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Publications

Filtering by Category: icddrb

Determinants of readiness to adopt mHealth in a rural community of Bangladesh

Future Health Systems

 

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.

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Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh

Future Health Systems

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.

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Understanding Health Information Seeking from an Actor-Centric Perspective

Future Health Systems

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.

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Addressing Resistance To Antibiotics In Pluralistic Health Systems

Future Health Systems

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. 

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What Do They Do? Interactions Between Village Doctors and Medical Representatives in Chakaria, Bangladesh

Future Health Systems

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.

eHealth and mHealth initiatives in Bangladesh: A scoping study

Future Health Systems

The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential.

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E-health and M-health in Bangladesh: Opportunities and Challenges

Future Health Systems

There is growing enthusiasm amongst analysts of global health for the possibilities opened up by the rapid spread of mobile phone coverage. This includes substantially increasing access to health-related information and advice and to expert medical consultations.This report presents a snapshot of how information and communication technologies (ICTs) are influencing health system development in Bangladesh.

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Health progress and research culture in Bangladesh

Future Health Systems

The emergence of a research culture in Bangladesh promoting rigorous research, developing interventions, and translating evidence into policies made a substantial contribution to the improvement of health outcomes in Bangladesh. Notably, the reduction of mortality from diarrhoea and vaccine preventable diseases and control of fertility have made the most significant contributions to recent health gains.
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Innovation for universal health coverage in Bangladesh: a call to action

Future Health Systems

A post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges.
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Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh

Future Health Systems

This article explores strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms.
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Harnessing pluralism for better health in Bangladesh

Future Health Systems

How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change.
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The Bangladesh paradox: exceptional health achievement despite economic poverty

Future Health Systems

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households.
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FHS Bangladesh Research Brief 5: Use of mHealth to improve the quality of services of the village doctors

Future Health Systems

Village doctors are the dominant health care providers in rural areas of Bangladesh. icddr,b has previously tested interventions to improve the quality of their services – especially training on acceptable practice and the creation of a franchise called ShasthyaSena (health soldier). But training alone met with limited success. To improve the quality of these services, icddr,b has been testing an mHealth intervention that linked ShasthyaSenas to qualified physicians through a call centre. This brief documents the successes and challenges faced during the first year of implementation of the mHealth intervention.
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Future Health Markets: A meeting statement from Bellagio

Future Health Systems

Policy-makers, entrepreneurs, academics and funders convened at the Rockefeller Foundation Bellagio Center from 10th-14th December 2012 to discuss the changing face of health markets, and in particular to consider future trends in such markets. Their aim was to promote a greater shared understanding and analysis of health market systems, and to consider how markets can better serve the needs of the poor in low- and middle-income countries (LMICs). This report is an attempt to capture the rich discussions held during the meeting, which reviewed the evolution of health markets, identified key drivers of and gaps resulting from their rapid development, and highlighted critical issues that must be tackled to ensure the poorest have access to safe, affordable, effective and equitable health services. The report concludes with recommendations for shaping future health markets as agreed during the meeting.
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Exploring the Ethics of Long-Term Research Engagement With Communities in Low- and Middle-Income Countries

Future Health Systems

Over the past few decades, there has been increasing attention focused on the ethics of health research, particularly in low- and middle-income countries. Despite the increasing focus on the literature addressing human protection, community engagement, appropriate consent procedures and ways to mitigate concerns around exploitation, there has been little discussion about how the duration of the research engagement may affect the ethical design and implementation of studies. In other words, what are the unique ethical challenges when researchers engage with host communities for longer periods (10 years or more), and what special considerations does this time commitment generate when applying ethical principles to these kinds of studies? This article begins to outline key areas of ethical concern that arise during long-term, sustained research activities with communities in low-resource settings. Through a review of the literature and consultations with experts in health systems, we identified the following key themes: fair benefits and long-term beneficence; community autonomy, consultation and consent; impacts on local health systems; economic impacts of research participation; ethical review processes; and institutional processes and oversight within research organizations. We hope that this preliminary exploration will stimulate further dialogue and help inform ethical guidance around long-term research engagements in the developing world.
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Doctoring the Village Doctors: Giving Attention Where it is Due

Future Health Systems

Previous work from ICDDR,B established village doctors as an important player Bangladesh’s healthcare system, as they are often the first port of call for the rural poor. Considering this importance and the huge shortfall of formally trained health workforce in the country, there is a clear need to improve the quality of the services offered by these semi-trained village doctors. In response, a team of ICDDR,B researchers tested a package of interventions, which included training of the village doctors, establishing a community watch for improved accountability and establishing branded franchise of better trained village doctors.
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Creating a public space and dialogue on sexuality and rights: a case study from Bangladesh

Future Health Systems

This article describes and analyses a research based engagement by a university school of public health in Bangladesh aimed at raising public debate on sexuality and rights and making issues such as discrimination more visible to policy makers and other key stakeholders in a challenging context.
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Medical Representatives in rural Bangladesh: Who are They and What Is Their Role in the Drug Market?

Future Health Systems

M Hafizur Rahman from Johns Hopkins Bloomberg School of Public Health looks at the role of medical representatives in Chakaria, Bangladesh. He focuses on their link with informal providers of health services in rural areas. The presentation was given on 11 July 2011 at the 8th World Congress on Health Economics (iHEA).
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Making health markets work better for poor people: the case of informal providers

Future Health Systems

There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria.
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