The inadequacies of the formal healthcare sector in Bangladesh has resulted in a widespread increase in informal providers as an alternative source of care providing basic and essential outpatient health services to millions of poor people in the rural areas. Close proximity to clients, availability to the community day and night, sympathetic behavior, well established relations within the community, and flexible payment methods have made the village doctors a popular source of care.
Findings from our initial studies confirmed that the village doctors (VDs) provide care of questionable quality with considerable over-prescription of drugs, including the prescription of drugs that are mostly inappropriate and potentially harmful. Regardless, the widespread existence of VDs and their significance as an integral contributor of healthcare within rural communities in Bangladesh necessitates an effective regulatory arrangement that improves and ensures a minimum standard in the quality of services provided.
FHS Phase 1
In the first phase, FHS Bangladesh established the ShasthyaSena intervention, which employed a combination of three strategies to improve healthcare services in rural Chakaria, Bangladesh. All of the 157 village doctors (VDs) practicing in the intervention areas were invited to participate in a free training in managing common illnesses such as pneumonia, diarrhea, hepatitis, malaria, tuberculosis, viral fever, and various complications related to labor and delivery. A small booklet with information on what to do and what not to do for eleven common illnesses was distributed as a source of future reference. As members of the SS network, qualified village doctors were awarded crests containing the SS logo. A memorandum of understanding outlining the responsibilities and objectives of SS was signed between each joining member and the network.
The study has shown that training and branding has acceptability among village doctors although their behaviour has had no drastic changes due to the lack of financial incentives. The ShasthyaSena intervention has also resulted in a change in the attitude of the government toward informal healthcare providers.
FHS Phase 2
In Phase 2, FHS Bangladesh is pursuing branding and social franchising mechanisms and marrying them to new technologies such as telemedicine and the “health box”. This will show and guide the informal healthcare providers how to treat and manage many common illnesses through the use of computer-based diagnostic algorithms. These components together will create a brand with serious content that is attractive to village doctors and even more attractive to customers through improvements in the quality of care. The intervention will further link village doctors with formal healthcare providers for more complicated illnesses. While over-the-counter drugs can be dispensed by the village doctors themselves, dispensing prescription drugs will be guided by linking them with qualified physicians. Dispensing of medicines will be part of the profit made by village doctors and will provide them with a financial incentive. All the above activities will be ensured and supervised by the project. If acceptability and efficacy of the intervention can be shown, a stronger case can be made that shows that using informal healthcare providers will be profitable in a country that has a huge shortfall in the health workforce.
FHS Partners in Bangladesh
News and announcements from FHS Bangladesh
Future Health Systems research in Bangladesh and Uganda is assessing how community empowerment strategies can affect service delivery and community capabilities. In Uganda, FHS partner, Makerere University School of Public Health, has partnered with Kibuku District in Eastern Uganda to develop and test a community and facility score card for maternal and newborn health service delivery. The feasibility study aims at identifying facilitators, barriers and factors that could influence implementation, institutionalization and scale-up of community and facility score cards in Uganda.
Delivering for Success at Scale - a two day conference from 7 to 8 February 2017 at the BRAC Auditorium, Mohakhali, Dhaka, Bangladesh - will build on the longstanding partnership between BRAC, ICDDR,B and the Institute of Development Studies to explore the role of knowledge in the conceptualisation, design, delivery and management of development programmes and policies.
Recent FHS Bangladesh Publications
Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw S-T (2016) Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration, International Journal of Medical Informatics, Volume 93, pp 49–56, DOI: 10.1016/j.ijmedinf.2016.05.010
There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.
Bhuiya A, Hanifi SMA and Hoque S (2016) Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh, BMC Health Services Research, 16:1865, DOI: 10.1186/s12913-016-1865-9
People’s participation in health, enshrined in the 1978 Alma Ata declaration, seeks to tap into community capability for better health and empowerment. One mechanism to promote participation in health is through participatory action research (PAR) methods. Beginning in 1994, the Bangladeshi research organization ICDDR,B implemented a project “self-help for health,” to work with existing rural self-help organizations (SHOs). SHOs are organizations formed by villagers for their well-being through their own initiatives without external material help. This paper describes the project’s implementation, impact, and reflective learnings.
Paina L, Vadrevu L, Hanifi SMMA, Akuze J, Rieder R, Chan KS and Peters DH (2016) What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda, BMC Health Services Research, 16:1861, DOI: 10.1186/s12913-016-1861-0
While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.
In Future Health Systems, we focused on communities as active service delivery participants across a wide variety of contexts. In this brief, we reflect on the process of unlocking community capabilities, the key actors involved, and the productive tensions within community partnerships forged to build more responsive, resilient and equitable health systems.
Mirelman AJ, Rose S, Khan JAM, Ahmed S, Peters DH, Niessen LW, Trujillo AJ (2016) The relationship between non-communicable disease occurrence and poverty—evidence from demographic surveillance in Matlab, Bangladesh, Health Policy and Planning. 2016, 1-8, doi: 10.1093/heapol/czv134
In low-income countries, a growing proportion of the disease burden is attributable to non- communicable diseases (NCDs). There is little knowledge, however, of their impact on wealth, human capital, economic growth or household poverty. This article estimates the risk of being poor after an NCD death in the rural, low-income area of Matlab, Bangladesh.
Khan JAM, Trujillo AJ, Ahmed S, Siddiquee AT, Alam N, Mirelman AJ, Koehlmoos TP, Niessen LW and Peters DH (2015) Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh - an analysis over a 24 year period, International Journal of Epidemiology, 44 (6), 1917-1926, doi: 10.1093/ije/dyv197
Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty.