Causes for Differentials in the Utilisation of Public Health Services: A Comparative Study between Andhra Pradesh and Uttar Pradesh

Public health services use has as its determinants socio-demographic, economic factors of health seekers, the behaviour of functionaries of health offices and, lastly, service accessibility. Kerala (and four other southern states in India) shows a greater use of these services compared to the Middle-Eastern state of Bihar, say. Large differentials in health service use patterns vis-à-vis its determinants are the cause for the gap noted between northern and southern states in theirs having widely different health indices, like infant (IMR) and maternal mortality rates (MMR). A comparative study using random sampling method on the households in the rural areas of the districts of Chittoor (A.P.) and Ghaziabad (U.P.) found the weak organizational structure at the state level to Sub Centre level to be the root of the differing use patterns of health services in these two states. Financial constraints also affect the tendencies to seek health services treatment, including where women's involvement in Self Help Groups (SHGs) and empowerment result in greater health awareness and its greater use. This study concludes a specialized soft skills training program needs to be designed and conducted for all health disbursers irrespective of their education level. Above all, improvement of concomitants of health, like easy reachability of PHC without having to traverse a long distance, can lead to high use of health facilities.