Availability and accessibility of Primary Health Care services in a district of Bangladesh with lower health outcomes: a study based on consumer perceptions.

BACKGROUND

Consumer perspectives in Primary Health Care (PHC) need further exploration in Bangladesh. The study aimed to explore consumer-perception-based availability and accessibility of PHC services, along with equity, in a lower health outcome district.

METHODS

A cross-sectional study was conducted in the low-performing district, Moulvibazar. Adult Health Care Consumers (HCCs, n = 417), attending PHC facilities were purposively selected and data were collected through face-to-face interviews. Individual questions were weighted, and Self-Reported Availability Score (SRAvS) and Self-Reported Accessibility Score (SRAcS) were derived (0-100% scale). Equities in availability and accessibility were explored by analysing gender (male-female), location (rural-urban), and Income-Quintiles (InQ).

FINDINGS: Proportions of HCCs perceiving availability of services were low: laboratory diagnosis (19%), nutrition-health education (31%), basic emergency (49%), and 'most of the time drug supply' (18%). Of HCCs, 43% visited other facilities. Accessibility was fair (eg, waiting time ≤30 minutes for 86% and <one hour for 11%). Median SRAvS ranged from 42 to 52 with no difference between any of the two gender-, location-, or InQ-based groups. Median SRAcS ranged from 65 to 95 and it was significantly lower among urban vs rural (p < 0.001) subgroups. In the regression analysis, higher age (p = 0.041), female gender (p < 0.001) and urban location (p = 0.049) were found to be significantly associated with lower SRAcS.

CONCLUSION

Comprehensive availability of PHC services is poor in a low-performing district of Bangladesh. Overall accessibility to PHC services is relatively better, but it is lower for urban consumers. Gender, location and socioeconomic status are important factors to modulate inequities in service availability and accessibility.