Beyond Scaling Up: Work with informal providers and village doctors in Bangladesh


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This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Bhuiya's presentation focussed on ICDDR,B's work with informal providers of health care and village doctors in Bangladesh.

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Beyond Scaling Up: Work with informal providers and village doctors in Bangladesh

  1. 1. Experience in Engaging with Informal Health Care Providers in Rural Bangladesh<br />AbbasBhuiya<br />On behalf of BangladeshTeam<br />Beyond Scaling Up ConferenceBrighton24-25 May 2010<br />
  2. 2. Background<br />Informal healthcare providers are most common – 95% of the health work force <br />They make their living by selling drugs<br />They make inappropriate use of drugs<br />
  3. 3. Objectives <br /><ul><li>Engaging with ‘Village Doctors’
  4. 4. Reducing inappropriate and harmful use of drugs
  5. 5. Improving quality of services
  6. 6. Establishing accountability </li></li></ul><li>Interventions<br />Training on Dos and Dont’s<br />Information for referral <br />Consultation service over mobile phone with a qualified doctor<br />Oversight committee at Union level with 33 members <br />Assessment & Recognition<br />
  7. 7. Interventions - 1<br />Training on Dos and Dont’s<br />Diarrhea<br />Hepatitis<br />Malaria,<br />Tuberculosis<br />Viral Fever<br />Obstructed labor<br />Ante-partum hemorrhage<br />Post-partum hemorrhage, and <br />for under-five children<br />pneumonia, severe pneumonia, very severe disease<br />
  8. 8. Information for referral <br />Facilities with name, location, mode and cost of transport<br />Estimated cost of treatment, estimated duration, <br />Telephone directory of contacts<br />Refresher trainings every two to three months<br />Consultation service over mobile phone with a qualified doctor<br />Interventions - 2<br />
  9. 9. Interventions - 3<br />Oversight committee at Union level with 33 members <br />UP Chairman-1, <br />UP Members- 9 male and 3 female – total 12 <br />Village Doctors -04<br />VHP committees -02<br />Local elites -03<br />Imam -01 <br />School teachers -1 male and 1 female -02 <br />Beneficiaries ( poor, women) -03<br />NGO group leaders -03<br />Students/Youths -02<br />
  10. 10. Assessment and Recognition<br /><ul><li>Assessment
  11. 11. Quality of physical facility
  12. 12. cleanliness, privacy, water availability, sanitation, waiting area
  13. 13. Assessment of the knowledge on dos and don’ts about 11 common diseases
  14. 14. Award
  15. 15. Crest in large community meeting
  16. 16. All 125 eventually passed</li></li></ul><li>Study Design<br />Quasi experimental (pre-post with two cells)<br />125 in the intervention area<br />120 in the comparison area (12 was covered in mid-term assessment) <br />Data collection<br />Community level<br />Exit interview of patients<br />Two post interventions exit interview<br />
  17. 17. Table 1 - Mean no. of drugs prescribed by Village Doctors for pneumonia (< 5 yr), cold and fever during pre and post intervention, Chakaria 2009-10<br />Data source: Exit interview<br />
  18. 18. Table 2 – Harmful and inappropriate prescription of drugs by Village Doctors during pre and post intervention for pneumonia, diarrhoea and cold and fever, Chakaria, 2009-10t<br />Data source: Exit interview<br />
  19. 19. Conclusions<br />It was possible to get engaged with the informal healthcare providers<br />Only training, recognition and local watch is not enough to reduce inappropriate and harmful practices substantially<br />Alternative source to protect their income is needed<br />
  20. 20. Communication<br />Print<br />Research briefs<br />Monograph<br />Journal article<br />Mass media<br />Oral<br />Seminar, workshop, conference<br />Strategy and other meeting, discussion<br />
  21. 21. Outputs<br />So far<br />Research Briefs, monograph, journal articles based on baseline data<br />Future<br />Research briefs, monograph, journal articles<br />