The study looked at preferences in treatment seeking by substance users between GO, NGO, and private sectors in India. A variance in the population profile in the three sectors was observed. The treatment seekers’ profiles showed some commonalities and differences. The mean ages were similar across the sectors (35 years) and most were males and married. However, persons with higher education status and students presented to the private sector while persons with low education status and unemployed were higher in the GO and NGO sectors. This is not surprising as preferences for health service utilization by individual predisposing factors such as age, religion, education, and enabling factors like income and wealth[567] have been found to influence people's health care-seeking behavior.

The setting of choice for primary drug for which treatment was being sought also differed. Treatment seeking for illicit drug use was higher in GO sector; injection use in NGO; alcohol and sedative/hypnotics use in the private sector. Women were under-represented in accessing treatment services in all sectors. Findings suggested a higher rate of treatment demand for alcohol use disorders followed by opioids (largely heroin) being the dominant drug (illicit) and some cannabis users also accounted for treatment demand.[8] From the study findings, it emerged that the GO settings are meeting treatment needs of illicit drug users. Health care utilization reportedly is influenced by organizational factors which entail structure and processes of the health care systems where trust,[910] user fees,[11] time, distance, waiting time, acreage,[12] and affordability have been mentioned. The governmental sector is generally recognized as the first option and people trust public providers for their clinical skills, referral system, and honest interactions with patients.[10]

It has also been noted that the poor interpersonal relationships in GO sector act as access barrier, pushing people to seek care from private providers.[9] There is a common perception that the private sector will offer better service[11] (although more expensive), continuity of care, availability of same clinician each time, and personalized attention and are visited by choice. As there was a low response from the private sector in the present study, it is difficult to speculate on reasons for choice. Though care for IDUs supported by National AIDS Control Organization (NACO), GO of India (NACO) is available both at the GO and NGO centers, in present study, the injection drug users were largely accessing services from NGO settings which are probably perceived as more client centered[13] as also their visibility in the community setting is high.

Researchers report that for-profit treatment facilities are less likely to serve poorer clients and offer key ancillary/transitional services than nonprofits.[14] For India, the GO and NGO sector appear to be serving an important part in increasing access to treatment for the poor and providing the extent of treatment services required by the vulnerable drug-using population. The GO sector is an important treatment provider, and the NGO sector has the flexibility and access to most vulnerable population at the community level. Strengthening linkages between these two sectors is important for improved coverage and quality of treatment services in the country. Further increasing community awareness on the availability of addiction treatment services in GO/NGO sector is important as such information increases the probability of visiting a health provider.[15]