A barrier in meeting the goal of ‘Health for all’ in India is the existing inequalities in utilization between indigenous and non-indigenous people. This study aimed to explore the determinants of utilization or non-utilization of public healthcare services among the Santals, an indigenous community living in West Bengal, India. The study explored the utilization of public healthcare facilities using a conceptual model which hypothesized that the service coverage depends on a set of determinants—such as, nature and severity of the ailment, availability, accessibility (geographical and financial) and acceptability of the healthcare options—and decision-making around those, which further depends on background characteristic of the individual or their family/household.
This cross-sectional study conducted among 422 adult Santals living in both rural (Bankura) and urban (Howrah) areas of West Bengal. The participants were interviewed for demographic and socio-economic characteristics and healthcare utilization behaviour by using a pre-tested data collection schedule.
The findings revealed that utilization of the public healthcare facilities was low, especially in urban areas. Living in urban area, being female, having higher education, engaging in salaried occupation, and having availability of private allopath and homeopath doctors in the locality were having higher odds for not utilizing public health services. Issues like misbehaviours from the health personnel, inadequacy of medicine, and mismanagement in controlling the crowd were reported as the major reasons for non-utilization of public health service. The study holistically examined the role of different factors nature of ailments, availability, accessibility, and acceptability of healthcare provider along with background characteristics of the clients that play decisive role in utilization of the health service among an indigenous community in India. The finding highlights the importance of improving the availability and quality of care of healthcare services for marginalized populations that could improve the utilization of public healthcare services.
