Reality Check, 2009 on Primary Health Care
Declining quality of public health services is leading to increased use of private healthcare services
20 May 2010. DHAKA: Shasthya Andolon, a network of researchers, physicians, and health and environmental activists organised a "Dissemination & Discussion Session" on sharing of findings of the study Reality Check Bangladesh 2009: Listening to Poor People's Realities about Primary Healthcare. Shasthaya has organised this event on behalf of Sida (Swedish International Development Agency) as their commitment to engage with the policy makers and development partners to create an enabling policy environment for positive directions in national healt policy, strategy and health financing issues. The event took place on 20 May, 2010 at CIRDAP Auditorium, Dhaka.
A form of ‘listening study’, the research documents annually people’s experiences and perceptions of changing health and education services, based on short intensive home stays with 27 households for four days and nights in nine locations including urban slums, peri-urban villages and rural villages in three northern, central and southern districts.
Special Guest Dr. Makhduma Nargis speaking on the occassion
Prof. (Dr.) M. S. Akbar, Chairman, Honorable Member of Parliament and Chairman, Bangladesh Red Crescent Society was the Chief Guest, and Mr. Samuel Egero Country Director, Swedish International Development Cooperation Agency, (Sida) and Dr. Makhduma Nargis, Additional Secretary and Project Director, Community Clinic Project, Government of Peoples Republic of Bangladesh were the Special Guests of the Dissemination & Discussion Session. Farida Akhter, Co-Convenor of Shasthya Andolon and Executive Director of UBINIG (Policy Research for Development Alternative) chaired the session.
The team leader of the northern district Enamul Huda and a member of southern team Nurjahan Begum presented the findings, which included,
1. People actively seek to optimise access to health services from the variety of formal and informal, governmental and non-governmental providers available – but with only very limited information.
2. Quality and use of public health services continue to decline (in terms of staff, equipment and additional costs imposed by gatekeepers), with increasing use of private health providers such as diagnostic centres.
3. The informants prefer private diagnostic centres or private facilities to public providers, despite the higher prices that they may charge.
4. People who feel failed by formal service providers tend to go to traditional providers (such as healers and homeopaths), where service is cheap but quality may be variable. Some formal providers unhelpfully undermine the reputation of useful informal providers such as traditional birth attendants.
5. New, effective individual leadership is the main factor contributing to examples of positive change in public health facilities, where these have taken place.
6. Most people still feel unable to make complaints about poor public services, and view most health professionals as remote and non-responsive.
7. The Community Clinic system (recently revived by the new government) does not yet function well, and is mainly used by people only as an occasional collection point for free drugs.
8. Increased cell-phone use can improve access to information and assist referrals, but new health helplines are perceived as too costly and remain underused.
The study recommended that awareness must be raised among people to demand for better services, and key public health issues, including excessive salt intake, public spitting and first-aid awareness, should be increased using simple messages.
The Special Guest Dr. Makhduma Nargis talked about the Community Clinics as a very special programme of the government. About 13,500 healthcare providers will be recruited who will work for 6 days a week. So far 10,000 Community clinics have started functioning from 9:00 to 3 pm. She emphasised on the need for integration of health and family planning services.
In his speech as Chief Guest, Dr. M. S Akbar emphasised on the role of traditional midwives (known as Dai) and critised the donor dependence for programme such as Specialised Birth Attendents (SBA) which resulted in a failure as they did not represent the truely service providers for maternal health.
The speakers in the Open forum raised many important issues related to prevention aspects of healthcare as part of community clinics, and use of Unani, Ayurvedi and traditional medicines.