Perceptions of appropriate treatment among the informal allopathic providers: insights from a qualitative study in two peri-urban areas in Bangladesh

Abstract

Background How the informal providers deliver health services are not well understood in Bangladesh. However, their practices are often considered inappropriate and unsafe. This study attempted to fill-in this knowledge gap by exploring their perceptions about diagnosis and appropriate treatment, as well as identifying existing barriers to provide appropriate treatment. Methods This exploratory study was conducted in two peri-urban areas of metropolitan Dhaka. Study participants were selected purposively, and an interview guideline was used to collect in-depth data from thirteen providers. Content analysis was applied through data immersion and themes identification, including coding and sub-coding, as well as data display matrix creation to draw conclusion. Results The providers relied mainly on the history and presenting symptoms for diagnosis. Information and guidelines provided by the pharmaceutical representatives were important aids in their diagnosis and treatment decision making. Lack of training, diagnostic tools and medicine, along with consumer demands for certain medicine i.e. antibiotics, were cited as barriers to deliver appropriate care. Effective and supportive supervision, training, patient education, and availability of diagnostics and guidelines in Bangla were considered necessary in overcoming these barriers. Conclusion Informal providers lack the knowledge and skills for delivering appropriate treatment and care. As they provide health services for substantial proportion of the population, it’s crucial that policy makers become cognizant of the fact and take measures to remedy them. This is even more urgent if government’s goal to reach universal health coverage by 2030 is to be achieved. Electronic supplementary material The online version of this article (10.1186/s12913-019-4254-3) contains supplementary material, which is available to authorized users.

Healthcare seeking behavior and delays in case of drug-resistant Tuberculosis patients in Bangladesh: Findings from a cross-sectional survey

“…Informal care providers usually treat with medicine without suggesting any investigations (15). Prescription of antibiotics irrationally is also common among them (34). Also, they don't refer patients to formal providers or DOTS centers.…”

Role of informal healthcare providers in tuberculosis care in low- and middle-income countries: A systematic scoping review

“…This finding is similar to a systematic review paper by Sudhinaraset et al, where only 24% of 122 studies reported quality outcomes [ 16 ]. Studies have found that IPs lack appropriate knowledge to deliver health care [ 21 ], including TB care [ 70 ], and IPs knowledge and skills are identified as a crucial factor that influences the quality of care [ 16 ]. Hence, future research should employ validated methods, such as standardized patient methods and vignettes, to measure IPs’ knowledge and skills in TB care [ 71 , 72 ].…”

“…As there is no uniform definition for IPs, we referred to previously published papers in this field [ 16 , 17 , 20 , 21 , 41 , 42 ] and developed a summary table to identify the common elements in each definition, available as a S2 File . Hence, in this study, we define IPs as "individuals who are not affiliated or registered to any government body or institution, independently delivering some form of health services, and not possessing a recognized certification for the type of services they offer".…”

“…Although unrecognized and undocumented in many settings, a considerable amount of evidence establishing their contribution to the health system exists. This is especially evident in rural and underserved areas of LMICs, where primary care-seeking from IPs by patients ranges from 65%-90% [ 16 , 19 , 21 ]. The pivotal role of IPs in TB care is increasingly recognized at the global level and evident through multiple patient health-seeking behaviour studies [ 22 – 26 ], as well as through some large scale surveys [ 27 , 28 ].…”

Patients’ choice of healthcare providers and predictors of modern healthcare utilisation in Bangladesh: Household Income and Expenditure Survey (HIES) 2016–2017 (BBS)

“…One study noted that shortage and unequal distribution of qualified doctors had left the patients with no option to seek healthcare from modern formal healthcare providers. 14 Sultana and colleagues conducted an extensive qualitative study to find out why patients seek treatment from alternative healthcare providers in the presence of accessible modern healthcare facilities. 13 They outlined several points.…”