Health Facilities In Bangladesh Research Articles

Women’s Autonomy and its Influences on Utilization of Maternal and Child Health Care Facilities in Bangladesh

Women’s autonomy and its association with maternal and child health care have emerged as a focal point of investigations and interventions around the world. It is also an important issue in Bangladesh. In this paper, different dimensions of women’s autonomy and their influences into maternal and child health-care utilization are investigated using data from BDHS 2007. The core hypothesis behind this work is that, women’s with higher autonomy will be more likely to use maternal and child health care services. We employed binary logistic regression and multinomial logistic regression model for the multivariate analyses part. In this study, women’s autonomy defined as women’s decision making power relative to their male partners. Women’s autonomy has increased with age, education, employment and number of children. This study showed that maximum autonomy indicators were important predictors of maternal and child health care utilization. Policymakers need to address women’s autonomy in the household in addition to implement direct health interventions towards improvement of maternal health & child health care.

Human resource assessment for scaling up VL active case detection in Bangladesh, India and Nepal

To determine whether medical staff at PHC level would have the time to take up additional activities such as 1-day fever camps for active VL case detection. This article assessed the workload of health staff of different professional categories working at health facilities in Bangladesh, India and Nepal. Data were collected from different sites in high endemic VL areas. The study population was the health staff of government health facilities at all levels. Workload indicators of staffing need (WISN) software were adopted to carry out the analysis of staff workload and their availability in the selected health facility. The WISN difference and WISN ratio for a particular health facility were calculated from actual staffing available and calculated staffing requirement. The results showed a mixed picture of the availability of health workers. In most settings of Bangladesh and India, physicians with or without laboratory technicians would have time for active case detection. In Nepal, this would be performed by trained nurses and paramedical personnel. If all vacant posts were filled, active case detection could be performed more easily. The elimination programme can be scaled up with the current staffing levels in the endemic areas with some short training if and when necessary.

Out-of-Pocket Expenses for Maternity Care in Rural Bangladesh: A Public-Private Comparison

Out-of-pocket expenses incurred by women for availing maternal healthcare services at public and private health facilities in Bangladesh were examined using a baseline household survey evaluating the impact of demand side financing vouchers on utilization and service delivery for maternal healthcare. The survey was conducted in 2010 among 3,300 women who gave birth in the previous 12 months from the start of data collection. Information on costs incurred to receive antenatal, delivery, and postnatal care services was collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal healthcare services both at public and private health facilities. Out-of-pocket expenses include registration, consultation, laboratory examination, medicine, transportation, and other associated costs incurred for receiving maternal healthcare services. On average, women paid US$3.60 out-of-pocket expenses for receiving antenatal care at public health facilities and US$12.40 at private health facilities. Similarly, women paid one and half times more for normal (US$42.30) and cesarean deliveries (US$136.20) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care services did not vary significantly between public and private health facilities. Utilization of maternal healthcare services can be improved if out-of-pocket expenses can be minimized. At the same time, effective demand generation strategies are necessary to encourage women to utilize health facilities.

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

BackgroundLittle is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG) targets the financial sustainability of such facilities is crucial.MethodsThe study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value). Sensitivity analysis was done using 3% discount rate.ResultsThe cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient.ConclusionThe cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase utilization, efficient planning, resource allocation and their optimum use. It also requires controlling variable costs and preventing any wastage of resources.

Assessment of quality of care in maternal and newborn health services available in public health care facilities in Bangladesh

The study was conducted using the exit interview with patients (n=120), in depth interview with health care providers (n=87) and focus group discussion (n=16) with stakeholders to assess the perceived level of quality of care in maternal and newborn health at public facilities in Bangladesh. Both clients and providers expressed dissatisfaction for inadequate quality of care represented by poor cleanliness, long waiting time with less consultation time, poor compassion by providers, inadequate supply of drugs and unnoticed cost for services varied by level of facilities. Inadequacy in human resource and absenteeism and poor laboratory service were reported to worsen the condition especially at lower level of service delivery. Thus this study explored some important factors like poor quality of care, inadequate technical competencies, information exchange and follow-up services. A deficit in supplies and logistics are strong barrier in regards to quality of care at various levels which needs to be addressed immediately.

Clinical signs that predict severe illness in children under age 2 months: a multicentre study

Neonatal illness, particularly in the first week of life, is a leading cause of death worldwide. Improving identification of young infants who require referral for severe illness is of major public-health importance. Infants under 2 months of age brought with illness to health facilities in Bangladesh, Bolivia, Ghana, India, Pakistan, and South Africa were recruited in two age-groups: 0-6 days and 7-59 days. A trained health worker recorded 31 symptoms and clinical signs. An expert paediatrician assessed each case independently for severe illness that required hospital admission. We examined the sensitivity, specificity, and odds ratio (OR) for each symptom and sign individually and combined into algorithms to assess their value for predicting severe illness, excluding jaundice. 3177 children aged 0-6 days and 5712 infants aged 7-59 days were enrolled. 12 symptoms or signs predicted severe illness in the first week of life: history of difficulty feeding (OR 10.0, 95% CI, 6.9-14.5), history of convulsions (15.4, 6.4-37.2), lethargy (3.5, 1.7-7.1), movement only when stimulated (6.9, 3.0-15.5), respiratory rate of 60 breaths per minute or more (2.7, 1.9-3.8), grunting (2.9, 1.1-7.5), severe chest indrawing (8.9, 4.0-20.1), temperature of 37.5 degrees C or more (3.4, 2.4-4.9) or below 35.5 degrees C (9.2, 4.6-18.6), prolonged capillary refill (10.5, 5.1-21.7), cyanosis (13.7, 1.6-116.5), and stiff limbs (15.1, 2.2-105.9). A decision rule requiring the presence of any one sign had high sensitivity (87%) and specificity (74%). After we reduced the algorithm to seven signs (history of difficulty feeding, history of convulsions, movement only when stimulated, respiratory rate of 60 breaths per minute or more, severe chest indrawing, temperature of 37.5 degrees C or more or below 35.5 degrees C), mainly on the basis of prevalence of each sign or symptom, sensitivity (85%) and specificity (75%) were much the same. These seven signs also did well in 7-59-day-old infants (sensitivity 74%, specificity 79%). A single simple algorithm could be recommended for identifying severe illness in infants aged 0-2 months who are brought to health facilities. Further research is needed on screening newborn children for illness in the community during routine home visits.

Causes of death among women aged 10-50 years in Bangladesh, 1996-1997.

Limited information is available at the national and district levels on causes of death among women of reproductive age in Bangladesh. During 1996-1997, health-service functionaries in facilities providing obstetric and maternal and child-heath services were interviewed on their knowledge of deaths of women aged 10-50 years in the past 12 months. In addition, case reports were abstracted from medical records in facilities with in-patient services. The study covered 4,751 health facilities in Bangladesh. Of 28,998 deaths reported, 13,502 (46.6%) occurred due to medical causes, 8,562 (29.5%) due to pregnancy-related causes, 6,168 (21.3%) due to injuries, and 425 (1.5%) and 259 (0.9%) due to injuries and medical causes during pregnancy respectively. Cardiac problems (11.7%), infectious diseases (11.3%), and system disorders (9.1%) were the major medical causes of deaths. Pregnancy-associated causes included direct maternal deaths (20.1%), abortion (5.1%), and indirect maternal deaths (4.3%). The highest proportion of deaths among women aged 10-19 years was due to injuries (39.3%) with suicides accounting for 21.7%. The largest proportion of direct obstetric deaths occurred among women aged 20-29 years (30.5%). At least one quarter (24.3%) of women (n = 28,998) did not receive any treatment prior to death, and 47.8% received treatment either from a registered physician or in a facility. More focus is needed on all causes of deaths among women of reproductive age in Bangladesh.

Measurement of Quality of Healthcare in Private Subsector of Bangladesh: Study of Selected Private Providers in Dhaka City

Rationale: In a developing country like Bangladesh, proper development of the health sector requires existence of both public and private components of the sector in considerable size and with the highest possible merits of each, and of the private-public mix, wherever feasible, so as to rapidly increase service provision, improve quality of care, raise economic efficiency, and enhance, equality of service utilization. Although the public health sub-sector is overwhelmingly dominant in Bangladesh, the experts argue that the public component is rapidly approaching the limit of expansion. The limit is being set by, inter alia, widening of financing gap, wastage of resource use and inefficiency of management. Hence, rapid development of the private component is needed to cater to the increasing demand for appropriate care. Objectives: The objectives of this paper were to compute the indices of quality of health care provided by the private health facilities in Bangladesh, rank the facilities in order of value of indices, assess the present level of development of the private sub-sector, and identify the major constraints and the required measures for accelerating the pace of its development. Methodology: The paper first devised an appropriate method of assessing quality of care. This involved identification of the major indicators of quality of healthcare, assigning reasonable weights on the indicators, selection of the sub-indicators for each indicators, measurement of values of the sub-indicators, and computation of quality indices. The method was carefully formulated based on an extensive review of literature, opinions of local experts, and direct observations of the operations of private providers. The indicators of the quality considered were: effectiveness, promptness, expert healthcare, acceptability, motivated staff, and economic efficiency. Each indicator comprised a number of sub-indicators. The method was applied to 19 randomly chosen private facilities of Dhaka city and one facility in Singapore was used as the benchmark. The facilities included hospitals, clinics, diagnostic centres, and GPs. Data were collected from managers, providers of care, and patients/ clients. The quality scores computed were used to rank the facilities in each category, and compare with the performance of the benchmark facility. Findings: The findings show that most of the private sector facilities obtain lower than 50 scores and have serious constraints and problems. The major problems of them are: non-existence of regular doctors, non-existence of minimum needed number of modern equipments, lack of provision of training to staff, most of the support staff being seriously under-qualified, very low nurse-doctor ratio, very low amount of time spent by the provider for a patient, etc. The survey also reveals, on the other hand, that at least a few facilities exist in Bangladesh which obtain more than 70 scores, when the score of the benchmark facility is 100. Conclusion: The study suggest that the scope of improvement of performances amply exists for the private providers in Bangladesh. A number of measures have been recommended and it has been argued, using the evidence, that adoption of the measures will rapidly develop the sub-sector.

Experience from Bangladesh: implementing emergency obstetric care as part of the reproductive health agenda

This paper describes the activities of the Ministry of Health and Family Welfare of the Government of Bangladesh and UNFPA to introduce emergency obstetric care (EmOC) services into the reproductive health care agenda. Working through the existing system of Maternal and Child Welfare Centers (MCWC), the quality and availability of comprehensive Reproductive Health and Emergency Obstetric Care services was improved. Investments in training, infrastructure, management information systems, quality assurance mechanisms and linkages between health care facilities in Bangladesh, have produced positive results in terms of increased utilization of these services. The Ministry of Health first implemented services in one division of the country and later scaled up to include all of the MCWCs nationally. While there are still obstacles to preventing obstetric deaths in Bangladesh, this experience shows that improvements in the quality and expansion of the range of services in existing health systems is an important step toward increasing the use of reproductive health care services by the women who need them most.

Adopting integrated management of childhood illness module at local level in Bangladesh: implications for recurrent costs.

This study estimated the recurrent cost implications of adopting Integrated Management of Childhood Illness (IMCI) at the first-level healthcare facilities in Bangladesh. Data on illnesses of children who sought care either from community health workers (CHWs) or from paramedics over a four-month period were collected in a rural community. A total of 5,505 children sought care. About 75% of symptoms mentioned by mothers were directly related to illnesses that are targeted in the IMCI. Cough and fever represented 64% of all reported complaints. Referral of patients to higher facilities varied from 3% for the paramedics to 77% for the CHWs. Had the IMCI module been followed, proportion of children needing referral should have been around 8%. Significant differences were observed between IMCI-recommended drug treatment and current practice followed by the paramedics. Adoption of IMCI should save about US$ 7 million on drugs alone for the whole country. Proper implementation of IMCI will require employment of additional health workers that will cost about US$ 2.7 million. If the current level of healthcare use is assumed, introduction of IMCI in Bangladesh will save over US$ 4 million.

A note on the hierarchy of health facilities in Bangladesh

The existing health facilities available in Bangladesh have been categorized according to their hierarchy with the help of a triangle. Further attempts have been made to classify them on the basis of their location and management type. It is proposed that retaining the basic principles, health facilities of any country of the world can be classified according to their hierarchy, location and management type through a similar triangle.