'First We Go to the Small Doctor' : First Contact for Curative Health Care Sought by Rural Communities in Andhra Pradesh and Orissa, India

Background: Against the backdrop of insufficient public supply of primary care and reports of informal providers, we sought fresh descriptive evidence on 1st contact curative health care seeking choices among rural communities in Andhra-Pradesh (AP) and Orissa. Methods: Our cross sectional study design combined a Household Survey (1,810 households in AP; 5,342 in Orissa), 48 Focus Group Discussions (19 in AP; 29 in Orissa), and 61 Key Informant Interviews with healthcare providers (22 in AP; 39 in Orissa). Results: In AP, 69.5% of respondents accessed non-degree allopathic practitioners (NDAPs) practicing in or near their village; in Orissa, 40.2% chose first curative contact with NDAPs and 36.2% with traditional healers. In AP, all NDAPs were private practitioners, in Orissa “public sector NDAPs” e.g. some pharmacists and nurses employed in health facilities, also practiced privately. Respondents explained their choice by proximity and providers’ readiness to make house-calls when needed. NDAPs typically combined consultation and dispensing of allopathic drugs for a quick-fix treatment of common health problems. Less than a quarter of respondents chose qualified doctors as their first point of call: mostly private practitioners in AP, and public practitioners at understaffed facilities in Orissa. Amongst those who chose a qualified practitioner, the most frequent reason was doctors’ quality rather than proximity. Conclusions: This study confirms that most rural persons seek first level of curative healthcare close to home, and pay for a composite convenient service of consulting-cum-dispensing of medicines. NDAPs fill a huge demand for primary curative care which the public system does not satisfy, and are the de facto 1st level access in most cases