In Bangladesh and India, informal healthcare providers (IHPs) have long been part of the countries’ health systems. However, formal recognition of their existence is sensitive, partly due to resistance and concern from professional health bodies. Research by Future Health Systems (FHS) partners ICDDR,B and IIHMR has been instrumental in bringing the issues to discussion tables. Consequently, stakeholders have begun to recognize and work with IHPs – something previously unheard of.
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‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information
Waldman L, Ahmed T, Scott N, Akter S, Standing H and Rasheed S (2018) ‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information, Globalization and Health, 14:31, DOI: 10.1186/s12992-018-0349-6
Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers’ control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students’ usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this.Read More
A fundamental challenge for health systems is the need to adapt to changes in the patterns of health service need, scientific and technological developments, and the economic and institutional contexts within which providers of health services are embedded. This is especially true of many low and middle-income countries, where the pace of multiple and interconnected changes is breath-taking. This paper introduces the Thematic Issue on Innovation in Health Systems in Low- and Middle-Income Countries.Read More
Hanifi SMA, Das S, and Rahman M (2018) Bangladeshi neonates miss the potential benefits of early BCG vaccination, International Journal of Epidemiology, Volume 47, Issue 1, Pp 348–349, DOI: 10.1093/ije/dyx223
Bangladesh is a high-TB-burden country. It is recommended, for TB-endemic areas, that BCG be given to neonates at the first possible opportunity of their life. Several observational studies and lately a few randomized trials show that BCG offers ‘heterologous protective effects’ beyond its target disease tuberculosis. A recent review by WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) on non-specific effects of BCG vaccine shows that vaccination at birth reduces neonatal mortality by 48% (18–67%), which is mainly due to the prevention of neonatal sepsis and respiratory infections. In Bangladesh, neonatal mortality is high (28 per 1000 live births) (and accounts for about two-thirds of all under-five deaths), mainly due to infections, birth asphyxia, respiratory infection and prematurity.Read More
Socioeconomic inequalities in under-five mortality in rural Bangladesh: evidence from seven national surveys spreading over 20 years
Chowdhury AH, Hanifi SMA, Mia MN and Bhuiya A (2017) Socioeconomic inequalities in under-five mortality in rural Bangladesh: evidence from seven national surveys spreading over 20 years, International Journal for Equity in Health (2017) 16:197, DOI: 10.1186/s12939-017-0693-9
Socioeconomic inequality in health and mortality remains a disturbing reality across nations including Bangladesh. Inequality drew renewed attention globally. Bangladesh though made impressive progress in health, it makes an interesting case for learning. This paper examined the trends and changing pattern of socioeconomic inequalities in under-five mortality in rural Bangladesh. It also examined whether mother’s education had any effect in reducing socioeconomic inequalities.Read More
Khatun F, Heywood AE, Hanifi SM, Rahman MS, Ray PK, Liaw ST and Bhuiya A (2017) Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh, BMC health services research, 17:573, DOI: 10.1186/s12913-017-2523-6
Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.Read More
Opportunities for strengthening infant and young child feeding policies in South Asia: Insights from the SAIFRN policy analysis project
Thow AM, Karn S, Devkota MD, Rasheed S, Roy SK, Suleman Y, Hazir T, Patel A, Gaidhane A, Puri S, Godakandage S, Senarath U and Dibley MJ (2017) Opportunities for strengthening infant and young child feeding policies in South Asia: Insights from the SAIFRN policy analysis project, BMC Public Health, 17(Suppl 2):404 DOI: 10.1186/s12889-017-4336-2
South Asian countries experience some of the highest levels of child undernutrition in the world, strongly linked to poor infant and young child feeding (IYCF) practices. Strong and responsive policy support is essential for effective interventions to improve IYCF. This study aimed to identify opportunities for strengthening the policy environment in the region to better support appropriate infant and young child feeding.Read More
Analysis of stakeholders networks of infant and young child nutrition programmes in Sri Lanka, India, Nepal, Bangladesh and Pakistan
Uddin S, Mahmood H, Senarath U, Zahiruddin Q, Karn S, Rasheed S and Dibley M (2017) Analysis of stakeholders networks of infant and young child nutrition programmes in Sri Lanka, India, Nepal, Bangladesh and Pakistan, BMC Public Health, 17(Suppl 2):405, DOI: 10.1186/s12889-017-4337-1
Effective public policies are needed to support appropriate infant and young child feeding (IYCF) to ensure adequate child growth and development, especially in low and middle income countries. The aim of this study was to: (i) capture stakeholder networks in relation to funding and technical support for IYCF policy across five countries in South Asia (i.e. Sri Lanka, India, Nepal, Bangladesh and Pakistan); and (ii) understand how stakeholder networks differed between countries, and identify common actors and their patterns in network engagement across the region.
Rasheed S, Roy SK, Das S, Chowdhury SN, Iqbal M, Akter SM, Jahan K, Uddin S and Thow AM (2017) Policy content and stakeholder network analysis for infant and young child feeding in Bangladesh, BMC Public Health, 17(Suppl 2):402, DOI: 10.1186/s12889-017-4338-0
Appropriate infant and young child feeding (IYCF) practices are essential for nutrition of infants and young children. Bangladesh has one of the highest levels of malnutrition globally along with sub-optimal IYCF practices. A supportive policy environment is essential to ensure that effective IYCF interventions are scaled up.
The objectives of our study were to assess the support for IYCF in the national policy environment through policy analysis and stakeholder analysis and in so doing identify opportunities to strengthen the policy environment.Read More
Impact of fortified biscuits on micronutrient deficiencies among primary school children in Bangladesh
Adams AM, Ahmed R, Mahbub Latif AHM, Rasheed S, Das SM, Hasib E, Farzana FD, Ferdous F, Ahmed S, Faruque ASG (2017) Impact of fortified biscuits on micronutrient deficiencies among primary school children in Bangladesh, PLOS One, 12(4): e0174673, DOI: 10.1371/journal.pone.0174673
Micronutrient deficiencies can compromise the development potential of school-aged children, and their later health and productivity as adults. School feeding and school-based fortification approaches have been utilized globally to redress nutritional deficiencies in this age group. The authors explored the acceptability and micronutrient impact of a Bangladesh Government supported school-based micronutrient fortification program for children attending rural primary schools in 10 disadvantaged sub-districts.
Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh
Iqbal M, Chowdhury AH, Mahmood SS, Mia MN, Hanifi SMA and Bhuiya A (2017) Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh, Global Health Action, Vol 10, Issue 1, DOI: 10.1080/16549716.2017.1287398
Out-of-pocket (OOP) healthcare expenditure is a major obstacle for achieving universal health coverage in low-income countries including Bangladesh. Sixty-three percent of the USD 27 annual per-capita healthcare expenditure in Bangladesh comes from individuals’ pockets. Although health insurance is a financial tool for reducing OOP, use of such tools in Bangladesh has been limited to some small-scale voluntary micro health insurance (MHI) schemes run by non-governmental organizations (NGO). The MHI, however, can orient people on health insurance concept and provide learning for product development, implementation, barriers to enrolment, membership renewal, and other operational challenges and solutions. Keeping this in mind, icddr,b in 2012 initiated a pilot MHI, Amader Shasthya, in Chakaria, Bangladesh. This paper explores the determinants of membership renewal in this scheme, which is a perpetual challenge for MHI.Read More
Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria
Mia MN, Hanifi SMA, Rahman MS, et al (2017) Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria, BMJ Open 2017;7, DOI: 10.1136/bmjopen-2016-012765
The health hazards associated with the use of smokeless tobacco (SLT) are similar to those of smoking. However, unlike smoking, limited initiatives have been taken to control the use of SLT, despite its widespread use in South and Southeast Asian countries including Bangladesh. It is therefore important to examine the prevalence of SLT use and its social determinants for designing appropriate strategies and programmes to control its use.Read More
Health literacy in a community with low levels of education: findings from Chakaria, a rural area of Bangladesh
Das S, Mia MN, Hanifi SMA, Hoque S and Bhuiya A (2017) Health literacy in a community with low levels of education: findings from Chakaria, a rural area of Bangladesh, BMC Public Health, 17:203, DOI: 10.1186/s12889-017-4097-y
Health literacy (HL) helps individuals to make effective use of available health services. In low-income countries such as Bangladesh, the less than optimum use of services could be due to low levels of HL. Bangladesh’s health service delivery is pluralistic with a mix of public, private and informally trained healthcare providers. Emphasis on HL has been inadequate. Thus, it is important to assess the levels of HL and service utilization patterns. The findings from this study aim to bridge the knowledge gap.
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.Read More
Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh
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.Read More
Khatuna F, Heywood AE, Ray PK, SMA Hanifi, Bhuiya A, Liaw ST (2015) Determinants of readiness to adopt mHealth in a rural community of Bangladesh, International Journal of Medical Informatics, Volume 84, Issue 10, Pages 847–856, http://dx.doi.org/10.1016/j.ijmedinf.2015.06.008
Evidence in favour of mHealth for healthcare delivery in settings where trained health workforce is limited or unavailable is accumulating. With rapid growth in access to mobile phones and an acute shortage of health workforce in Bangladesh, mHealth initiatives are increasing with more than 20 current initiatives in place. “Readiness” is a crucial prerequisite to the successful implementation of telehealth programs. However, systematic assessment of the community readiness for mHealth-based services in the country is lacking. This article reports on a recent study describing the influence of community readiness for mHealth of a rural Bangladesh community.Read More
Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh
Khan NUZ, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, Hanifi SMA, Hoque S, Iqbal M and Bhuiya A (2015) Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh, BMC Medical Informatics and Decision Making, 15:62, doi:10.1186/s12911-015-0188-9
Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. This study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention.Read More
This paper presents a conceptual approach for discussing health information seeking among poor households in Africa and Asia. This approach is part of a larger research endeavor aimed at understanding how health systems are adapting; with possibilities and constraints emerging. These health systems can be found in a context of the changing relationships between states, markets and civil society in low and middle income countries. The paper starts from an understanding of the health sector as a “health knowledge economy”, organized to provide people with access to knowledge and advice. The use of the term “health knowledge economy” draws attention to the ways the health sector is part of a broader knowledge economy changing the way individuals and households obtain and use specialist information. The paper integrates an actor centric approach with the theory of planned behavior. It seeks to identify the actors engaged in the health knowledge economy as a precursor to longer term studies on the uptake of innovations integrating health services with mobile phones, commonly designated as mHealth, contributing to an understanding of the potential vulnerabilities of poor people, and highlighting possible dangers if providers of health information and advice are strongly influenced by interest groups.Read More
There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets.Read More
What Do They Do? Interactions Between Village Doctors and Medical Representatives in Chakaria, Bangladesh
Hafizur Rahman, M, Agarwal, S, Tuddenham, S, Iqbal, M, Bhuiya, A, and Peters, DH (2014) What do they do? Interactions between village doctors and medical representatives in Chakaria, Bangladesh International Health doi:10.1093/inthealth/ihu077
Informally trained village doctors supply the majority of health care services to the rural poor in many developing countries. This study describes the demographic and socioeconomic differences between medical representatives, hired by pharmaceutical companies to provide their products to health providers, and village doctors in rural Bangladesh, and explores the nature of their interactions. The research team used focus group discussions, in-depth interviews, and a quantitative survey to understand practice perceptions. They found that medical representatives have a higher average per capita monthly expenditure compared to village doctors, and that the former are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less. Medical representatives are the principal information source about new medications for the village doctors. Furthermore, incentives offered by medical representatives and credit availability might influence the prescription practices of village doctors. Findings suggests that improvements in the quality of health care delivered to the rural poor in informal provider-based health markets require stricter regulations and educational initiatives for providers and medical representatives.