|Year : 2016 | Volume
| Issue : 3 | Page : 187-190
Client's satisfaction with the health services under Janani Suraksha Yojana in rural area of Himachal Pradesh
Prem Lal Chauhan, DS Dhadwal, Anjali Mahajan
Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||9-Jun-2016|
Department of Community Medicine, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Satisfaction can be defined as the extent of an individual's experience compared with his or her expectations. Client satisfaction is one of the commonly used outcome measures of patient care and is an important indicator of quality of primary care and healthcare performance. Objective: To assess the satisfaction with the services among Janani Suraksha Yojana (JSY) beneficiaries in a rural field practice area of Indira Gandhi Medical College (IGMC), Shimla, and to recommend measures for improvements of services being provided to the beneficiaries. Materials and Methods: A community-based, cross-sectional study was undertaken from April 2013 to March 2014 in the rural field practice area of IGMC, Shimla, among the JSY beneficiaries who delivered and received the services under the JSY Scheme in the previous 1 year. The data were collected using a pretested, predesigned, and semi-structured questionnaire and these data were analyzed using SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results: The study observed that 49 (69%) of beneficiaries were found to be satisfied with services received at subcenter and the amount of JSY incentive received. It was also revealed that out of 64 beneficiaries who delivered at hospital, most 52 (81%) of them were satisfied with the services received at the place of delivery. It was found that 51 (65.38%) and 16 (20.5%) beneficiaries were found satisfied and dissatisfied with the behavior of health functionaries at subcenter, respectively. Conclusion: Client satisfaction is one of the most important determinants of health service utilization. There is a need for regular training program for health functionaries on improvement of communication skills and quality of care.
Keywords: Client, Janani Suraksha Yojana, satisfaction
|How to cite this article:|
Chauhan PL, Dhadwal D S, Mahajan A. Client's satisfaction with the health services under Janani Suraksha Yojana in rural area of Himachal Pradesh. CHRISMED J Health Res 2016;3:187-90
|How to cite this URL:|
Chauhan PL, Dhadwal D S, Mahajan A. Client's satisfaction with the health services under Janani Suraksha Yojana in rural area of Himachal Pradesh. CHRISMED J Health Res [serial online] 2016 [cited 2022 Aug 8];3:187-90. Available from: https://www.cjhr.org/text.asp?2016/3/3/187/183737
| Introduction|| |
It is an established fact that satisfaction influences whether a person seeks medical advice, complies with treatment, and maintains a continuing relationship with practitioners. , Donabedian, arguably the leading theorist in the area of quality assurance, has emphasized that client satisfaction is of fundamental importance as a measure of the quality of care because it gives information on the provider's success at meeting those client values and expectations, which are matters on which the client is the ultimate authority. ,
Quality services increase the confidence of the patient about hospital care. Patient satisfaction and healthcare service quality can be increased by using a multidisciplinary approach that combines patient inputs as well as expert judgment. 
It is difficult to measure the patient satisfaction level. Both clinical and nonclinical outcomes of care have influence on patient satisfaction.  Patients carry certain expectations before their visit, and the resultant satisfaction or dissatisfaction is the outcome of their actual experience. ,, Patient satisfaction depends on many factors such as quality of clinical services provided, availability of medicine, behavior of doctors and other health staff, cost of services, hospital infrastructure, physical comfort, emotional support, and respect for patient preferences.  Mismatch between patient expectation and the service received is related to decreased satisfaction. Therefore, assessing patient perspectives gives them a voice, which can make public health services more responsive to people's needs and expectations. ,
As client satisfaction is considered to be a healthcare outcome, predictor of treatment utilization, and adherence to the care and support, this study is therefore conducted to assess the level of satisfaction with the services received among Janani Suraksha Yojana (JSY) beneficiaries in a rural field practice area of Indira Gandhi Medical College (IGMC), Shimla, and to recommend measure of improvements of services being provided to beneficiaries.
To assess the level of satisfaction with the services received among JSY beneficiaries in a rural field practice area of IGMC, Shimla.
To recommend measures for improvement of services being provided to the beneficiaries.
| Materials and methods|| |
This was a cross-sectional study conducted among all the beneficiaries of JSY schemes in the rural field practice area of Department of Community Medicine, IGMC, Shimla, who have delivered and received services under JSY scheme in previous 1 year. The study sample included 78 JSY beneficiaries who delivered and availed the services under JSY in previous year. The study was conducted between April 2013 and March 2014. Before conducting the study, prior permission was taken from the Chief Medical Officer, Shimla, Head of the Concerned Institution, and then a meeting was held with the health workers of the rural health training center, Mashobra, and its subcenters and Anganwadi workers (AWWs) of the area. In the meeting, health workers and AWWs were apprised of the objectives of the study. A baseline list of all the JSY beneficiaries who have delivered and utilized/availed the services under JSY in the previous 1 year (w.e.f. April 1, 2012, to March 31, 2013) was taken from the register of block accountant, rural health training center, Mashobra, Department of Community Medicine, IGMC, Shimla. Eligible beneficiaries under JSY scheme were interviewed by a predesigned, pretested, semi-structured, close-ended questionnaire by house-to-house visits after obtaining consent. The satisfaction response was rated in a 5-point Likert scale as "very satisfied," "satisfied," "neither dissatisfied nor satisfied," "dissatisfied," and "very dissatisfied."
Janani Suraksha Yojana
JSY is a voucher scheme under National Rural Health Mission. The scheme integrates the cash assistance with antenatal care during the pregnancy period, institutional care during delivery, and immediate postpartum care in government healthcare centers or accredited private health institutions through coordinated care by the field level health worker to reduce maternal and infant mortality rate by promoting institutional deliveries.
Janani Suraksha Yojana beneficiaries
Here, beneficiaries are those who meet the inclusion criteria for JSY and have availed services under JSY Scheme.
In this study, service utilization means the extent to which the beneficiaries avail the services under JSY such as antenatal, intranatal, postnatal services and cash incentives through government and accredited private healthcare facilities. The service utilization of JSY was assessed by collecting information from the beneficiaries using a checklist.
In this study, client satisfaction refers to perception of services provided under JSY based on expectation of the beneficiaries which is assessed using client satisfaction rating scale (on areas such as registration, availability of services and personnel, technical skill and art of health personnel, explanation of care, outcome of care, cash incentives and disbursements, and postnatal visits).
Ethical clearance for conducting the study was taken from the ethical committee of the institution and informed consent was taken from the women participating in the study with the assurance that confidentiality will be maintained and the information obtained for this study will not be used for any other purpose except for academic purpose.
| Results|| |
Satisfaction level of beneficiaries with the services
The study observed that 54 (69.23%) and 24 (31%) of beneficiaries were found to be satisfied and dissatisfied, respectively, with services received at subcenter. Nearly two-third (49 [63%]) of them were found to be satisfied with the amount of JSY incentive they received. It was also revealed that out of 64 beneficiaries who delivered at hospital, most (52 [81%]) of them were satisfied and only 12 (18.75%) were found to be dissatisfied with the services received at place of delivery [Table 1].
|Table 1: Satisfaction level with services received by Janani Suraksha Yojana beneficiaries|
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It was found that 51 (65.38%) of beneficiaries were found satisfied with the behavior of health functionaries at subcenter. Two-third 42 (65.62%) of them were found satisfied with behavior of staff nurses at place of delivery and 18 (28%) of them were found dissatisfied. Majority 50 (78%) of them were found to be satisfied with the behavior of doctors at the place of delivery [Table 2].
|Table 2: Satisfaction level of Janani Suraksha Yojana beneficiaries with behavior of health staff|
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Reason for dissatisfaction with the services
The reasons cited by the beneficiaries for dissatisfaction with the services at subcenter included unavailability of iron and folic acid tablets during antenatal period of the beneficiaries 20 (83%), unsuitable location of subcenter, i.e. difficulty in access to the subcenter 18 (75%), irregularity of opening of subcenter 14 (58%), and services not available after working hours, i.e., after 4 pm when the health institutions close 12 (50%).
The reasons for dissatisfaction with services at place of deliveries cited by the beneficiaries who delivered in hospital included - not attended in time (after half an hour) when reached at hospital 10 (83%), not given clean bed sheet 10 (83%), unclean toilets/bathrooms 9 (75%), and not enough space available at waiting room 7 (58%).
| Discussion|| |
Client/patient satisfaction is a main indicator of quality of care. The greater is the client satisfaction, greater is the quality of services being provided. The overall satisfaction is an important aspect of service itself and is considered to be an important outcome measure for health services. Patient care is not considered to be of high quality unless the patient is satisfied. The study has found that most 52 (81%) of beneficiaries were satisfied with the services received at place of delivery. A study conducted by Centre for Operations Research and Training (CORT), Vadodara, in Orissa  and Himachal Pradesh  found that 94% and 97% of beneficiaries, respectively, were satisfied with the services received at place of delivery.
The study found that nearly two-third 49 (63%) of beneficiaries were found to be satisfied with the amount of JSY incentive. A study conducted by CORT, Vadodara, in Himachal Pradesh  and Uttar Pradesh  revealed that 41% and 36% study population were not satisfied with the amount of JSY incentive, respectively. Satisfaction level with the amount JSY incentive is not high, so there is need to reconsider the amount being paid to the beneficiaries under the scheme. The reasons cited by these beneficiaries for their dissatisfaction with the services received at health facilities need to be adequately addressed so that these beneficiaries can receive quality of care at these facilities.
The present study found that 42 (65.62%) and 50 (78%) of beneficiaries were found satisfied with behavior of staff nurses and doctors at place of delivery, respectively, while 18 (28%) of them were found dissatisfied with the behavior of staff nurses. A study conducted by CORT, Vadodara, in Himachal Pradesh  found that 56% of beneficiaries were satisfied with behavior of staff nurses and doctors at place of delivery and only 0.9% of them were found dissatisfied with the behavior of health staff at place of delivery. These findings emphasize the need of improving the counseling skills, behavior, and approach of health functionaries toward people availing services at health facilities. Similarly, a study conducted by CORT, Vadodara, in Orissa  found that majority (68%) of beneficiaries were satisfied with behavior of the health staff at place of delivery.
| Conclusion|| |
Client satisfaction is one of the most important determinants of health service utilization. The incentive under JSY scheme is quite less as expressed by the beneficiaries during the study; therefore, efforts should be made to increase the incentive so that any out of pocket expenditure could be met easily. Provision of residential complexes with the subcenters, Primary Health Centre, and Community Health Centers for doctors and other paramedical staff should be made so that any pregnant woman can avail the emergency services. There is also need for more cleanliness to be maintained at the health facilities so that a healthy environment can be provided to these beneficiaries to make them more comfortable at these health facilities. There is a need for regular training program for health functionaries on improvement of communication skills and quality of care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
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[Table 1], [Table 2]