CPD-UNFPA
Programme on Population and Sustainable
Development
Paper 9 (Summary)
Under-utilisation
of Healthcare Services in Bangladesh:
An Emerging Issue
Mazharul Islam
INTRODUCTION
The
Government of Bangladesh, since
independence in 1971, is investing
substantially in the institution
building and strengthening of health
and family planning services in
the country, giving special attention
to the vast population living in
the rural areas. The main thrust
of the health programmes has been
in the provision of primary health
care (PHC) services. The Government
has already initiated the institutionalisation
of maternal and child health care
and family planning activities through
a phased program on Maternal and
Child Health and Family Planning
(MCH-FP) services. In order to provide
MCH-FP services, a wide range of
service infrastructure and outlets
such as Health and Family Welfare
Centre (H&FWC), Rural Dispensary
(RD), and Satellite Clinic (SC)
at Union level and Thana Health
Complex (THC) at Thana level
have
been established throughout the
country. These focal points provide
health and family planning services
in both rural and urban areas. Moreover,
the Government is implementing an
integrated health and FP service
delivery through static centres
called Community Clinics (CCs) for
6,000 people at village level. However,
the Government's efforts to provide
health facilities at various levels,
though free of cost and managed
by trained professionals, has not
lead to the
desired level of use of
the services. Reports from the government
as well as private sources indicate
that primary health care facilities
are greatly under-utilised, despite
the tremendous health needs and
repeated efforts by the government
to improve these services. Most
of the people in rural areas still
remain outside the reach of the
government health system. On the
other hand, a great majority of
the people are found to use private
facilities and traditional faith
healers.
OBJECTIVES
OF THE STUDY
The
main objective of the study is to
examine the maternal and child health
care seeking behaviour and identify
the factors affecting the use or
non-use of maternal and child health
care services in Bangladesh with
particular attention to the utilisation
of public health care facilities
for effective antenatal care (ANC)
and delivery care as well as for
treatment of childhood morbidity.
In this regard, the study aims at:
·
Analysing the patterns and determinants
of maternal health services utilisation,
· Examining the patterns
and determinants of childhood morbidity
and treatment.
· Suggesting a set of policy
recommendations that would enable
policy makers to design effective
intervention programmes to increase
the utilisation of MCH services
and improve the maternal and child
health and survival rate in Bangladesh.
METHODOLOGY
This
study analyses the patterns and
determinants of maternal and child
health care utilisation in Bangladesh
using data from the 1996-97 Bangladesh
Demographic and Health Survey (BDHS).
The study focused on the 6,230 women
who had a child in the five years
preceding the survey.
FINDINGS OF THE STUDY
- The study showed that only 29
per cent of women received some ANC during pregnancy.
Of those who received some ANC,
the majority of them (27
per cent) received
care from qualified doctors (20
per cent) and nurse or trained midwives
or FWV (7 per cent) from government
facilities. Amongst the 29 per
cent
of the women who received some ANC,
in about 7 per cent of cases, it was
adequate (at least 3 visits with
first visit during the first three
months of pregnancy by medically
trained personnel i.e. doctor, nurse
and FWV). In the remaining 22
per cent
cases it was inadequate. Only 8
per cent of births were assisted
by medically trained personnel Almost
13 per cent of children under five
years of age had a cough with rapid breathing
(i.e. ARI) in the two weeks before
the survey, and about 70 per cent
of them received some treatment.
The majority of them (46 per cent)
received treatment from an unqualified
health provider (such as pharmacy,
shop, traditional doctors or homeopathic
doctor), and the remaining one-forth
(24 per cent) received treatment
from a government provided health
facility or a qualified private health
provider/doctor.
- Although
a majority of those
who had received ANC preferred
a government
health facility for delivery assistance,
the majority of them utilised traditional
birth attendants (TBA). The use
of TBA for delivery assistance is
more common among the wide majority
of rural mothers, and among Muslims
with poor economic conditions. The
results also showed that unqualified
health providers were consulted
more for childhood illnesses, than
the qualified government provided
health providers in Bangladesh.
- Both bivariate and multivariate
analysis indicated several important
factors which are common for the
use of both maternal and child healthcare
services use. Education, particularly
mother's education, is one such
significant predictor of the use
of ANC and use of the health facility
during childhood illness. Mother's
mobility status is also a common
factor for utilisation of both maternal
and child healthcare.
-
Among the demographic factors,
mother's age at childbirth and parity
are two important predictors of
utilisation of ANC and delivery
assistance from medically trained
personnel. This indicates that women
who give birth during adolescence
are at greater risk of receiving
no maternity care. Mother age and
parity, however, do not seem to
be strongly related to seeking treatment
for childhood ARI, but age of
the child
is a strong determinant of receiving
treatment for ARI. Sex of child
is also a strong predictor of receiving
treatment for ARI from health facility
and qualified health provider; male
children are 1.6 times more likely to
receive treatment from a health facility
than female children, indicating a
sex bias in seeking treatment for
childhood illness. The results also
indicate that a closely spaced subsequent
birth reduces the likelihood of
receiving the treatment for childhood ARI. All
this evidence support
the hypothesis that an improved
maternal and child survival rate
will help reduce fertility level
and vice versa in Bangladesh. Income
and social class of the mothers
were also found to be important
predictors of receiving ANC and
delivery assistance from qualified
providers.
- Factors measuring the accessibility,
availability and communication
of health messages (programme related
factors) such as urban residence,
distance to the THC, distance to
the health clinic, distance to FWC,
presence of income generating activities,
TV in the community and mass media
exposure to health messages were
also found to have
a strong effect
on receiving ANC and delivery assistance
from qualified providers.
POLICY RECOMMENDATIONS
-
Promote education, especially
female education
-
Improve the status of women in the
community and their strengthen
their decision making power.
-
Education, employment and
unrestricted mobility are
essential elements for women
empowerment
-
Strengthen IEC/BCC activities of
reproductive health programmes to
educate community, especially the
rural, poor and uneducated women
about reproductive health services,
and the need for maternal and child
healthcare
-
Establish health clinics
(community clinics) in each
community within a short distance
(within 1 mile) and ensure easy
accessibility
-
Provide health and family planning
services from the community clinics
in an integrated manner
-
Devise mechanisms to attract
adolescents, poor and uneducated
women to receive maternal and
child health care services from
qualified service providers
-
Integrate traditional birth attendants
(TBAs) into the
mainstream government
health care system by providing
them appropriate training for safe
delivery and referral for complicated
cases
-
Promote effective communication on
reproductive health matters and
services between the community and
the service providers
-
Make the reproductive health
services available in a culturally
accepted manner (arranging for
privacy, providing maternity care
by female health personnel,
adjusting clinic times etc.) and
improve the quality of care and
management
-
Strengthen family planning programmes
and encourage birth spacing and
small family norm
To obtain the full text of this report
please contact:
Centre for Policy Dialogue
Dialogue
and Communication Division
House No 40/C, Road No 11, Dhanmondi
R/A, Dhaka-1209
GPO Box 2129, Dhaka-1000, Bangladesh
Tel: (+880 2) 8124770,9141734,9141703
; Fax: (+880 2) 8130951
E-mail: cpd@bdonline.com
Price: Tk. 100.00 (The price quoted
does not include postal charges)
Pages: 47
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