Source: http://ijmp.jor.br/index.php/ijmp/article/view/817/988
Timestamp: 2019-04-18 17:24:08+00:00

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A study on availability of Health care services in Zarol village as per the Indian Public Health Standards has been undertaken with the main objective to find out the prevailing gap between expected health standards and actual Indian Public health standards. A sample of 80 respondents was undertaken for the survey. Data were collected through structured closed ended questionnaire using Non-probability convenience sampling method through personally interviewing the respondents. The Service Quality Dimensions were used to measure the Service Quality Assurance of Public Health care services. Research result reveals that means score of major service quality dimensions is relatively high indicating higher level of patient’s satisfaction from PHC of Zarol. Whereas the mean score of only personnel quality and safety measures having relatively low score indicating lower level of patient’s satisfaction.
As per the Planning Commission, a town with a most extreme populace of 15,000 is viewed as provincial in nature.
The National Sample Survey Organization (NSSO) characterizes 'rural' as the area with a populace density of up to 400 for every square kilometer. Villages with clear reviewed limits yet no city board and at least 75% of male working populace engaged in agribusiness and associated exercises.
Health care sector is playing a dynamic role for the overall health of our country. Despite the fact that there are such a large number of changes in the setting of Indian Rural Health Care Services yet with regards to country's overall health care scenario.
Guidelines are a methods for depicting a level of value that the health care centers are relied upon to meet. A Primary Health Center fills in as the first port of call to a qualified specialist in the public health care division in provincial zones giving a scope of Curative, Promotive and preventive health care services. A PHC furnishing 24 hours services and with proper linkages, assumes a critical part of expanding institutional conveyances accordingly diminishing maternal mortality and infant mortality.
PHC is the main contact point between village community and the Medical Officer. The PHCs were imagined to give an incorporated curative and preventive health care to the country populace with emphasis on preventive and primitive parts of medicinal services. The PHCs are set up and kept up by the State Governments under the Minimum Needs Program. PHC acts as a referral unit for 6 Sub Centers and has 4-6 beds for patients. The activities of PHC involve curative, Preventive, Promotive and family welfare services.
Service quality is a multidimensional concept and in order to operationalize it many variables have to be considered. SERVQUAL is a widely used scale to measure different quality dimensions. Originally, as developed by Parasuraman, Zeithaml e Berry (1985), scale consisted ten dimensions used by the customer to Judge Company’s service, which were reduced into five major dimensions (CRONIN; TAYLOR, 1992): tangibles, reliability, responsiveness: assurance and empathy.
The SERVQUAL constructs impact is used to measure service quality and to identify service quality gaps but not their root causes for which other approaches are needed (WISNIEWSKI; WISNIEWSKI, 2005).
Some efforts have been invested to improve the methods. In this research we describe a study involving a new instrument and a new method that assures a reasonable level of relevance, validity and reliability, while being explicitly change oriented.
To achieve the goal of a truly caring commonwealth, we must improve quality and safety in health care, increase access and utilization of technology, promote greater consumer involvement at all stages, restructure the medical malpractice system to reach all who may be injured by systemic errors, and develop sustainable financing less subject to the vagaries of state revenues.
However, the access issue still remains a basic and important problem we have to confront. The rapidly evolving nature of the health care system presents both enhanced opportunities to address the access problem and new threats to the fragile health care system. However, with the efforts and resources of communities, providers, government, and others to create viable long-term solutions, a good tendency can be expected.
For example, Senate Bill No. 738 – the Health Access and Affordability Act, a petition from the Committee on Health Care Financing – appears strongest in its objectives to offer full health care coverage that is universal and continuous, and is affordable to individuals and families (MOORE, 2005).
There are few relevant healthcare regulations and their enforcement is weak. Social regulation is at best weak and economic regulation is non-existent. Patients have poor role-awareness, do not appreciate their responsibilities and their rights are limited.
Partnership and coordination among various health institutions are weak and managers in each institution are more concerned about their functions. Self-regulation among healthcare professionals is fragile and services are inefficient. The author contributes to the healthcare literature, first, by synthesizing the literature and identifying healthcare issues and challenges, and emphasizes regulation in molding healthcare service delivery.
Broader experiences in the literature suggest that governments in emerging economies are yet to synergize technical and functional quality for an all-encompassing service delivery. These issues seem to be well resolved in developed economies; however, healthcare shattering, long waiting times and underlying payment mechanisms need attention.
Theoretically, the study confirmed that all patient satisfaction dimensions are significant in assessing patient satisfaction which validate the existing findings of various researchers such as Raftopoulous (2005), Kang and James (2004), Chahal and Sharma (2004); Sardana (2003); Brady and Cronin (2001); Corbin et al. (2001); Newman et al. (1998); Gilson et al. (1994).
Besides, model testing conducted also provides new insight to understand the relationship between patient satisfaction dimensions and loyalty. The study also contributes in the understanding of patient behavior and their medical needs in general, which can be used for increasing patient satisfaction in particular.
It is also found that to retain patients and to improve relations with the patients; the medical staff must show concern and sympathy for the patients, which results in easy recovery, improved services, and above all, improved patient satisfaction and loyalty. The findings suggest that training programs on patient relationship management at least once a year, along with spiritual discourses should be considered and organized to inculcate the changes in the attitude and behavior of staff towards patients.
The patient-staff interactions (physicians, nurses and supportive staff) and their impact on satisfaction and loyalty are significant to understand patients’ behavior and to improve the image of the hospital over competitors. Further, the patient-oriented approach will help the Indian health service provides in linking their technological and non-technological factors to the unserved needs of the patients which, in turn, will help in enhancing the degree of patient satisfaction.
Strategies such as responding to patients’ enquiry promptly, bridging the communication gap between patients and medical personnel, becoming more friendly and understanding to the problems of patients, maintaining cleanliness in the units, both internally and externally, providing regular report regarding the patients’ progress without waiting for them to demand, providing a grievances system in the unit, conducting surveys to know about the attitude of the patients with regard to the employees, adopting patient-oriented policies and procedures, solving patient-related problems immediately and providing every type of essential facility should be implemented by the hospitals in India for improving and maintaining high patient satisfaction.
The fundamental issue hidden for rural health care is because of health issues or poor health services, the work efficiency of provincial people is at great hazard. It has been seen in a few villages that, the accessibility and nature of health care services are in the extremely poor state regardless of immense consumption and endeavors from the government.
Due to non-accessibility to Public Health care and low quality of medicinal services benefits, a major share of individuals in India swing to the nearby local private health center as their first decision of care. In any case, private medicinal services are costly, regularly unregulated and variable in quality.
Other than being temperamental for the unskilled, it is additionally not affordable by lower income groups. The key difficulties in the public health care services are low nature of care, poor responsibility, lack of awareness, and restricted access to facilities.
a) Government / government sponsored health centers or hospitals.
b) A charitable trust run health centers or hospitals.
The scope of study is Zarol village in the state of Gujarat.
The actual user of specific service will constitute the sample of the study. Sample of 80 respondents has taken for the survey.
For Data analysis, various statistical tests were used such as, Frequency distribution, Cronbach’s alpha for checking reliability, Mean, Standard Deviation as Descriptive Statistics, and Independent Sample T-test for equality of means and Analysis of Variance (ANOVA).
Quantitative research methods were used to measure availability of health care services by applying above mentioned statistical tests.
Profile of the interviewees: Demographic information on 80 respondents who participated in an interview was obtained from Zarol village. Of the 80, 40 (50%) were male and remaining 40 (50%) were female. Equal division between masculine and feminine was intentional so that by using independent sample T-test, we can analyze and compare the means and find out if there is any significant difference between various dimensions of service quality and gender.
· H02: mean of various dimensions of service quality does not have significance difference across (or between) age groups.
Means scores of Infrastructure, Clinical care, administrative procedures, Image, trustworthiness, social responsibility are relatively high indicating a higher level of patient’s satisfaction from PHC of Zarol. Whereas personnel quality and safety measures are having relatively low score indicating a lower level of patient’s satisfaction.
Female respondents gave highest rate to Image as it has highest mean of 3.6833 and they gave lowest rate to safety measure as it is having lowest mean of 2.2125. For male respondents Image is having highest mean of 3.8583 and safety measures are having lowest mean of 2.3750.
H02: mean of various dimensions of service quality does not have significance difference across (or between) age groups.
For the age group of below 25 years, highest mean representing highest rate by respondents i.e. 2.5181 for Social Responsibility & lowest mean of 1 for safety measures, Trustworthiness & personnel quality. For the age group of 25 to 35 years highest mean was 3.1778 for Image and lowest mean of 1.1667 for safety measures. For the age group of 36 to 45 years, highest mean of 4.2549 for Clinical care & lowest mean of 2.0294 for safety measures.
For the age group of above 46 years, highest mean of 4.9867 for Clinical care & lowest mean of 3.69 for Social Responsibility.
All the p values are statistically significant at 95% confidence level as all p values are < 0.05 so there is a significant difference between various dimensions of service quality and age groups. So Null hypothesis (H02) can be rejected.
H03: mean of various dimensions of service quality does not have significance difference across qualification.
For the Illiterate group, highest mean of 4.8667 for Clinical Care & lowest mean of 3.5750 for Social Responsibility. For the SSC group, highest mean of 4.2381 for Image and lowest mean of 2.6667 for safety measures. For HSC group, highest mean of 3.7436 for Image and lowest mean of 1.7885 for safety measures. For Graduation group, highest mean of 2.5341 for Social Responsibility and lowest mean of 1.1364 for safety measures. For Post-graduation group, highest mean of 2.5714 for Image and lowest mean of 1.1429 for safety measures.
All the p values are statistically significant at 95% confidence level as all p values are < 0.05 so there is a significant difference between various dimensions of service quality and qualification groups. So Null hypothesis (H03) can be rejected.
For the single group of respondents, highest mean of 2.5208 for Social Responsibility & lowest mean of 1 for Personnel quality, Trustworthiness, safety measures. For Married (Not having kids group), highest mean of 2.5833 for Social Responsibility and lowest mean of 1 for personnel quality, Trustworthiness, safety measures. For married (having kids group), highest mean for Image i.e. 4.0657 and lowest mean of 2.4577 for safety measures.
All the p values are statistically significant at 95% confidence level as all p values are < 0.05 so there is a significant difference between various dimensions of service quality and marital status groups. So Null hypothesis (H04) can be rejected.
2. Staff of government hospital must be given training of how to behave with customers.
4. Government hospital of rural area should also progress towards Digitalized direction.
5. Enough amenities should be developed for waiting room patients.
This study focuses on availability of Health Care Services in Zarol village as per the Indian Public Health Standards. From our research findings we can say that for H01all the p values were >0.05 so they are not statistically significant at 95% confidence interval so Null hypothesis (H01) cannot be rejected so there is no significant difference between dimensions of Service Quality and Gender.
For H02, All the p values are statistically significant at 95% confidence level as all p values are < 0.05 so there is a significant difference between various dimensions of service quality and age groups. So Null hypothesis (H02) can be rejected.
For H03 all p values are < 0.05 so there is a significant difference between various dimensions of service quality and qualification groups. So Null hypothesis (H03) can be rejected.
For H04 All the p values are < 0.05 so there is a significant difference between various dimensions of service quality and marital status groups. So Null hypothesis (H04) can be rejected.
We also faced certain limitations during our study like because of time constraint limited sample size was taken, as this survey is for remote area, Google survey form didn’t work so a questionnaire was redrafted in regional language hence it took longer for field survey. Research scholar can further carry this research to map the real changes in the context of the health status of the remote area.
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 Adapted from a definition by Christopher Lovelock (identified anonymously as Expert 6, Table II, p.112) in Bo Edvardsson, Anders Gustafsson, Inger Roos, “Service Portraits in Service Research: A Critical Review”, International Journal of Service Industry Management, 16, No.1,2005, 107-121.

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