Can you model growth of trust? A study of the sustainability of a rural community health centre in North India

Abstract

Trust in the service provided by any health facility is of vital importance to its sustainability, whether it is a community clinic in a rural area of a developing country or an international telemedicine service. Community health centres can be used as a means of delivering highly accessible, low-cost health service in the developing world. A major strategic issue for planners of such centres is the expected level of uptake of services throughout a region and its effect on sustainability of any facility. In this study of a clinic in rural north India, Monte Carlo simulation is used in modelling the spatio-temporal spread of usage of the service. Trust in the provider is built both through word-of-mouth contacts and previous development activities: our study contributes to the literature with a practical application of trust modelling.

Keywords:

• trust
• sustainability
• Monte Carlo simulation
• OR for developing countries
• OR for health service
• word-of-mouth spread

Acknowledgements

We thank the anonymous referees whose suggestions have considerably improved this paper. This research was funded by the UK Engineering and Physical Sciences Research Council: DTA Grant EP/P500478/1 and Science and Innovation grant EP/F033982/1. Our grateful thanks go to Dr Ann Thyle of Emmanuel Hospital Association, whose vision for a sustainable clinic inspired this study. The busy staff of Prem Sewa Hospital and the Paltandih clinic gave much assistance. Without the kind support of Dr Ronghaklien Joute, Medical Superintendent and Senior Administrative Officer of Prem Sewa, our visit and data collection could not have taken place. Sadly, Dr Joute died not long after our visit. We are grateful for the advice of Prof Russell Cheng on parameter estimation and bootstrapping. Jon Smith of Selective Analytics Ltd gave much-needed help with mapping and graphics.