Feasibility of Integrated Facility Cost Assessment and Patient Experience Evaluation for Outpatient Services at a Rural Community Health Centre: A Single-Site Pilot Study from North Karnataka, India

In the quiet corners of rural India, where public health facilities serve as the primary lifeline for thousands, the question of how well these services work is often answered with a guess rather than a measurement. To truly understand a clinic's performance, one must look at two distinct things: the money it costs to treat a patient and the experience that patient has while receiving that care. The first involves tallying the price of medicines, consultations, and procedures, while the second asks whether the patient felt heard, waited too long, or found the staff kind. Usually, gathering both sets of information requires a massive team of researchers, expensive software, and weeks of disruption to the daily rhythm of a busy hospital. In resource-poor settings, this comprehensive approach is often impossible, leaving administrators to manage without a clear picture of their efficiency or their patients' satisfaction.

A team of researchers set out to see if a simpler, lighter approach could work in a rural Community Health Centre in the Shirahatti district of Karnataka. They wanted to know if they could combine a quick look at the clinic's existing financial records with brief, face-to-face conversations with patients, all without stopping the flow of daily medical work. This was not a study designed to prove that a specific treatment worked or to calculate the exact economic burden on every family. Instead, it was a pilot test, a trial run to see if the method itself was practical. The researchers asked a straightforward question: Can we build a useful assessment of outpatient services using only the tools already sitting on the clinic's shelves and a few minutes of a patient's time?

The study took place over two visits in February 2025. The researchers first turned their attention to the clinic's routine records, which are the daily logs where staff write down the number of patients seen and the general costs associated with their care. They looked at 827 outpatient cases, covering three main groups of health issues: infectious diseases like tuberculosis and dengue, long-term conditions such as diabetes and high blood pressure, and services for women related to pregnancy and childbirth. The goal was to see if they could pull the cost numbers out of these books without causing a delay for the doctors or nurses. The team found that they could successfully extract the data. The records showed that the average cost for treating a patient with a long-term condition was roughly 1,125 rupees, while infectious diseases averaged about 1,705 rupees. For women's health services, which included everything from prenatal checkups to surgeries, the average cost was significantly higher at nearly 3,500 rupees. In total, the records accounted for over two million rupees in treatment expenditures. However, the researchers also discovered a limitation: the books only held the total cost for a group of patients, not a detailed breakdown of what each individual person paid for.

Next, the team moved to the second part of their plan: talking to the people who had just received care. They approached twenty patients waiting in the clinic and asked if they would share their thoughts on the service they had just received. Twelve agreed to speak with them. Due to the short timeframe of their fieldwork, the researchers completed interviews with five of these willing participants. They used a simple, ten-question list that covered topics like how long they waited, how the staff treated them, whether the clinic was clean, and if they could get the medicines they needed. The interviews went smoothly. Every single question was answered, and the conversations were finished within the planned time, causing no interruption to the clinic's operations. The patients shared a mix of experiences. Some described the care as excellent and the staff as supportive, while others noted long waits that stretched from a few minutes to over three hours. Most felt the cost was manageable or free, though one person mentioned having to buy medicine elsewhere. The feedback highlighted a desire for cleaner facilities, shorter waits, and better communication.

The results of this small-scale test were clear. The researchers proved that it is possible to gather both cost data and patient feedback in a rural clinic without needing a large budget or a specialized team. The method worked well enough to show that the clinic's records could provide a snapshot of spending, and that patients were willing to share their stories if asked politely and briefly. However, the study also pointed out what would need to change for a larger, more definitive investigation. Because the records did not contain itemized costs for individual patients, a future study would need to collect that specific data directly from patients or billing systems. Additionally, the small number of interviews meant the findings about patient feelings were just a starting point, not a final verdict. The researchers noted that future work would need to track exactly how many people agreed or refused to talk, and they would need to interview a much larger group to get a true sense of the community's experience.

Ultimately, this pilot study demonstrated that a combined review of existing financial records and short patient interviews is a practical way to evaluate rural health services. It showed that administrators do not necessarily need to wait for a massive, expensive study to begin understanding their operations. By using the tools already at hand, they can start to see where the money goes and how patients feel, provided they are willing to refine their methods to capture more detailed information in the future. The work serves as a blueprint for a larger, more detailed study that could eventually help improve the quality and efficiency of healthcare for the hundreds of thousands of people who rely on these rural centers.