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Abstract
The existing models of eye care in India have so far not adequately addressed the issues of access, affordability and community involvement, therefore making little impact on avoidable blindness.
To this end, The LV Prasad Eye Institute, located in Hyderabad, India has developed a novel approach to reach underserved population in remote rural areas of Andhra Pradesh State in Southern India through a network of tertiary and Secondary Centres integrated with Primary Care facilities known as “Vision Centres”. The objective of the Vision Centre approach was to enhance the access of underserved communities to affordable basic eye care services through a permanent infrastructure and well-trained, community based Vision technician.
While the Vision Centre model per se has been successful, it is also apparent that the individual centres vary in terms of success and impact. While many factors are no doubt responsible, the perceptions of the targeted communities in terms of benefit and ease of access may play an important role, little or no work has been carried out in developing countries to understand the underlying factors that determine patients’ satisfaction with health services at the primary level, and issues such as cost versus benefit, and how these might relate to uptake of services.
A combination of qualitative and quantitative methods was used in this study. Participants included a randomly selected 136 patients (of the 136 selected, 4 patients of “Better of Rural Locations” (BRLs) were rejected and 5 patents of “Poor Rural Locations” (PRLs) were not available) who accessed the 4 selected Vision Centres (of the 8 Vision Centres initially selected, 4 were included in this study). Analyses applied included: a) factor analyses of patients’ satisfaction with two Vision Centres in BRLs and two in PRLs; b) regression analysis to determine the associations with patients’ characteristics and patient with patients’ satisfaction; c) chi-square to explore differences in satisfaction of patients with Vision Centre services; d) Paired sample t – test to check if the costs to access Vision Centre and town based clinic were significantly different. A p-value of <0.05 was considered significant in each instance.
Three factors were obtained from factor analysis: Vision Technician (Factor-1), Access to the location of Vision Centre (Factor-2) and Vision Centre services (Factor-3). These three factors of patients’ satisfaction can explain 50.0 % cumulative variance of patient satisfaction. Patients’ ease to travel to the Vision Centre facility ( = -0.47; P <0.001), perceived the severity of eye problem ( = -0.19, P <0.002), level of affordability ( = -0.27; P = 0.004), ease to identify the Vision Centre building ( = -0.24; P <0.001), and geographical setting of patients ( = 0.38; P = 0.001) were significant variables associated with patient satisfaction, which was higher among the patients of BRLs Vision Centres. The total costs were significantly lower for patients who accessed the Vision Centres compared to the patients’ costs of town - based facilities (mean INR 178.4 48.3, (SE mean: 4.2) and INR 366.2 48.2, (SE mean: 4.2) respectively, t-test p- value <0.001).
Conclusions: Three factors are accountable for patients’ satisfaction with the Vision Centre facility. Vision Centres, besides providing quality eye care services, offer substantial cost savings to rural population compared with town-based optical clinics. These findings call for greater attention to decentralized eye care services closer to the communities. However, effective service delivery through Vision Centres should also take into account patients’ perceptions in order to build a Primary Eye Care System which is truly sustainable and serves the needs of population optimally.