As good as physicians: patient perceptions of physicians and non-physician clinicians in rural primary health centers in India

Background: Attracting physicians to rural areas has been a long-standing challenge in India. Government efforts to address the shortage of rural physicians include posting non-physician clinicians (NPC) at Primary Health Centres (PHC) in select areas. Performance assessments of NPCs have typically focused on the technical quality of their care with little attention to the perspectives of patients. This study investigates patient views of physicians (Medical Officers) and NPCs in terms of patient satisfaction, perceived quality, and provider trust. NPCs include: Indian system of medicine physicians (AYUSH Medical Officers) and clinicians with three years of training, such as Rural Medical Assistants (RMA). At PHCs without clinicians, paramedics provide clinical care, though they are not trained for this.

Methods: PHCs in the state of Chhattisgarh were stratified by provider type: Medical Officer, AYUSH Medical Officer, RMA, and paramedics. PHCs were randomly sampled in each group. A total of 1,082 exiting patients were sampled from138 PHCs. Factor analysis was used to identify perceived quality domains. Multiple regression analysis was used to test for group differences.

Results: Patients of Medical Officers and NPCs reported similar levels of satisfaction, trust, and perceived quality, with scores of 84% for Medical Officers, 80% for AYUSH Medical Officers, and 85% for RMAs. While there were no significant differences in these outcomes between these groups, scores for paramedical staff were significantly lower, at 73%.

Conclusions: Physicians and NPCs performed similarly in terms of patient satisfaction, trust, and perceived quality. From a patient's perspective, this supports the use and scale up of NPCs in primary care settings in India. Leaving clinician posts vacant undermines public trust and quality perceptions of government health services.