Reaching the Unreachable: A mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern Riverine Bangladesh

Abstract

Background Remote and hard-to-reach riverine communities of northern Bangladesh face unique challenges in health care services. Friendship, an international social purpose organization, has implemented a 3-tier health care model addressing these unique challenges over the past 20 years. This study evaluates Friendship’s 3-tier health care model, focusing on general health care service-seeking practices, beneficiary and stakeholder perspectives, and cost benefits. Methods A mixed-method approach was employed, including desk reviews, a cross-sectional quantitative survey, and qualitative interviews with service recipients, community representatives, health care providers, and health managers. Data were collected from five hard-to-reach riverine sub-districts across Kurigram, Gaibandha, Bogura, Sirajganj, and Jamalpur districts of Bangladesh between April 2022 and July 2023. Data analyses followed major thematic domains for a comprehensive and complementary understanding. Results A significant proportion (43.0%) of survey participants had no formal education, were aged 18–35 (57.5%), and earned less than 1,620 USD yearly (66.6%). Friendship's health care services at doorstep through satellite clinics and Female Community Medic Aides are widely accepted and preferred within the community for convenience, affordability (0.05–0.09 USD service charges), and superior quality, particularly the specialized treatments available on the hospital ships. Conclusion The 3-tier health care model offers a wide range of services, including ante- and post-natal care, family planning, and specialized treatment, complemented by nutrition demonstrations and community-based health awareness initiatives. With generalized acceptance among the target communities, Friendship's 3-tier health care model has made primary health care accessible and affordable. Upon implementing a robust referral mechanism and continuing collaboration with the Government of Bangladesh, this model has the potential to be effective in similar settings in Bangladesh and other developing countries, as well as during emergency responses.