Primary-care doctor and nurse consultations among people who live in slums : a retrospective, cross-sectional survey in four countries

2021 
Objectives: To survey on the availability and use of primary care services in slum populations. Design: Retrospective, cross-sectional, household, individual, and healthcare provider surveys. Setting: Seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). Participants: Residents of slums and informal settlements. Primary and secondary outcome measures: Primary care consultation rates by type of provider and facility. Results: We completed 7,692 household and 7,451 individual adult and 2,633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 minutes and the median cost per visit was between 2 and 10% of a household’s monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54-78%) and service quality 5(31-95%) being a reason for choosing a provider than fees (23-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. Conclusions: People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health seeking behavior to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries. Funding This research was funded by the National Institute for Health Research (NIHR) (16/136/87) using UK aid from the UK Government to support global health research. RJL is also funded from the NIHR Applied Research Collaboration (ARC) West Midlands and PG is an NIHR Senior Investigator. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government. Strength and limitations of this study: -This study provides the most comprehensive evidence across multiple nations to date on the facilities available to people who live in slums in general and on doctor and nurse consultations. -We surveyed over 7,000 individuals across seven slum sites in four counties on their access to and use of healthcare. -We estimated consultation rates and provider types for primary care visits as well as the elasticity of demand for provider type with respect to time and cost of a visit.
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