Health Seeking Behaviour of Rajbanshi ethnic group of Katahari and Baijanathpur villages of Morang, Nepal (Part-2)
By: Nawaraj Subba, MPH, MA

Summary
Objective: The objective of the study was to assess the health seeking behaviors in Rajbanshi community. Specific objective of the study was to assess the causes, cost and satisfaction from their practices. Design: Descriptive, Quantitative as well as Focus Group Discussion (FGD) and Observation for Qualitative information. Setting: This study was conducted in two different Villages, Katahari and Baijanathpur of Morang district, selected purposively based on thick settlement. Subjects: 175 households of two Villages were selected from the VDCs rosters using random number table for convenience and to cover the expected households. Major outcome measures: Demographic information, and medication practices on the basis of economic and education status. Results: Cause: People were mostly guided by their perceived satisfaction (82.8). Other determinants of choosing certain practice were distance, custom, cost etc. Family members and self-knowledge had played the driving role to decide the probable options. Visits: Most patients went more than one time to take health care and their second visits had provided significant satisfaction. Average expenditure per case was Rs. 1031.64 (SD=6) for a treatment. 73% people were unable to afford cost and they take either loan or sell their belongings to accomplish the treatment. The proportion of the expense goes on buying drugs (58%) and paying fees (19.55%). Rest portion was expensed for transportation, helper and other. Satisfaction: Rich were found satisfied with alternative medication was statistically significant (0.0050). Educated was found satisfied with alternative medication was highly significant (P=0.0000).
Conclusions: There is some relationship between economic, education status and health seeking behaviour in Rajbanshi community.

Introduction.
The second part presents the causes of adopting a practice, cost for treatment and its satisfaction. According to Dixit¹ the reality is that the expansion of the health has not occurred, neither in the government nor the private sector to the extent that is even required for the increase of the population. Behaviours of people of taking care are mainly guided by their perceived satisfaction². Places where they get good investigation, diagnosis and treatment, as well as good inter-personal communication was the place of their choice. Other determinants were distance, custom, cost and other. Patient mostly used to go to health facility with the advice of his/her family, neighbour/friends and by self-knowledge, IEC such as Radio and TV, and health workers.

Table I. Causes of taking Services.

(Note: Response by duplication).

Table I shows that why people were going to take a particular health care service. 82.8% people were driven towards where they felt satisfied. Second guiding factor was short distance (26.2%) and custom (13.7%) cost (9.7%) and other 0.5% respectively.

Figure I1. Advice for refers.

The contribution on giving advises for referral by family members the proportion was 61.1% and self-knowledge 45.7%, neighbour/ friends 9.1%, IEC/Radio/TV 1.1%, and Health workers 0.5% respectively.

Table II1. Frequency of visits for treatment.

Out of 175 patients 57 (32.5%) patients visited once and 35.4% visited twice for treatment. Similarly, 14.8%, 5.7%, 11.4% patients visited thrice, four times and five or more respectively for the treatment.

Satisfaction and visit numbers.

Table IV indicates that patients were satisfied with their second visits rather than first visit. In their first contact 57.7% patients were satisfied with the treatment and 90.2% satisfied with second visit.

Bulk amount of expense was (58.0%) for purchasing drugs and paying fees (19.5%). And 5.0% for transportation, 3.7% for helper and 13.8% for others.

Table VI suggests that 73.2% people was reported to be unable to afford the cost for treatment. Only 26.8% people were able to afford treatment cost. So it is striking to note that, only less than one-third people were found to be able to afford the cost for treatment.

Bearing of Cost of treatment.

Above figure suggests that 32% people took help or burrowed from their family members. 53% sold their belongings such as agricultural products, land etc., and 15% took loan for treatment. More than two third people were found unable to afford cost for the accomplishment of treatment.

User’s satisfaction from service providers determines by the local people who might have taken various forms depending on who administers what medicine to whom and how. Sometimes it happened that even when modern medicine is used, it is done without the advice of a regular doctor. Such cases occurred when a person consumed medicine on his own or procured it from someone who did not possess the necessary knowledge in medicine. In such cases it is immaterial whether the medicine administered is the correct one. Despite having skills and knowledge a doctor or a paramedical could not function well in a hospital/PHC/ HP settings at desired level due to limited resources, support and burden of works. It also plays a vital role on the satisfaction of a consumer.

There are several chances of being misuse of health human resources in our health system. A Village Health Worker who has got training for certain preventive and promotive in public health areas. They are supposed to work in the field of immunization, health education and sanitation. But people expect more during their frequent visits. So, sometime VHW/ MCHW or paramedical are providing services beyond their training level.

Kirana shops Keepers (Grocers) are those who hold shops of daily use such as rice, pulse, oil etc. But they sell certain medicines such as Paracetamol, Antihelminths, Antibiotics, ointments for eye, skin etc. It is easily estimated that there is maximum irrational use of drugs from the grocery but it is not easy to control. Because large number of people are getting service from here³.

Dhami-Jhakris is regarded as the representative of the supernatural powers and with their aid they can cast off evil spirits that cause affliction to people. While curing the patient through some ritual practices, they are held to be in communion with gods and goddesses.

Despite the health facilities provided by the government more than 50 percent of health problems never reach the health services. They are treated through a system of self-care and plural medications, which is based on home remedies. Other methods of unconventional treatments include commercial sales of over the counter (OTC) drugs often combined with religious healing practices and culturally based treatments, which are economically beneficial to the people⁴.

94.0% patients were found satisfied with the process of investigation during the treatment. Only 6.0% were dissatisfied with the process of investigation during treatment.

It was found that people were taking services from multiple medication such as -Modern medication, Self-medication and Alternative medication practices.

Usual place to visit for 96.0%(168) people was modern medication, self-medication for 57.1%(100) and Alternative medication for 22.8%(40). (N=175).

Satisfaction as perceived from their medication practices adopted.

Out of 175 respondents 158 (90.2%) were satisfied with modern medication, 102(58.2%) satisfied with self-medication and 60 (34.2%) satisfied with alternative medication. It was due to the cure rate, low cost, provider behaviour, free medicines, good counselling which are the causes for satisfaction.

Figure VI. Satisfaction of medication on the basis of Education.

There was no difference between educated and uneducated in the use of modern medication that is statistically insignificant (P=0.03271). Similarly, there was no difference between educated and uneducated in adopting the self-medication that is statistically insignificant (P= 0.669). But educated were adopting more alternative medication practices than uneducated that is statistically highly significant (P=0.0000).

It was noted that there was no difference among poor, medium and rich in the use of modern medication that is statistically insignificant (P=0.28947). Similarly, there was no difference among different strata in using self-medication that was statistically insignificant (P=0.2000). But rich were adopting alternative medication more than other economic strata that is statistically significant (P=<0.005).

Conclusion: People were mostly guided by their perceived satisfaction (82.8%). Other determinants of choosing certain practice were distance, custom, cost etc. Family member and self-knowledge had played the driving role to decide the probable option. Most patients go more than one time to take health care and their second visits gave them more satisfaction. The proportion of people paying between Rs.51-200 was 39% of sample. But average expenditure per case was Rs. 1031.64 (i.e. mean; and SD=6) for a treatment. It was reported to be unaffordable for 73% people. They take either loan or sell their belongings to accomplish the treatment. Most of the proportion of expense goes for buying drugs and paying fees. Rest portion expensed for transportation, helper cost and other. Rich was found more satisfied than poor by alternative medication were statistically significant (0.0050). Educated people was found more satisfied by alternative medication than uneducated people was highly significant (P=0.0000).

References:
1. Dixit, H., (1999), The quest for Health. Educational Enterprises Kathmandu Nepal.
2. Bastola, S., (1999), A study on the factors affecting user's satisfaction from the services in
      Primary health cares setting in Khopashi, Kavrey district (MPH -Thesis),TU, IOM, Kathmandu.
3. Kafle, K.K., Gartoulla, R.P., (1993), Self-medication and its impact on Essential DrugsScheme in Nepal, W.H.O. DAP - 10.
4. Gartoulla, R.P. (1998), An introduction to Medical Sociology and Medical Anthropology,RECID, Kathmandu, Nepal.

      ©2002. Nawaraj Subba, nrsubba@hotpop.com