Reasons for low utilisation of public facilities among households with hypertension: analysis of a population-based survey in India

Introduction In India, for most patients, primary healthcare remains the intended entry point for the management of non-communicable disease risk factors. The extent and determinants of non-utilisation of public primary care among households with hypertension are not well examined. We explored health facility utilisation patterns and reasons for non-utilisation of public facilities in 21 states and union territories in India, with a focus on hypertension. Methods We used data from the 2012-2013 District Level Household and Facility Survey. We examined the self-reported usual source of care for all households, households with hypertension and-to understand multimorbidity for those with hypertension-households with hypertension and diabetes. Hypertension was defined by self-reported diagnosis or measurement of systolic blood pressure >= 140 mm Hg or diastolic blood pressure >= 90 mm Hg. Diabetes was defined by self-reported diagnosis or fasting blood glucose level >= 7.0 mmol/L or non-fasting blood glucose level >= 11.1 mmol/L. We assessed facility utilisation choice and reasons for non-utilisation of public facilities by household with the presence of hypertension alone and hypertension with diabetes. Results In 336 305 households, 37.6% (N=126 597) had at least one household member with hypertension, while 15.9% (N=53 385) had members with hypertension and diabetes. 20.0% of households sought care at public primary clinics, 29.9% at public hospitals and 48.3% at private facilities. Choice of private facilities increased with the burden of disease. Households with hypertension only and hypertension and diabetes cited quality reasons for non-utilisation of public facilities more than households without hypertension. Conclusion Households, particularly those with hypertension, chose private over public primary facilities for usual care. Quality of care was an important determinant of facility choice in households with hypertension and diabetes. With the increase in hypertension and cardiovascular disease in India, quality of public primary healthcare must be addressed for current policy to become reality.