waited less than half an hour to see the doctor. 65.3% of the population said that the waiting time was satisfactory (Table 2).  Among the 150 participants interviewed 29 (19.3) percent of the participants claimed that the doctor was not always available during their previous visits. Only 63.3% of people said that the ability of the doctor to understand the problem was satisfactory. 84% of the participants said that they received satisfactory explanation regarding the problem they had. About 72.7% of participants' aid that they were satisfied with the privacy of consultation and about one fourth of the participants showed dissatisfaction towards the privacy of consultation. Only about half of the participants (54%) said that they were satisfied with the availability of medicines in the facility. About 67% of the population said they were not satisfied with the working hours of the facility. Majority of the participants i.e. about 87% were satisfied with the cleanliness of the facility. More than half the participants (54%) were not satisfied with the behaviour of the staff at the facility and when asked about the overall impression of the facility 68% of participants said the facility was satisfactory and 32% of participants showed dissatisfaction (Table 3).

CONCLUSION
Most of the respondents in the study were satisfied with the overall services provided by the primary health care facility. Patients were most satisfied by explanation regarding the problem by the doctor and cleanliness of the facility. Patients were not satisfied with availability of medicines and behaviour of the paramedical staff in the facility. This study shows that there is room for improvement in the quality of services provided by the PHCs. The findings of this study will help in better understanding of the patient's perception of the services provided and thus help in providing better services in order to improve utilization of the services provided.