What did the public think of health services reform in Bangladesh? Three national community-based surveys 1999–2003

Abstract

BackgroundSupported by development partners, the Government of Bangladesh carried out a comprehensive reform of health services in Bangladesh between 1998 and 2003, intended to make services more responsive to public needs: the Health and Population Sector Programme (HPSP). They commissioned a series of surveys of the public, as part of evaluation of the HPSP. This article uses the survey findings to examine the changes in public opinions, use and experience of health services in the period of the HPSP.MethodsWe carried out three household surveys (1999, 2000 and 2003) of a stratified random sample of 217 rural sites and 30 urban sites. Each site comprised 100–120 contiguous households. Each survey included interviews with 25,000 household respondents and managers of health facilities serving the sites, and gender-stratified focus groups in each site. We measured: household ratings of government health services; reported use of services in the preceding month; unmet need for health care; user reports of waiting times, payments, explanations of condition, availability of prescribed medicines, and satisfaction with service providers.ResultsPublic rating of government health services as "good" fell from 37% to 10% and the proportion using government treatment services fell from 13% to 10%. Unmet need increased from 3% to 9% of households. The proportion of visits to government facilities fell from 17% to 13%, while the proportion to unqualified practitioners rose from 52% to 60%. Satisfaction with service providers' behaviour dropped from 66% to 56%. Users were more satisfied when waiting time was shorter, prescribed medicines were available, and they received explanations of their condition.ConclusionServices have retracted despite increased investment and the public now prefer unqualified practitioners over government services. Public opinion of government health services has deteriorated and the reforms have not specifically helped the poorest people. User satisfaction could be increased if government doctors improved their interaction with patients and if waiting times were reduced by better management of facilities.

Challenges of Satisfaction of Key Stakeholders of the District Health System of Bangladesh and Ways to Improve: A Qualitative Study

“…Note: FGD: Focus Group Discussion results of our previous quantitative studies and are also consistent with other studies [1,8]. With the exception of corruption, intersector authoritative gaps and moral issues, no notable new issues emerged; however, the insights in this regard were deepened.…”

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Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: Implications for the HRH problem

“…Recent studies on health-seeking behaviour of the poor and disadvantaged populations (such as the ultra-poor consuming <1805 kcal per capita per day, ethnic minorities, elderly, women) in rural Bangladesh revealed that the unqualified practitioners are the major providers of health care for these populations [8,[14][15][16]. This varies from 40 to 60% in different Table 1 Socio-economic and demographic characteristics of the unqualified/semi-qualified health care providers (%) studies.…”

Balancing satisfaction, balancing health

“…Cockcroft et al, 2007;Cockcroft et al, 2011). With the exception of corruption, inter-sector authoritative gaps and moral issues, no notable new issues emerged; however, the insights in this regard were deepened.…”