n n o v a t i o n in Informal Health Market  in Bangladesh Innovations in informal health market in Bangladesh
Outline <ul><li>Who constitute healthcare providers </li></ul><ul><li>Health seeking behavior </li></ul><ul><li>Quality of...
Data Sources <ul><li>ICDDR,B study in 2006-07 in Chakaria, a sub-district  </li></ul><ul><li>Bangladesh Health Watch surve...
Health Care Providers in Chakaria, Bangladesh, 2006 TBA Spiritual Healer Village Doctor Homeopath Formal sector Kabiraj Po...
Prevalence of Illness, Chakaria, 2007  <ul><li>43.5% of the 6,162 individuals included in the community survey reported su...
Sources of First Line of Care, Chakaria, 2007 * SACMO=Sub assistant community medical officer Source of healthcare % Villa...
Use of Physicians and Village Doctors by Poor and Better Off, Chakaria, 2007
Circumstances Preferring Physicians and Village Doctors, Chakaria, 2007 <ul><li>MBBS doctors for perceived severe conditio...
Reasons for Choosing Village Doctors, Chakaria, 2007 Multiple responses recorded Reasons for choosing the health care prov...
Why are the Village Doctors So Popular? Chakaria, 2007  <ul><li>  </li></ul><ul><li>They are always available </li></ul><u...
Use of Drug for Treating Diarrhoea, Fever, and ARI by the Village Doctors, Chakaria, 2006 Inappropriate 75% Appropriate 18...
Shortage of physician, nurse and technologist, Bangladesh, 2007 Gap between the need as per  WHO recommendation and existi...
Summary Situation <ul><li>Village doctors are the most dominant group practicing modern medicine </li></ul><ul><li>Village...
A Few Questions??? <ul><li>What are the possible solutions for immediate future? </li></ul><ul><li>Who do we resort back t...
Working with the Village Doctors to Make Health Systems Work for the Poor in Bangladesh
Why Village Doctor? <ul><li>Has been in existence for long </li></ul><ul><li>Dominant first line healthcare provider  </li...
Challenges <ul><li>Quality of services  </li></ul><ul><li>Accountability </li></ul>Need for a Model
In Search of a Model - Interventions Component Activity Quality of service Training Accountability Watch Reward, consolida...
Quality of Services - Training <ul><li>Content of training </li></ul><ul><li>DOs and DON’Ts for managing:  </li></ul><ul><...
Accountability – Union Health Watch <ul><li>Composition </li></ul><ul><li>Elected representatives </li></ul><ul><li>Social...
Branding –  Shysthya Sena <ul><li>Network of Village Doctors – </li></ul><ul><li>Shysthya Sena </li></ul><ul><li>Membershi...
Phases of Activities <ul><li>Phase I – Pilot (Ongoing) </li></ul><ul><li>Phase II – Impact evaluation (2009 +) </li></ul><...
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Innovation in informal health markets in Bangladesh

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This presentation was given by Hafiz Rahman at the Future Health Systems meeting in Abuja January 2009. www.futurehealthsystems.org

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Innovation in informal health markets in Bangladesh

  1. 1. n n o v a t i o n in Informal Health Market in Bangladesh Innovations in informal health market in Bangladesh
  2. 2. Outline <ul><li>Who constitute healthcare providers </li></ul><ul><li>Health seeking behavior </li></ul><ul><li>Quality of services </li></ul><ul><li>Challenges and opportunities </li></ul>
  3. 3. Data Sources <ul><li>ICDDR,B study in 2006-07 in Chakaria, a sub-district </li></ul><ul><li>Bangladesh Health Watch survey </li></ul><ul><li>(nation wide) in 2007 </li></ul>
  4. 4. Health Care Providers in Chakaria, Bangladesh, 2006 TBA Spiritual Healer Village Doctor Homeopath Formal sector Kabiraj Population (560,000) Per 10,000 Formal (4%) 2.00 Qualified Physician (Regular) 39 .70 Qualified Physician (Guest) 20 .36 Sub-Assistant Community Medical Officer (SACMO-Paramedics) 7 .13 Family Welfare Visitor 13 .23 Midwife (ICDDR,B Trained) 12 .21 Family Welfare Assistant (Trained on midwifery by government) 13 .23 Nurse 8 .14 Informal (96%) 43.64 Village doctor (Allopathic) 328 5.86 Village doctor (Homeopathy) 174 3.11 Kabiraj (Traditional) 289 5.16 Religious/spiritual healer 694 12.39 Traditional birth attendant 959 17.13
  5. 5. Prevalence of Illness, Chakaria, 2007 <ul><li>43.5% of the 6,162 individuals included in the community survey reported suffering from some kind of illness during the 14 days preceding the survey . </li></ul>Wave of Viral Fever
  6. 6. Sources of First Line of Care, Chakaria, 2007 * SACMO=Sub assistant community medical officer Source of healthcare % Village doctors/Pharmacy 50.3 Home remedy 23.3 MBBS 10.6 Homeopath 8.1 SACMO* 4.7 Spiritual healers 1.1 Others 1.9
  7. 7. Use of Physicians and Village Doctors by Poor and Better Off, Chakaria, 2007
  8. 8. Circumstances Preferring Physicians and Village Doctors, Chakaria, 2007 <ul><li>MBBS doctors for perceived severe conditions </li></ul><ul><li>Villager doctors for not so severe conditions </li></ul>
  9. 9. Reasons for Choosing Village Doctors, Chakaria, 2007 Multiple responses recorded Reasons for choosing the health care provider (n=340) % Quality of treatment is good 69.5 Nearest health care provider 42.5 Low treatment cost 17.3 Well behaved health care provider 17.3 Treatment cost on credit 14.6 No other health care facility available nearby 5.8 Health care provider is a family member or a relative or a known person 5.6 Advised by the neighbors or others 0.4
  10. 10. Why are the Village Doctors So Popular? Chakaria, 2007 <ul><li>  </li></ul><ul><li>They are always available </li></ul><ul><li>In case of emergency they go to the patient’s house </li></ul><ul><li>They charge lower consultancy fee </li></ul><ul><li>They refer patients to other doctors if and when needed </li></ul><ul><li>Patients can get medicines according to the money they have </li></ul>
  11. 11. Use of Drug for Treating Diarrhoea, Fever, and ARI by the Village Doctors, Chakaria, 2006 Inappropriate 75% Appropriate 18% Harmful 7%
  12. 12. Shortage of physician, nurse and technologist, Bangladesh, 2007 Gap between the need as per WHO recommendation and existing numbers Source: Bangladesh Health Watch 2008
  13. 13. Summary Situation <ul><li>Village doctors are the most dominant group practicing modern medicine </li></ul><ul><li>Village doctors are popular among patients from all socioeconomic strata </li></ul><ul><li>Patients seek care from village doctors with the belief that they are receiving quality care </li></ul><ul><li>The quality of services provided by the village doctors are questionable </li></ul><ul><li>Increasing the number of MBBS doctors in the immediate future does not seem feasible. </li></ul>
  14. 14. A Few Questions??? <ul><li>What are the possible solutions for immediate future? </li></ul><ul><li>Who do we resort back to in order to ensure health care for the rural people? </li></ul><ul><li>Can we make use of the vast army of village doctors? How? </li></ul>
  15. 15. Working with the Village Doctors to Make Health Systems Work for the Poor in Bangladesh
  16. 16. Why Village Doctor? <ul><li>Has been in existence for long </li></ul><ul><li>Dominant first line healthcare provider </li></ul><ul><ul><li>62% of the service providers using modern medicine are Village Doctors </li></ul></ul><ul><ul><li>Majority villagers contact them first for treatment </li></ul></ul><ul><li>Live in the rural area </li></ul><ul><li>Acute shortage of formally trained providers </li></ul><ul><li>Unlikely to have enough number of trained provider in the foreseeable future </li></ul><ul><li>Can work as a link between the formal sector and the villagers </li></ul><ul><li>Has the potential to bridge the transition from informal system to formal </li></ul>
  17. 17. Challenges <ul><li>Quality of services </li></ul><ul><li>Accountability </li></ul>Need for a Model
  18. 18. In Search of a Model - Interventions Component Activity Quality of service Training Accountability Watch Reward, consolidation, promotion Branding/Franchising
  19. 19. Quality of Services - Training <ul><li>Content of training </li></ul><ul><li>DOs and DON’Ts for managing: </li></ul><ul><ul><li>Pneumonia, diarrhea, </li></ul></ul><ul><ul><li>viral fever, malaria, hepatitis, </li></ul></ul><ul><ul><li>APH, Obstructed labour, PPH </li></ul></ul><ul><li>DOs and DON’Ts in using Antibiotics and Steroids </li></ul><ul><li>Referral and information about referral </li></ul><ul><li>Cover page of the booklet </li></ul>
  20. 20. Accountability – Union Health Watch <ul><li>Composition </li></ul><ul><li>Elected representatives </li></ul><ul><li>Social leaders </li></ul><ul><li>Representative of Village Doctors </li></ul><ul><li>Activity </li></ul><ul><li>Orientation of healthcare system, drug, major health problems, monitoring techniques </li></ul><ul><li>Monitoring performance of Village Doctors </li></ul><ul><li>Meeting once a quarter </li></ul><ul><li>Provide feedback </li></ul>
  21. 21. Branding – Shysthya Sena <ul><li>Network of Village Doctors – </li></ul><ul><li>Shysthya Sena </li></ul><ul><li>Membership criteria </li></ul><ul><ul><li>Adherence to desired agreed practices </li></ul></ul><ul><ul><li>Maintenance of records </li></ul></ul><ul><ul><li>Physical facility </li></ul></ul><ul><li>Yearly assessment by oversight committee </li></ul><ul><li>Public recognition </li></ul><ul><li>Badge, stationery, logo, sign etc. </li></ul><ul><li>Committee and its function </li></ul><ul><li>Village Doctors, Health and Administration, local government, civil society </li></ul><ul><li>Quarterly meeting </li></ul><ul><li>Decide guidelines for operation and assessment </li></ul><ul><li>Oversight of the quality of services </li></ul><ul><li>Awarding of reward </li></ul>
  22. 22. Phases of Activities <ul><li>Phase I – Pilot (Ongoing) </li></ul><ul><li>Phase II – Impact evaluation (2009 +) </li></ul><ul><li>Phase III – Scale Up </li></ul>
  23. 23. Thank You

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