scispace - formally typeset
Search or ask a question
Journal ArticleDOI

People’s Participation in Health Services: A Study of Bangladesh’s Rural Health Complex

TL;DR: The paper shows that the Government's allocation and technical support (medical equipments) are not sufficient in the rural health complex and that the people’s participation is far from being satisfactory, and concludes with a variety of recommendations.
Abstract: Health is a basic requirement to improve the quality of life. A national economic and social development depends on the state of health. A large number of Bangladesh’s people, particularly in rural areas, remained with no or little access to health care facilities. The lack of participation in health service is a problem that has many dimensions and complexities. Education has a significant effect on participation in health services and administrative factors could play a significant role in increasing the people’s participation in Bangladesh’s health sector. But the present health policy is not people oriented. It mainly emphasizes the construction of Thana Health Complexes (THCs) and Union Health and Family Welfare Centers (UHFWCs) without giving much attention to their utilization and delivery services. The study reveals that financial and technical support is very helpful to ensure health service among village people. However, the Government allocates only 5 percent of the budget to the health sector, while it allocates 13 percent for defense. The paper shows that the Government’s allocation and technical support (medical equipments) are not sufficient in the rural health complex and that the people’s participation is far from being satisfactory. The paper concludes with a variety of recommendations.

Summary (5 min read)

Rights and Permissions

  • Text and graphics may be reproduced in whole or in part and in any form for educational or non-profit purposes, provided that credit is given to the source.
  • The Bangladesh Development Research Center (BDRC) disseminates the findings of work in progress to encourage the exchange of ideas about development issues in Bangladesh.
  • The papers are signed by the author(s) and should be cited and referred accordingly.
  • The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s).

II. Background and Methodology

  • According to the Alma-Ata conference in 1978, people’s participation was described not as an optional extra but as an essential component of primary health care (PHC).
  • Excluding a few initiatives of non-governmental organizations (NGOs) that were adopted shortly after independence, there is little experience with people’s participation in Bangladesh’s health sector.
  • Participation as a Process of Empowering: Whereby a group of people who previously had no basis from which to intervene in or influence rural health service activities, achieve this basis and use it for their continued involvement in these activities.
  • This literature has attributed the success or failure of participatory mechanisms either to the degree of civil society involvement or to the level of commitment to such mechanisms on the part of the political authorities.
  • The study shows that there were problems of people’s participation, hygienic practices as well as effective use and maintenance of hand pumps and latrines.

II.1. Significance of the Study

  • There is no research work regarding the development of health service through people’s participation in Bangladesh.
  • The present study makes a preliminary effort at understanding the people’s participation of health service in Bangladesh.
  • It explores people’s participation in health services by focusing especially on the rural health complex and asks the following five questions:.

II.2. Research Problem

  • Health service is one of the fundamental rights of the people.
  • Too many corrupt doctors do not serve the common people well, take bribes, and do not maintain office time at the public health centers.
  • Common people most often do not complain about this simply because they lack awareness about their rights.
  • From various observations it has become clear that the Government is not able to provide service as well as people’s participation in the public health service of Bangladesh even at the basic level.
  • Hence, the dependent variable of this study is the people’s participation in health services which is determined by sanitation facilities, arsenic free water, medical services and precautionary system.

III. Public Health Service Delivery Pattern and Mechanisms in Bangladesh

  • The history of health services in Bangladesh can be traced back to the early 17th century when the East India Company came to rule over the Indian sub-continent and governed it as a police state from England (Rashid and Hyder, 1995).
  • Subsequently, some facilities were extended to small towns in the form of hospitals with few beds.
  • Bangladesh was the eastern zone of Pakistan and emerged as an independent nation in 1971.
  • Subsequently, when the World Health Organization (WHO) called upon the member countries to formulate individual national strategies and a plan of action for attaining Health For All (HFA) by the year 2000, Bangladesh responded by preparing a country paper in 1980.
  • Different levels of health institutions, hospitals, health centers provide different public health care services to the beneficiaries.

III.1. Central or National Level

  • The supervisory structure of Bangladesh’s health services begins with the Ministry of Health and Family Welfare , headed by a Minister.
  • Two directorates, the Directorate General of Health Services (DGHS) and the Directorate General of Family Planning (DGFP) operate under the ministry.
  • The ministry is responsible for policy formulation and decision making, whereas the directorates have the responsibility for planning and implementation of programs and projects.
  • Besides the MOHFW, the Planning Section in the Planning Commission under the Ministry of Planning acts as a technical body with regard to the development plan of the health sector.
  • There also is a Mother and Child Health (MCH) committee, which takes decisions related to the promotion of mother and child health services throughout the country.

III.2. Regional/ Division Level

  • Within Bangladesh’s six divisions , there are fourteen medical college hospitals which provide tertiary health care across the nation.
  • A wider range of specialists and better laboratory facilities are available here for the treatment of difficult and complicated cases.
  • Government medical college hospitals have also been working as referral institutions for the districts.
  • These are all teaching hospitals, which have bed capacities varying from 250-1050, of which a maximum number of beds are free.
  • The divisional health authority is the functional unit at the divisional level headed by a divisional health director.

III.3. District (Zila) Level

  • Secondary health care facilities are available at the districts level hospitals.
  • At present there are 36 hospitals with bed capacity of 50 each, 21 hospitals have 100 beds each, two have 150 each and one hospital in Narayanganj has 200 bed capacities.
  • All hospitals deal with referred cases of the thanas for further improved treatment.
  • At the district level, the Civil Surgeon (CS) acts as the district health manager, who also functions as the superintendent of the district hospital.
  • At the district level there are several committees which take care of different development and management issues concerning health service.

III.4. Thana/Upazila Level

  • Bangladesh has currently 482 upazilas and 599 administrative thanas.
  • The Thana Health Complex (THC) is a union of Health and Family Welfare Centres , each covering a population of about 20,000.
  • UHCs also act as referral for Union sub-centers (USC) and Union Health and Family Welfare Center .
  • Health volunteer and trained traditional birth attendants assist domiciliary workers (see Hashem (2006), p. 81).
  • The UHFPO coordinates with these committees and takes care of all activities regarding health and family planning services of the thana/upazila.

III.5. Union Level

  • At this level health care services are delivery through both USC and UHFWC.
  • About fifteen health and family planning personnel are managing the static health care facility and are rendering domiciliary services at the union level (see Hashem (2006), p. 79).
  • A USC is managed by one medical officer, one medical assistant, one pharmacist and other support staff while FWC is managed by one medical assistant, one family welfare visitor, one pharmacist and other support staff.
  • From time to time, this health services are delivered (say once a month).

IV. Health Problems and Health Care Needs in Bangladesh

  • In Bangladesh communicable diseases are responsible for high mortality and constitute major health concerns.
  • Malnutrition and infections are very common among children, pregnant and lactating mothers also usually suffer from various forms of malnutrition and vitamin/iron deficiency.
  • Among the non-communicable diseases, diabetes, paralysis, blood pressure, heart diseases, respiratory and gastrointestinal disease account for increasing proportions of death tolls.
  • Even in the face of general sub-nutritional level of the majority of the population, mortality and morbidity rates in Bangladesh are declining.
  • There has now been full eradication of small pox, while communicable diseases like tuberculosis, malaria, diarrhea and cholera are now being controlled in increasing proportions.

IV.1. Public Consciousness about Government Health Facilities

  • From above the study, it is observed that the health facility is not sufficient, even though there are more free beds available than paying beds.
  • As for example, people are sometime unaware about the schedule time of the satellite clinics.
  • That is why, dropout cases of EPI are usually happening.
  • The main reason for such problem is improper campaign and irregularity in the organization of these clinics.
  • Family Welfare Assistant (FWA) and Health Assistant (HA) mainly work to motivate people.

IV.2. Financial Allocation in Health Care

  • Public health services programs and the operation maintenance of health facilities, etc. are financed through the budget every year.
  • It is observed that in every fiscal year, allocation for health sector has gradually increased.
  • The total allocation for health and family planning in 1987/88 represents approximately 1.2 percent of Gross National Product (GNP) or 5.6 percent of the total public expenditure allocation that year.
  • The total cost of health care spent by the government, donor agencies, NGOs and individuals thus amount to nearly tk. 2750 crore.

IV.3. Government Strategies Regarding General Health Services

  • The man objectives of the government health service are eradication of communicable and non-communicable diseases through both curative and preventive interventions.
  • In this perspective the Government devised some strategies aiming at providing health for all citizens.
  • One of the strategies is the Primary Health Care (PHC) approach which includes the following major applications: 5.
  • To ensure effective implementation of its policy, the Government adopted the policy of posting medical graduates in rural areas for at least two years in order to ensure the availability of an adequate number of doctors in rural health centers.
  • The Government also adopted the Private Clinics and Laboratory Ordinance in 1982 to regulate and improve the quality of private facilities and services.

IV.4. Government Strategy Regarding Arsenic Mitigation

  • To mitigate Bangladesh’s serious arsenic water problem, the Government has initiated various actions through the Department of Public Health Engineering (DPHE), local administration, union and ward committees of local government.
  • The Government emphasizes public participation on this issue.
  • It has conducted different surveys with the collaboration of different international organizations.
  • An action research project has been undertaken through joint collaboration of the Government and the United Nations Children’s Fund in five upazilas, where 744 arsenicosis patients have been identified.
  • Under this survey project, 13,733 safe drinking water sources have been set up.

IV.5. Social Mobilization for Sanitation

  • In Bangladesh, people are habitual of open defecation.
  • Open defecation and improper sanitation system pollutes water of rivers and ponds, etc.
  • Build alliance with different partners and allies like local administration, elected representatives, schools, religious leaders, local elites, NGOs, etc. to initiate social mobilization activities and campaigns to promote hygiene, sanitation and safe water use.
  • In 1988, the “Integrated Water and Sanitation Programme through NGOs” was conducted by an NGO forum.
  • The project was funded by Germany’s MISEREOR.

IV.6. Family Planning Program

  • The majority population of Bangladesh resides in rural areas, but the share of the population in urban areas is gradually increasing.
  • The Government has taken serious precautions to reduce population growth by promoting family planning services.
  • The Government has declared awards for those who adopt permanent method of family planning (see Hashem, 2006).
  • Ignorance, fanaticism, lack of skilled health provider, lack of trained staff, lack of motivational efforts, lack of access to information and services at grass root levels etc. posed hurdles to government efforts to achieve full success.

V. People’s Participation in Health Services: Results of Field Data

  • This section presents an analysis based on the opinion and comments collected through interviews, structured questionnaires and observation.
  • The analysis is based on both qualitative and quantitative data, and used primary as well as secondary sources.
  • The present study shows that the existing government infrastructure is not used properly due to the irresponsible mentality of the government staff, lack of accountability, mismanagement, malpractice of doctors and the lack of coordination of the health service providers.
  • Until now, the Government budget allocation for the health sector did not get proper attention.
  • The study reveals that the participation status of the people is very significant for the health characteristics, viz., facing physical problem, proper sanitation, frequency of doctor visits, and distance to hospital.

VI. Conclusion and Recommendations

  • Health service is most important factor for human well being.
  • These initiatives have not been achieved in Bangladesh till now.
  • Now-a-days, the 16 Government tries to create awareness among the village people as stipulated in the constitution.
  • The Government needs to make sure that the donors’ view does not negatively influence its policy making and implementation in the health sector.
  • Regular monitoring and supervision should be adopted in government health sector for ensuring participation of people in rural health complex.

Did you find this useful? Give us your feedback

Content maybe subject to copyright    Report

Bangladesh Development Research Working Paper Series
(BDRWPS)
BDRWPS 7 (June 2009)
People’s Participation in Health Services:
A Study of Bangladesh’s Rural Health
Complex
Mohammad Shafiqul Islam
Shahjalal University of Science & Technology (SUST)
and
Mohammad Woli Ullah
Shahjalal University of Science & Technology (SUST)
Bangladesh Development Research Center (BDRC)

ii
The views and interpretations in this paper are those of the
author(s) and do not necessarily represent those of the
Bangladesh Development Research Center (BDRC).
Copyright © 2009
Bangladesh Development Research Center (BDRC) for the overall
Working Paper Series. The copyright of the content of the paper remains
with the author(s) and/or the institution(s) submitting the content.
Bangladesh Development Research Center
(BDRC)
2508 Fowler Street
Falls Church, VA 22046-2012, U.S.A.
Tel. +1 703 532 4893
E-Mail: contact@bangladeshstudies.org
http://www.bangladeshstudies.org
Rights and Permissions
All rights reserved.
Text and graphics may be reproduced in whole or in part and in any form for educational
or non-profit purposes, provided that credit is given to the source. Reproductions for
commercial purposes are forbidden.
The Bangladesh Development Research Center (BDRC) disseminates the findings of work in
progress to encourage the exchange of ideas about development issues in Bangladesh. Our
main objective is to disseminate findings and ideas quickly, so we compromise to some degree
on quality. The papers are signed by the author(s) and should be cited and referred accordingly.
The findings, interpretations, and conclusions expressed in this paper are entirely those of the
author(s). They do not necessarily represent the view of the BDRC.
Working Papers are available online at http://www.bangladeshstudies.org/wps/

iii
People’s Participation in Health Services:
A Study of Bangladesh’s Rural Health Complex
Mohammad Shafiqul Islam and Mohammad Woli Ullah
*
Abstract
Health is a basic requirement to improve the quality of life. A national economic and
social development depends on the state of health. A large number of Bangladesh’s
people, particularly in rural areas, remained with no or little access to health care
facilities. The lack of participation in health service is a problem that has many
dimensions and complexities. Education has a significant effect on participation in health
services and administrative factors could play a significant role in increasing the people’s
participation in Bangladesh’s health sector. But the present health policy is not people
oriented. It mainly emphasizes the construction of Thana Health Complexes (THCs) and
Union Health and Family Welfare Centers (UHFWCs) without giving much attention to
their utilization and delivery services. The study reveals that financial and technical
support is very helpful to ensure health service among village people. However, the
Government allocates only 5 percent of the budget to the health sector, while it allocates
13 percent for defense. The paper shows that the Government’s allocation and technical
support (medical equipments) are not sufficient in the rural health complex and that the
people’s participation is far from being satisfactory. The paper concludes with a variety
of recommendations.
*
Respectively, Assistant Professor, Department of Public Administration, Shahjalal University of Science
& Technology (SUST), Sylhet-3114, Bangladesh; and M.S. in Public Administration, Department of Public
Administration, Shahjalal University of Science & Technology (SUST), Sylhet-3114, Bangladesh.
Comments are welcome; please send any communication to: sislam_psa@yahoo.co.in
.

1
I. Introduction
Bangladesh is a mostly rural, developing country of South Asia, located on the northern
shore of the Bay of Bengal, covering 147,570 square km. People of this country are
known as hardworking, with proven capability to preserve mental strength in the event of
unexpected extensive loss due to natural calamities, such as floods, cyclones, epidemics,
etc. But, their basic needs have remained unfulfilled. Health is a basic requirement to
improve the quality of life. National economic and social development depends on the
status of a country’s health facilities. A health care system reflects the socio-economic
and technological development of a country and is also a measure of the responsibilities a
community or government assumes for its people’s health care. The effectiveness of a
health system depends on the availability and accessibility of services in a form which the
people are able to understand, accept and utilize.
The Government of Bangladesh is constitutionally committed to “the supply of basic
medical requirements to all levels of the people in the society” and the “improvement of
nutrition status of the people and public health status” (Bangladesh Constitution, Article-
18). The health service functions were initially restricted to curative services. With the
development of modern science and technology, health services emphasize promotive
and preventive rather than curative health care. Yet, a large number of people of
Bangladesh, particularly in rural areas, remain with no or little access to health care
facilities. It would be critical for making progress in Bangladesh’s health services to
improve the people’s participation in the health sector. The Government therefore seeks
to create conditions whereby the people of Bangladesh have the opportunity to reach and
maintain the highest attainable level of health. Bangladesh has a good infrastructure for
delivering primary health care, but the full potential of this infrastructure has due to lack
of adequate logistics never been utilized.
This study aims to explore the sequence of the development and status of people’s
participation in Bangladesh’s public health services. It uses the methodological
triangulation qualitative and quantitative approach as well as a case study design in
analyzing data, whereby the exploratory-descriptive design is followed. The study
explores people’s participation in health services through personal interview as well as
case studies for which Muradnagar Upazila had been chosen as it provides an ideal
research setting.
This paper is structured as follows. The next section provides some background,
including a review of the literature and the methodology of this study. The third section
then presents Bangladesh’s public health service delivery pattern and mechanisms, while
the fourth section provides a summary of Bangladesh’s health problems and health care
needs. The fifth section presents an analysis based on the opinion and comments of
government officials and different categories of people at the village level, which were
collected through interviews, structured questionnaires and observation. The last section
provides the conclusion and recommendations.

2
II. Background and Methodology
According to the Alma-Ata conference in 1978, people’s participation was described not
as an optional extra but as an essential component of primary health care (PHC). Despite
being an essential component of Bangladesh’s PHC approach,
1
the people’s involvement
in PHC is still very much at an experimental stage in Bangladesh. Excluding a few
initiatives of non-governmental organizations (NGOs) that were adopted shortly after
independence, there is little experience with people’s participation in Bangladesh’s health
sector. The following literature summarizes some of the main experiences at the national
and international levels.
A study undertaken for the United Nations (UN) Panel on People’s Participation in 1982
(cited in Oakley, 1988, p. 6) reviewed the practice of participation in rural development
and suggested four different, but not mutually exclusive, forms of participation:
Participation as Collaboration: Whereby rural people are involved in rural health
service programs and health policy and their collaboration is sought, but they
have no direct control over the policy, decision making activities.
Participation through Organization: Organization is a crucial part for
participation. So health service should be decentralized for ensuring participation
through organization. Whereby organizations and government health facilities are
set up which ostensibly have the objective of felicitating participation.
Participation in Community Development Activities: Whereby the direct and
active involvement in health service of local people is sought to undertake and
complete a whole range of physical improvements at the community level. Local
people have a meaningful say in their planning and execution, but the dynamic of
participation is limited to the task at hand and does not extended beyond the
completion period of the physical improvements.
Participation as a Process of Empowering: Whereby a group of people who
previously had no basis from which to intervene in or influence rural health
service activities, achieve this basis and use it for their continued involvement in
these activities.
Salahuddin, Ali, Alam and Ali (1988) stated that Bangladesh, being a poor country with
scarce resources, cannot afford to provide sophisticated medical care to the entire
population. Emphasis is therefore given to primary health care covering the unnerved and
undeserved population with the minimum cost in the shortest time.
Mahmud (2004) explored people’s perceptions and reality about participation in newly
opened spaces within the Bangladesh public health care delivery system. The empirical
1
Bangladesh’s National Health Policy (2000) envisages a participatory approach to caring for people’s
health, at least at the local level. It calls for the decentralization of services and the participation of the local
population and local government institutions in the policy development, financing, and monitoring of
health services. In reality, however, such participation is far from adequate. Consequently, decisions at the
national level have been made in a non-participatory manner. Of course, the ordinary people have no scope
of participating in the national decision-making processes regarding how health services should be
delivered to them. Regardless of the quality of service they receive, the absence of participation itself
constitutes a violation of the people’s right to health.

Citations
More filters
Journal ArticleDOI
TL;DR: Common types of corruption like informal payments, bribery and absenteeism identified in the review have largely financial factors as the underlying cause and have a damaging impact on health outcomes and the quality of health care services.
Abstract: The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for ‘corruption’ in the LMICs of south and south-east Asia region. ‘Corruption’ works to undermine the UHC goals of achieving equity, quality, and responsiveness including financial protection, especially while delivering frontline health care services. This scoping review examines current situation regarding health sector corruption at frontlines of service delivery in this region, related policy perspectives, and alternative strategies currently being tested to address this pervasive phenomenon. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted, using three search engines i.e., PubMed, SCOPUS and Google Scholar. A total of 15 articles and documents on corruption and 18 on governance were selected for analysis. A PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist was filled-in to complete this report. Data were extracted using a pre-designed template and analysed by ‘mixed studies review’ method. Common types of corruption like informal payments, bribery and absenteeism identified in the review have largely financial factors as the underlying cause. Poor salary and benefits, poor incentives and motivation, and poor governance have a damaging impact on health outcomes and the quality of health care services. These result in high out-of-pocket expenditure, erosion of trust in the system, and reduced service utilization. Implementing regulations remain constrained not only due to lack of institutional capacity but also political commitment. Lack of good governance encourage frontline health care providers to bend the rules of law and make centrally designed anti-corruption measures largely in-effective. Alternatively, a few bottom-up community-engaged interventions have been tested showing promising results. The challenge is to scale up the successful ones for measurable impact. Corruption and lack of good governance in these countries undermine the delivery of quality essential health care services in an equitable manner, make it costly for the poor and disadvantaged, and results in poor health outcomes. Traditional measures to combat corruption have largely been ineffective, necessitating the need for innovative thinking if UHC is to be achieved by 2030.

42 citations

Journal ArticleDOI
TL;DR: Analysis of neuronal response to membrane raft disruption indicated that membrane rafts play an important role in neurite stability and neuronal viability.
Abstract: membrane domain-specific signaling events, maintaining synapses and dendritic spines. The purpose of this study is to examine the neuronal response to membrane raft disruption. Membrane rafts of 8 DIV primary neuronal cultures were isolated based on the resistance to Triton X-100 and ability to float in sucrose gradients. Membrane rafts from primary cortical neurons were also imaged using the membrane raft marker, cholera toxin subunit-B (CTxB), and were co-immunolabelled with the dendritic microtubule associated protein marker, MAP-2, the dendritic and axonal microtubule protein, β-IIITubulin, and the axonal microtubule protein, Tau. Exposure of cortical neurons to either the cholesterol depleting compound, methyl-beta-cyclodextrin (MBC), or to the glycosphingolipid metabolism inhibiting agent D-threo-1-phenyl-2-decanoylamino-3morpholino-1-propanol (D-PDMP), resulted in neuritic retraction prior to the appearance of neuronal death. Further investigation into the effects of MBC revealed a pronounced perturbation of microtubule protein association with membrane rafts during neuritic retraction. Interestingly, stabilizing microtubules with Paclitaxel did not prevent MBCinduced neuritic retraction, suggesting that neuritic retraction occurred independently of microtubule disassembly and that microtubule association with membrane rafts is critical for maintaining neuritic stability. Overall, the data indicated that membrane rafts play an important role in neurite stability and neuronal viability.

16 citations

Journal ArticleDOI
TL;DR: The most important attributes were the following: consistent access to a female doctor, the availability of branded drugs, respectful provider attitudes, a continuum of maternal healthcare including theavailability of a C-section delivery and lesser waiting times.
Abstract: Despite substantial improvements in several maternal health indicators, childbearing and birthing remain a dangerous experience for many women in Bangladesh. This study assessed the relative importance of maternal healthcare service characteristics to Bangladeshi women when choosing a health facility to deliver their babies. The study used a mixed-methods approach. Qualitative methods (expert interviews, focus group discussions) were initially employed to identify and develop the characteristics which most influence a women’s decision making when selecting a maternal health service facility. A discrete choice experiment (DCE) was then constructed to elicit women’s preferences. Women were shown choice scenarios representing hypothetical health facilities with nine attributes outlined. The women were then asked to rank the attributes they considered most important in the delivery of their future babies. A Hierarchical Bayes method was used to measure mean utility parameters. A total of 601 women completed the DCE survey. The model demonstrated significant predictive strength for actual facility choice for maternal health services. The most important attributes were the following: consistent access to a female doctor, the availability of branded drugs, respectful provider attitudes, a continuum of maternal healthcare including the availability of a C-section delivery and lesser waiting times. Attended maternal healthcare utilisation rates are low despite the access to primary healthcare facilities. Further implementation of quality improvements in maternal healthcare facilities should be prioritised.

16 citations

Journal ArticleDOI
TL;DR: The study finds that the use of ICT has a positive impact on the provision of health services in Bangladesh and the Government should take additional steps with regards to improving the health policy, legal framework and training to further strengthen ICT in Bangladesh’s health sector.
Abstract: Using Information and Communication Technologies (ICT) is a key strategy to meet the demand for health services in the 21st century. ICT in health services can provide services to the door steps of the people. It helps to meet increasing demands, rising costs, limited resources, workforce shortages and the national and international dissemination of best practices. ICT health service can also ensure efficiency and effectiveness in the health management system. In this study, the simple random sampling method has been applied to primary data collected from Hobiganj Adhunik Zila Sadar Hospital. The study finds that the existing ICT health services do not meet the demand of the people. Traditional and insufficient equipment is one of the main problems. The study also finds some other challenges, including unskilled manpower, inadequacy of ICT infrastructure, and a lack of financial support from the government. Despite these deficits, the study finds that the use of ICT has a positive impact on the provision of health services in Bangladesh. The Government should take additional steps with regards to improving the health policy, legal framework and training to further strengthen ICT in Bangladesh’s health sector.

10 citations

Journal ArticleDOI
TL;DR: Analysis of patterns of illness disclosure in Indian slums reveals that patterns of disclosure are not determined by the acknowledgment of illness but largely depend on the interplay between individual agency, disclosure consequences and the socio cultural environment.
Abstract: Slum dwellers display specific traits when it comes to disclosing their illnesses to professionals. The resulting actions lead to poor health-seeking behaviour and underutilisation of existing formal health facilities. The ways that slum people use to communicate their feelings about illness, the type of confidants that they choose, and the supportive and unsupportive social and cultural interactions to which they are exposed have not yet been studied in the Indian context, which constitutes an important knowledge gap for Indian policymakers and practitioners alike. To that end, this study examines the patterns of illness disclosure in Indian slums and the underpinning factors which shape the slum dwellers’ disclosing attitude. In-depth, semi-structured interviews were conducted among 105 men and 113 women who experienced illness in the year prior to the study period. Respondents were selected from four urban slums in two Indian cities, Bangalore and Kolkata. Findings indicate that women have more confidants at different social levels, while men have a limited network of disclosures which is culturally and socially mediated. Gender role limitations, exclusion from peer groups and unsupportive local situations are the major cause of disclosure delay or non-disclosure among men, while the main concerns for women are a lack of proper knowledge about illness, unsupportive responses received from other people on certain occasions, the fear of social stigma, material loss and the burden of the local situation. Prompt sharing of illness among men is linked with prevention intention and coping with biological problems, whereas factors determining disclosure for women relate to ensuring emotional and instrumental safety, preventing collateral damage of illness, and preventing and managing biological complications. The findings reveal that patterns of disclosure are not determined by the acknowledgment of illness but largely depend on the interplay between individual agency, disclosure consequences and the socio cultural environment. The results of this study can contribute significantly to mitigating the pivotal knowledge gap between health policymakers, practitioners and patients, leading to the formulation of policies that maximise the utilisation of health facilities in slums.

9 citations

References
More filters
Book
01 Jan 1980

60 citations


"People’s Participation in Health Se..." refers background in this paper

  • ...A study undertaken for the United Nations (UN) Panel on People’s Participation in 1982 (cited in Oakley, 1988, p. 6) reviewed the practice of participation in rural development and suggested four different, but not mutually exclusive, forms of participation: • Participation as Collaboration:…...

    [...]

Journal ArticleDOI
TL;DR: The community participation in BI could be improved if expectations were made explicit and this improvement should take into consideration the desires and priorities of the communities and issues impeding participation should be addressed.

35 citations

01 Nov 1968
TL;DR: Forward to Health is astakingly prepared after careful planning rather than a series of drab, annual reports that are often, and all too frequently, the rule with local health departments.
Abstract: painstakingly prepared after careful planning rather than a series of drab, annual reports that are often, and all too frequently, the rule with local health departments. "2. Heightening of appeal value through good printing and currently accepted methods of visual education excellent photographs and pictographs. "3. Use of the report as part of a syllabus for unit teaching in the high schools of the county." Health officers should obtain a copy of Forward to Health as a sample of how attractive a public health report can be. A. Marguerite Swan

29 citations

Frequently Asked Questions (1)
Q1. What are the contributions in "People’s participation in health services: a study of bangladesh’s rural health complex" ?

The study reveals that financial and technical support is very helpful to ensure health service among village people. The paper shows that the Government ’ s allocation and technical support ( medical equipments ) are not sufficient in the rural health complex and that the people ’ s participation is far from being satisfactory. The paper concludes with a variety of recommendations.