Table 3

Factors associated with provision of healthcare services in slums from service provider’s (supply side) perspective

Cognitive and experiential factors
 Perception/knowledge/experience/preference of health servicesFear of side effects, size of tablet and misconceptions regarding treatment, high demand for drugs in the final year of treatment134
Socioeconomic factors
 Income and wealthDifficulty in directly observing deworming treatment at mealtime due to food shortage134
 Social supportEffective community mobilisation134; poor community support135; non-involvement of community members and urban local bodies139; absence of community members during the drug administration exercise134; demand for incentives by community members to take deworming drugs134
Physical environment
 Environment of residence areaEnvironment (sanitation, territory)136; unsanitary environmental conditions134; inaccessibility (filthy and bush environment)134
Cultural and religious factors
 ReligionReligious beliefs and mistrust of interventions134
 Sociocultural influenceLack of shared understanding of the problems in community73; unrelated death and the associated negative publicity (of a deworming programme) by the media134
Legal, political and policy factors
 Policy issuesDevolution of service delivery transferring funds and responsibilities to elected local bodies137; management by professional managerial and technical cadres137; tight organisation of public health services137; professional support from the state directorate of public health137; healthcare policies132; policy prioritising low social development areas138
 Legal issuesFear of requirement for formal registration136
Health system factors
 CostPay scale of frontline healthcare workers135; medicine price140
 Quality and safety of servicesKnowledge of intervention area by community health workers134
 Service organisation and delivery arrangementIssues related to assignment of tasks136; requirement to follow standardised protocol136; demands from the management136; work overload132 136; underperformance of staff128; documentation work/work burden/no incentive for work135; insufficient time134; attitude of healthcare providers73; lack of supportive staff135; community health worker familiarity with households led to warm reception134; opportunity to integrate mass drug administration with other health interventions134; presence of community health workers and their supervisory structure, and points of referral for serious side effects134; restriction of range of services139; unserved areas and left-out urban slum pockets139; poor monitoring and supervision139; unreliable immunisation and household data128
 Facility and resourcesCommunity-based care132; inefficient utilisation of funds128; affordability and availability of medicine140; limited medical supplies73 135; infrastructural facilities135; inadequate space and equipment136; suboptimal training of staff139; insufficient availability of space, logistics and health manpower139