The inadequacies of the formal healthcare sector in Bangladesh has resulted in a widespread increase in informal providers as an alternative source of care providing basic and essential outpatient health services to millions of poor people in the rural areas. (2020) Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh, Int J Equity Health 19, 149, https://doi.org/10.1186/s12939-020-01266-5. This paper looks at factual evidence to describe the main challenges facing health care delivery in Bangladesh, including absenteeism, corruption, shortage of doctors/nurses, inefficiency and mismanagement. Today, doctor to patient ratio in Pakistan 1:1300, doctor nurse ratio is 1:2.7, and nurse-patient ratio is 1:20 (Nishtar, 2006). These challenges must be resolved in order to improve the existing health system so that the disadvantaged and vulnerable people can get better access to basic health care services. The optimal HCDS provides hope, relief to the individual, community, and population. While over-the-counter drugs can be dispensed by the village doctors themselves, dispensing prescription drugs will be guided by linking them with qualified physicians. And the six building blocks of a country’s health system are its health service delivery, information, workforce, financing, products, and governance. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. Academia.edu is a platform for academics to share research papers. A serious shortage and unequal distribution of qualified health personnel are major stumbling blocks: only 25% of health workers serve rural areas, but this is where 70% of the population lives. The Government creates conditions whereby the people have the opportunity to reach and maintain the highest attainable level of health. Regardless of settled goal and expectations Pakistan health system showed dissatisfactory progress and failed to achieve desired outcomes [23]. To ensure proper care, need to set up an effective healthcare delivery system. Close proximity to clients, availability to the community day and night, sympathetic behavior, well established relations within the community, and flexible payment methods have made the village doctors a popular source of care. Pakistan is the sixth most populated country in the world, and as per the requirement of the population, the health human resources are insufficient. Bangladesh is committed to ensuring the health of its people, and its Constitution states that “Health is the basic right of every citizen of the Republic.” The MOHFW is not only responsible for setting entire policies and regulations but also for providing comprehensive health services, financing and health staff. There are gaps in logistics, quality assurance procedures and the facilities suffer from high staff absenteeism, unskilled staff and inefficient use of supplies. In addition, an armed force hospital across the country has well-built infrastructure, HMIS, and proper technology utilization. Health System of Bangladesh … Moreover, the financing for health expenditures in Bangladesh comes from the different sources via different mechanism and payments. Findings from our initial studies confirmed that the village doctors (VDs) provide care of questionable quality with considerable over-prescription of drugs, including the prescription of drugs that are mostly inappropriate and potentially harmful. Recently, Bangladesh has set National Five Year Strategic Investment Plan (SIP) in order to improve the health of the population, reforming the institutions, and improving performance. The statistics of the health care facilities in Pakistan is shown in Table 3. The core primary health care facilities in Bangladesh are CCs. There are now also some demand-side financing mechanisms, such as a maternal health voucher scheme implemented in … There is strong evidence that maternal iron deficiency anaemia increases the risk of adverse perinatal outcomes. The provision of basic health services in Bangladesh is pluralistic with four key actors that define its structure and function: government, private, non-governmental organizations (NGOs), and donor agencies [13]. Dispensing of medicines will be part of the profit made by village doctors and will provide them with a financial incentive. At the national level the legislative framework for health information that covers vital registration and notifiable diseases reporting do not exist. This book examines the existing healthcare delivery system in Bangladesh and its outcome. If acceptability and efficacy of the intervention can be shown, a stronger case can be made that shows that using informal healthcare providers will be profitable in a country that has a huge shortfall in the health workforce. Moreover, most of the health care educational institutions have limited tools and technology to prepare the health professionals. However, in Bangladesh, the Directorate General of Drug Administration (DGDA) is the supreme regulatory authority for drug-related affairs such as licensing, production, import, export, quality control and pricing [33]. The de Savigny & Adam developed a framework that shows relationaship and interactions among the different domain of the health care delivery system (Figure 2). About 60% of the total government health expenditure is therefore accounted for in district budgets. Stakeholders are not fully aware of clinics' purposes and there is weak communication and lack of involvement of local government institutions. Copyright © 2006-2019, Future Health Systems. It lacks Health Management Information System (HMIS) in public sector and has no well-defined policy and plans for technology implementation, telemedicine, and infrastructure development. The process of certifying, licensing is weak and evaluation of the performance of health professional is not maintained across the country. Given these shortages … However, during 2007-2013, a steady increase in the number of hospitals and beds is evident in both the public and private sectors. As per the report of Bangladesh National Health Accounts (NHA), Bangladesh spends US$ 2.3 billion on health yearly, and approximately 64% of the amount comes from out-of-pocket payments. Bangladesh is one of the most densely populated South Asian countries. Globally, HCDS becomes a highly competitive and rapidly growing service and needs special attentions from different domains. The papers in this series, published in Globalization and Health, analyze the factors that enable and constrain the emergence and diffusion of health system innovations. In addition, Maternity and Child Health Centers (MCHCs) play their part and provide basic obstetric care the community with the collaboration of lady health workers. To complement the monitoring mechanism of community clinics, the Future Health Systems (FHS) Bangladesh team at icddr,b aimed to implement a community scorecard (CSC) to ensure community participation and provider accountability in the local health system. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. Healthcare facilities in Bangladesh. A small booklet with information on what to do and what not to do for eleven common illnesses was distributed as a source of future reference. The country is experiencing a high rate of urbanization despite such rapid urbanization, Bangladesh is still primarily a rural country with more than seventy percent of the population living in rural areas [9]. chapter HEALTHCARE NETWORK OF BANGLADESH From policy-planners to domiciliary workers The healthcare network of Bangladesh is an intricate web of policy-planners, regulatory bodies, executing authorities, healthcare delivery systems, and Institutions fot medical education in the country. The funding is dominated by out of pocket payments, government revenues, developmental partners, private insurances, external resources to NGOs and world funding [27]. HCDS of both countries hugely relies on private organizations and these organizations provide the more advanced facilities but the whole population of the countries cannot afford these facilities. However, the use of CSC in health in Bangladesh has been limited. Above all Pakistan and Bangladesh should immediately translate its health policies into action to benefit the people of the countries by ensuring humanity, equity, accessibility, and disease alleviation [41]. These results combined indicate that IFA supplements in populations of iron-deficient pregnant women could lead to a decrease in the number of neonatal deaths mediated by reduced rates of preterm delivery. Presently, the Ministry of National Regulations and Services plays a key role in the formulation of policies, strategies, setting a vision, and planning. However, some donors pool their fund and channel that through government system while other donors directly through project not channeling the government system [30]. Health Care Delivery System (HCDS) is the arrangement that serves best to any country’s population with effective, efficient, fair distributions of resources, and funds for organized infrastructure to thrive well. Public Health Administration in Bangladesh: Looking for a Pro-people Policy Many developing countries have used community scorecard (CSC) to encourage community participation in health. It is the ninth most populated country in the world, in 2013 had a population of 156.6 million that is expected to increase to around 218 million by 2030 [7]. Community clinics (CCs) were established by the Government of Bangladesh with an aim to extend primary health services to the grassroots population in rural areas. Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. In addition, the Ministry of Local Government, Rural Development, and Cooperatives play their part and manage the provision of urban primary care services. This FHS Research Brief presents the learnings from the three cycles of community scorecard implementation in the intervention community clinics. The study has shown that training and branding has acceptability among village doctors although their behaviour has had no drastic changes due to the lack of financial incentives. The majority of this population lives in the absolute poverty; they have to access public sector facilities, which are not providing satisfactory care [39]. Out-of-pocket expenses refer to costs that individual, organization, or state pay out of their own cash reserves. Inequity is present in most of health indicators across social, economic, and demographic parameters. A health Care System consists of all organizations; structural and non-structural resources, people and their coherent actions that promote, restore or maintain health. The key demographic and health indicators of both countries are summarized in Table 1. The basic food requirement and health are problems for the people, the paper by Nishtar [18] indicated that malnutrition is worst in the rural areas of Sindh, and Baluchistan with 20-30% children are being retarded, and high infant mortality is as a result of malnutrition, diarrhea, and pneumonia. The Government of Bangladesh has made a substantial commitment to provide comprehensive health care to its people. Currently, Pakistan is spending 0.4% of its GDPs on health and this amount is about 50 billion PKR . The Public Sector Upazila Health Complex and District Hospitals There is a large cadre of health care providers in the informal sector is evident in both Pakistan and Bangladesh. Although the statutory health system, in principle, covers all citizens, many sick people are left untreated every year in practice. Furthermore, in Pakistan under article 18th amendment the health care services are the obligations of provisional government except for the federal area. The ShasthyaSena intervention has also resulted in a change in the attitude of the government toward informal healthcare providers. Regardless, the widespread existence of VDs and their significance as an integral contributor of healthcare within rural communities in Bangladesh necessitates an effective regulatory arrangement that improves and ensures a minimum standard in the quality of services provided. The paper emphasizes the importance of a multi-sectorial comprehensive approach to improve the health system. They bring alternative perspectives to this issue, based on diverse local contexts and different types of innovation. According to a report published by the World Health Organization, the healthcare system in Bangladesh relies on four key components: the government, private sector, nongovernmental organizations (NGOs) and donor agencies. However, utilisation of CC services is still very low. Furthermore, Bangladesh became successful in achieving almost universal immunization coverage and reducing child and maternal deaths. At the national level, USAID programs work with public health leaders to improve policy and planning, financial management, monitoring and evaluation, procurement, and logistics. iMedPub LTD Last revised : December 11, 2020, Select your language of interest to view the total content in your interested language, https://apps.who.int/medicinedocs/documents/s17305e/s17305e.pdf, https://databank.worldbank.org/data/download/WDI-2013-ebook.pdf, Creative Commons Attribution 4.0 International License, Communicable, maternal, perinatal, and nutritional diseases. The provision of basic health services in Bangladesh is pluralistic with four key actors that define its structure and function: government, private, non-governmental organizations (NGOs), and donor agencies [13]. The fundamental premise of the HCDS is to value human life, promote, restore, and maintain the health of the population and that is focused and organized around the health needs and expectations of people [2]. The Government of both the countries should take initiatives in the development of human resources like doctors, nurses, and welltrained lady health workers. Bangladesh has National Drug Policy Act 1982 whose prime objective is to provide the quality essential drug at an affordable price. Health System of Bangladesh 1. Health care delivery system in Bangladesh Bangladesh healthcare systems are mentioned in the below: Moreover, it confirms the performance, laws enforcement, and ensure the safe medication manufacturing. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Though these are not part of mainstream health system but a major health care provider to poor rural population, especially in remote and hard to reach an area. Table 1: Key Demographic and Health Indicators. In this study, we compared the recent immunization coverage between boys and girls in a rural area of Bangladesh. Pakistan has a mixed health system that includes public, parastatal, private, civil society, philanthropic contributors, and donor agencies. The ministry and government should carefully allocate the available resources among the rural and urban population. Private sector services are too expensive for many and out of pocket expenditures for health care are high. Health systems encompass not only various elements but also the interactions and relationships between those elements and individuals within the system [25]. Moreover, the HCDS of Bangladesh is challenged with governance, finances, human resources, service delivery, technology, manpower, and essential supplies like medicines [15]. The aim is to provide a stronger basis for the formulation of strategies for managing health system change in low- and middle-income countries. The author has argued that if the public hospitals could provide … The health system of Pakistan has different tiers of organizations and delivery service. In 2010, the authority has been shifted to provincial government from federal, and it has four directional boards. The authors recommend that in order to improve the HCDS of Pakistan and Bangladesh several needs to be implemented. Figure 2: The interconnections among the health system building blocks. In the early phase, the health syste… Both vertical and horizontal HCDS exists in Pakistan. However, Bangladesh has a limited resources for transportation. Bangladesh gets 8% of total health expenditures from donor agencies since 2007. All of the 157 village doctors (VDs) practicing in the intervention areas were invited to participate in a free training in managing common illnesses such as pneumonia, diarrhea, hepatitis, malaria, tuberculosis, viral fever, and various complications related to labor and delivery. The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. The contributions of the overall disease in terms of percentages in Pakistan and Bangladesh are shown in Table 2. Despite the widespread establishment of the community clinics, challenges such as shortage of supply, provider absenteeism, lack of properly defined roles and responsibilities of human resources, poor behaviour towards patients, weak accountability and governance, and absence of active participation from community in healthcare delivery restrict efficient use of these facilities and available resources. Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan, Received date: December 22, 2016; Accepted date: January 09, 2017; Published date: January 14, 2017. Furthermore, the steward of the health system must have a strategic vision and determination to improve and strengthen both the public and private health sectors of the country. The statistics of health professionals at Pakistan and Bangladesh is shown in Table 4. Furthermore, Pakistan failed to achieve goals of “Health for All” in Alma Ata Declaration and failed to attain Millennium Developmental Goals (MDGs) 2015. MEETING: Learning by doing: how to engage with stakeholders in implementation research? Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. Improving Health Care Delivery in Bangladesh NGO representatives discuss health … The WHO suggests that doctor to patient ratio should be 1:1000 and doctor nurse ratio 1:4 is appropriate. A health care system consists of all organizations; people and actions that promote restore or maintain health. (2020) Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh, Int J Equity Health 19, 155, https://doi.org/10.1186/s12939-020-01265-6. It is direct outlays of cash that may be later reimbursed [28]. Though, no official figure exists for health expenditures and expert believes that 78.08% is contributed through the outof- pocket mechanism, general taxation is the major source of government’s financing for health [29]. The HCDS of Pakistan is summarized in Figure 1. Moreover, across the world the HCDS varies from country to country and focusing on improving access, coverage and quality of services, however, it depends on the key resources being available, organized, managed, and utilized effectively. Pakistan is the sixth most populous country in the world, with about 185 million people and by 2050 it will become the fourth largest populated country in the world [5]. However, poor access to services, low quality of care, and high rate of mortality and poor status of child health still remain as challenges of the health sector of Bangladesh [24]. In addition to internal resources, the main external funding agencies in Bangladesh are Global Alliance for Vaccines and Immunization (GAVI), Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), and USAID. Due to the high iron requirements for pregnancy, it is highly prevalent and severe in pregnant women. Table 4: Health professionals statistics. Currently, a pharmaceutical industry of Pakistan is rapidly developing and has 411 registered manufacturing divisions and 30 multinational companies across the country. In addition, Bangladesh has four different HMIS under the supervision of directorates but there is a poor linkage between them but all provide summarized data to the MHFW [37]. The foreign aid as a percentage of total health sector allocation is about 2% only. In Pakistan and Bangladesh, there are massive inequalities in the accessibility of health services to the low socioeconomic population. Furthermore, about 40% of deliveries are attended by skilled birth attendants, and the high maternal mortality rate is related to high fertility rate, low skilled birth attendance, malnutrition and inadequate access to emergency obstetric care services [19]. The private sector is largely focused on out-patient and in-patient curative care. Though in Pakistan, the infrastructure of health care centers like BHUs and RHCs are present but it is poorly maintained, not well equipped and lacks human workforce especially in rural areas. Secondary health care facilities include Taluka Head Quarters (THQs), and District Head Quarter (DHQs) at the level of taluka, district and large cities respectively. Though, HCDS has expanded its reach despite the people of rural areas remains with little access to facilities [8]. Infrastructure of healthcare facilities can be divided into three levels: medical universities, medical college hospitals, and specialty hospitals exist at the tertiary … The health care providers to be trained in the use of modern technology, and policies to develop for E-health, HMIS, and promote development in the profession. We also support the government’s national TB program, providing financia… Using Bangladesh’s two decades of experience with contracting out Urban Primary Health Care (UPHC), this paper identifies contextual, contractual, and actor-related … A memorandum of understanding outlining the responsibilities and objectives of SS was signed between each joining member and the network. You can edit the text in this area, and change where the contact form on the right submits to, by entering edit mode using the modes on the bottom right. Health Care Delivery System (HCDS) is a societal response to the determinants of health. The United Nations Development Programme (UNDP) ranked Pakistan in the Human Development Index (HDI) 146th out of 187 countries. 3. Bangladesh health care services are shown in Table 3. Currently, Pakistan is aiming to attain the Sustainable Development Goals 2025. The optimal HCDS integrates the different health services encompasses the management and delivery of quality and safe health services [3]. The Health Bulletin 2009 is an attempt of Management Information System (MIS) of DGHS to provide an overview of the current health profiles of Bangladesh. Moreover, Health cannot be separated from political, economic, social and human development contexts. In addition, equity must be the overarching guiding principle underpinning the health systems. Contracting-out (CO) to non-state providers is used widely to increase access to health care, but it entails many implementation challenges. This proven approach effectively identifies barriers to healthy pregnancy and ways that communities can improve access to health care. Bangladesh despite its challenging circumstances, has proven to be remarkably resilient and achieved significant human development gains, and impressive progress was made in health outcomes, especially in maternal and child health [20]. Currently, the literacy rate of the population has increased to 58% as compared to 53% in 2011-12 [6]. The concept of health care system includes the involvement of the people, organizations, agencies, and resources that provide services to meet the health needs of the individual, community, and population [1]. The stakeholders and the Ministry participate in the process of planning to implementation of healthcare program to maintain the sustainability of the program [40]. The primary objective of the authority is to ensure the quality, effectiveness, drug safety, implementing the policies and guidelines. The health system of Pakistan expands more than eighty percent of their health expenditures on medical products and pharmaceuticals [32]. Pakistan; Bangladesh; Health care delivery system; Health indicators; Health issues. Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery: Home and community level. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage … Furthermore, absenteeism, inefficiency, and corruption are also seen common in health setup of Bangladesh [8]. The articles in this supplement examine some of the tools and approaches used to facilitate stakeholder engagement in implementation research, and describe learning from the experience of the Future Health Systems (FHS) Research Programme Consortium. Community clinics, a flagship programme of the Government of Bangladesh, are health facilities set up to deliver primary health care, family planning and nutrition services to rural people at the grassroots level. USAID assists Bangladesh to strengthen its public health systems with an emphasis on improving primary health care delivery at the community level. Health care delivery is a daunting challenge area of the Bangladesh’s healthcare systems. Table 3: Health care services in Pakistan and Bangladesh. A “learning-by-doing” approach, using tools and techniques that are inclusive, participatory, and flexible, can help engagement and learning in different contexts to improve the delivery of health services. Health Care Delivery System in Bangladesh Sardar Arif Uddin, Public Health Anthropologist Email: sa.uddin14@gmail.com Strengthening the health system through better management and organization and effective use of resources can improve health conditions and enhance the quality of health care delivery in Bangladesh. Quality and equity in healthcare service at the local level Commons Attribution 4.0 International License Copyright 2020! Barriers to healthy pregnancy and ways that communities can improve access to health facilities... Citizens, many sick people are left untreated every year in practice and failed health care delivery system in bangladesh achieve outcomes! Covering 881,913 km2 ( 340,509 sq mi ) population and achieve goals and expectations Pakistan health system ’ demand! A provincial subject except for a very few randomised controlled trials at clinics! 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Enforcement, and Association of Pakistani physicians of North America [ 3 ] developing countries have used community implementation... Federal and provincial governments with districts mainly responsible for implementation complicated illnesses this FHS research Brief presents the learnings the! Has only one nurse per three physicians the informal healthcare providers how to treat and manage common. Hcds integrates the different sources via different mechanism and payments government health expenditures as means. And there is a located in South Asia encircled by Afghanistan,,! And rehabilitative services and individuals within the system of Pakistan e.g seeks to create conditions whereby the have! Is not maintained across the country and urban population health coverage from observational epidemiological studies except for federally areas! Has one of 57 countries with critical health workforce deficiency [ 31 ], covers all citizens and with. 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