The health services policy in Upazila Health Complex:

A Case Study of Chandpur Sadar Hospital.

SUBMITTED TO :Mr. Sayeedul Huq

Course InstructorPolicy Analysis SOC-422Dept. of Applied Sociology

Presented By:K. M. Asaduzzaman; 12-1-20-0023

Farjana Akter Eti; 111-20-0010Yeanur Hossain Khan; 12-3-20-0004

Aklima Akter; 12-3-20-0005Umme Salma; 12-3-20-0009Antora Saha; 12-3-20-0015

Uday Kumar Shil; 12-3-20-0025Sohaly Akter; 12-3-20-0031

Khing Khing May; 12-3-20-0036Rasel patuary; 12-3-20-0044

Rakiba Rahman; 12-3-20-0045

Date of Submission: 26-12-2015

INTRODUCTION:

Bangladesh is a mostly rural, developing country of South Asia, located on the northern shore ofthe Bay of Bengal, covering 147,570 square km. People of this country are known ashardworking, with proven capability to preserve mental strength in the event of unexpectedextensive loss due to natural calamities, such as floods, cyclones, epidemics, etc. But, their basicneeds have remained unfulfilled.

Health is a basic requirement to improve the quality of life. National economic and socialdevelopment depends on the status of a country’s health facilities. A health care system reflectsthe socio-economic and technological development of a country and is also a measure of theresponsibilities a community or government assumes for its people’s health care. Theeffectiveness of a health system depends on the availability and accessibility of services in aform which the people are able to understand, accept and utilize. The Government of Bangladeshis constitutionally committed to “the supply of basic medical requirements to all levels of thepeople in the society” and the “improvement of nutrition status of the people and public healthstatus” (Bangladesh Constitution, Article-18).

The study explores people’s participation in health services through personal interview as wellas case studies for which Chandpur Sadar Upazila health complex had been provided throughgovt.

.

LITERATURE REVIEW:

Mohammad Shafiqul Islam and Mohammad Woli Ullah*( 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.) studied about “People’s Participation in Health Services: A Study of Bangladesh’s Rural Health Complex” in the Muradnagar Upazilla under the Comilla District. According to this case study health services based on primary health services have been expanding gradually in Bangladesh to improve the health status of the people, especially in rural areas and maternal health where more than 85 percent of the people are living and are underserved and underprivileged groups. The study focused on the degree of people’s getting the public health services of Bangladesh. It suggests that the people’s getting the health services is not satisfactory.

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 findings suggest that the effectiveness and ability of community groups to function as spaces for participation and provide the means for developing capabilities to participate is limited, being constrained by poverty, social inequality and dependency relationships, invisibility, low self-esteem and absence of political clout.

HEALTH INDICATORS:

CDR – 5.2 /1000 Annual Growth rate – 1.48% MMR – 1.94 /1000 live births (BMMS 2010) IMR – 43 /1000 live births Under 5 MR – 83 /1000 live births Total Fertility Rate – 2.9 CPR – 53.8% Life expectancy at birth – 68 (m) and 69 (f) Fully immunized children – 52% TB (smear positive new) detection rate – 31.2%

HEALTH CARE INFRASTRUCTURE:

UHFWC – 3375 31–50 bed UHC – 397 Various types o district level hospitals – 80 Government medical college hospitals – 13 Postgraduate hospitals – 6 Specialised hospitals – 25 Doctor to population ratio – 1:4,3660 Nurse to population ratio – 1:8,226 Hospital beds – 40,773 (over 29,000 in GOB)

PROCESS FOR FORMULATION

The Ministry of Health and Family Welfare[3] assembled a Committee in 1996 for the purpose of preparing a health policy, with members drawn from civil society and professional bodies, including technocrats and bureaucrats.

A further five sub-committees were formed to:

Evaluate the existing health services and determining the goals Formulate policies to ensure essential services Formulate policies to ensure hospital-based services Design Strategies for HRD Integrate NGOs and the Private Sector and plan for resources and utilisation of funds

The sub-committees worked for more than a year and submitted their efforts/recommendations. A working group was formed and entrusted with the responsibilities for compiling the recommendations contained in the reports. The working group also organised workshops in all six Divisions to elicit opinions of cross-section of the society on these reports. Finally theworking group presented the proposals and recommendations to the National Health Policy Formulation Committee. A report on the health policy was thus formulated on the basis of consensus. The Cabinet on 14 Aug 2000 approved the National Health Policy.

HEALTH CARE SYSTEM:

The health care are designated to meet the health needs of the community through the use of available knowledge and resources. The services provided should be comprehensive and community based. The resources must be distributed according to the needs of the community. The final outcome of good health care system is the changed health status or improve health status of the community which is expressed in terms of lives saved, death averted, disease prevented, disease treated, prolongation of life etc.

Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery:

Home and community level. Union level, Union sub centre (USC) or Health and family welfare centre; This is the first health

facility level. Thana level, Thana Health Complex (THC): This is the first referral level. District Hospital: This is the secondary referral level. National Level: This is the tertiary referral level.

A) Primary level health care is delivered though USC or HFWC with one in each union domiciliary level, integrated health and family planning services through field workers for every 3000–4000 population and 31 bed capacities in hospitals.

B) The secondary level health care is provided through 100 bed capacities in district hospital. Facilities provide specialist services in internal medicine, general surgery, gynecology, paediatrics and obstetrics, eye clinical, pathology, blood transfusion and public health laboratories.

C) Tertiary Level health care is available at the medical college hospital, public health and medical institutes and other specialist hospitals at the national level where a mass wide range of specialised as well as better laboratory facilities are available.

The referral system will be developed keeping in view the following.

1. A clearly spent-out linkage between the specialised national institutes, medical college and district hospitals to ensure proper care and treatment of patients from the rural areas served by lower level facilities.

2. Patients from the rural areas referred by lower level facilities to district and Medical Collegehospitals and specialised institutions should get preferential treatment after admission.

IMPROVEMENT OF HEALTH CARE SYSTEM IN BANGLADESH:

Among countries that provide free medical services to the people at the community level through various public health facilities, Bangladesh has a top-ranking position in this regard. The primary healthcare is provided through an extensive network of health facilities extended down to the community level with upward referral linkage and a set of government funded permanent community healthcare workers.The community clinics are the lowest-level static health facilities located at the ward level. These have upward referral linkages with health facilities located at the union and upazila levels. There are 467 government hospitals at the upazila level and below, which altogether have 18,791 hospital beds. At the upazila level, there are 436 hospitals with 18,301 beds. At the union level, there are 31 hospitals with 490 beds and 1,362 health facilities for outpatient services only. So, at the union level, there are 1,393 health facilities. At the ward level, there are 12,584 community clinics in operation till date.

HEALTH CARE SYSTEM IN BANGLADESH:

The public healthcare network of Bangladesh is an intricate web of public health departments, NGOs, and private institutions constitutes. Responsibilities and functions range from policy planning, regulation, implementation, and healthcare delivery to medical education. The Ministry of Health and Family Welfare (MOHFW) is responsible for formulating national-level policy, planning, and decision-making in the provision of healthcare and education. The healthcare infrastructure under the DGHS comprises six tiers: national, divisional, district, upazila (sub district), union, and ward.

NATIONAL HEALTH POLICY OF BANGLADESH:

The Health Policy has 15 goals and objectives, 10 policy principles and 32 strategies.

Goal and objectives of the national health policy

First: To make necessary basic medical utilities reach people of all upazilla as per Section 15 (A) of the Bangladesh constitution and develop the health and nutrition status of the peoples as per Section 18 (1) of the Bangladesh Constitution

Second: To develop system to ensure easy and sustained availability of health services for the people, especially the poor communities in both rural and urban areas

Third: To ensure optimum quality, acceptance and availability of primary health care and governmental medical services at the upazilla and union levels

Fourth: To reduce the intensity of malnutrition among people, especially children and mothers; and implement effective and integrated programs for improving nutrition status of all segments of the population

Fifth: To undertake programs for reducing the rates of child and maternal mortality within the next 5 years and reduce these rates to an acceptable level

Sixth: To adopt satisfactory measures for ensuring improved maternal and child health at the union level, and install facilities for safe and hygienic child delivery in each village

Seventh: To improve overall reproductive health resources and services

Eighth: To ensure the presence of full-time doctors, nurses and other officers/staff, provide and maintain necessary equipment and supplies at each of the upazilla health complexes and Union Health and Family Welfare Centers (UHFWCs)

Ninth: To devise necessary ways and means for the people to make optimum usage of available opportunities in government hospitals and the health service system, and ensure satisfactory quality management, cleanliness of service delivery at the hospitals

Tenth: To formulate specific policies for medical colleges and private clinics, and to introduce laws and regulation for the control and management of such institutions including maintenance of service quality

Eleventh: To strengthen and expedite the family planning program with the objective of attaining the target of Replacement Level of Fertility

Twelfth: To explore ways to make the family planning program more acceptable, easily available and effective among the extremely poor and low-income communities

Thirteenth: To arrange special health services for the mentally retarded, the physically disabled and elderly populations

Fourteenth: To determine ways to make family planning and health management more accountable and cost-effective by equipping it with more skilled manpower

Fifteenth: To introduce systems for treatment of all types of complicated diseases in the country, and minimize the need for foreign travel for medical treatment ab Road.

POLICY PRINCIPLES:

The following policy principles have been adopted in order to attain the foregoing goals and objectives:

i. To create awareness among the enable every citizen of Bangladesh irrespective of caste, creed, religion, income and gender, and especially children and women, in any geographical region of the country, through media publicity, to obtain health, nutrition and reproductive health services on the basis of social justice and equality through ensuring everyone’s constitutional rights;

ii. To make the essential primary health care services reach every citizen in all geographical regions within Bangladesh;

iii.To ensure equal distribution and optimum usage of the available resources to solve urgent health-related problems with focus on the disadvantaged, poor and unemployed persons.

iv.To involve the people in various processes like planning, management, local fund raising, spending, monitoring and review of the procedure of health service delivery etc. with the aim of decentralizing the health management system and establishing people’s right and responsibilities in this system

v.To tacilitate and assist in the collaborative efforts between the government and the non-government agencies to ensure effective provision of health services to all

vi.To ensure availability of birth control supplies through integration, expansion and strengthening of the family planning activities

vii.To carry out appropriate administrative restructuring, decentralization of the service delivery procedure and the supply system, and to adopt strategies for priority-based human resource development aimed at overall improvement and quality-enhancement of health service, and to create access of all citizens to such services

viii.To encourage adoption and application of effective and efficient technology, operational development and research activities in order to ensure further strengthening and usage of health, nutrition and reproductive health services

ix.To provide legal support with regard to the rights, opportunities, responsibilities, obligations and restrictions of the service providers, service receivers and other citizens, in connection with matters related to health service; and

x.To establish self-reliance and self-sufficiency in the health sector by implementing the primary health care and essential services programs, in order to fulfill the aspirations of the people for their overall sound health and access to reproductive health care.

POLICY STRATEGIES:

In keeping with the purported goals, objectives and principles, the following policy strategies will be adopted

i.An appropriate implementation of the Health Policy needs mass-scale consensus and commitment that will facilitate socio-economic, social and political development

ii.Prevention of disease and health promotion will be emphasized to achieve the basic objective of Health for All”. The Health Policy focuses on provision of the best possible health facilities to as many people as possible using cost-effective methods, and will thus ensure effective application of the available curative and rehabilitative services.

iii.A primary health care is the universally recognized methodology to provide health services; this will be adopted as the major component of the National Health Policy in order to ensure delivery of cost-effective health services

iv. The Drug Policy will be liberalized and improved in keeping with the Health Policy to fulfill the overall needs for health services. There is need to ensure smooth availability of essential medicines focusing on the current needs for such medicines and their efficacy, including their affordability by all people. Necessary steps will be taken to maintain quality standards of the marketed medicines and raw materials used therein, and to rationalize the usage of medicines. In this line, the required number of skilled manpower will be acquired in the drug administration of the country.

The health policy will ensure distribution of birth control supplies and make improvements in the

management of the domestic sources of the same, including encouragement of the domestic sources of the same, including encouragement of the domestic entrepreneurs for production of such commodities.

v.Epidemiological surveillance method will be integrated with the disease control programs. A specific institution will be entrusted with the responsibility of such surveillance.

vi.The basic principles for ensuring quality standards in health care at various health centers will be adhered to. Standard quality assurance guideline including monitoring and evaluation will be provided to every health center

vii.A Health Services Reforms Body will be formed based on the Health and Population Sector Strategy aiming at meeting the current demand. The role of the Health Services Reforms Body will be the render the following services

�Infrastructure reforms �Acquisition of human resources,

�Planning and implementation of programs for development of human resources related to the health sector,

�Career planning of the staff, �Inspection of supplies and logistics,

�Consultations on how to effect overall development of health services including its management styles etc

�Recommendations will be implemented in phases based on the availability of necessary resources

viii.An appropriate and need-based approach to develop human resources will be designed in order to maximize the utilization of the knowledge and skills of health-related personnel. A number of posts will be created with a view to promoting the eligible staff at the grassroots level on the basis of their seniority and skills acquired. Special care will be taken to ensure that no staffs promotion is held up.

While a staff is sent for training outside his/her own organization, necessary replacement will be put in place for the term of the training, that is, no training leave may be allowed without replacement

ix.The people and the local government will be integrated with the health service system at all levels

x.An Integrated Management Information System (IMIS) and a computerized communication system will be installed countrywide, to facilitate implementation, action planning and monitoring. The existing information system will be further strengthened by recruiting more efficient and eligible incumbents. To this purpose, extensive and appropriate training will be arranged, and the available manpower will be expanded and their skills enhanced.

xi.The Bangladesh Medical and Dental Council (BMDC) and the Bangladesh Nursing Council (BNC) will be restructured and strengthened in order to ensure strict supervision of medical practitioners registration, their quality of skills, and related ethical issues. With a view to maintaining the required quality standards of the performance, education and training of the pharmacists, medical technologists and other paramedics, the Pharmacy Council and the State Medical Faculty will be restructured and organized.

xii.Various professional organizations, such as, Bangladesh Medical Association (BMA), Bangladesh Private Medical Practitioners Association (BPMPA), and the unani, ayurvedic and homeopathic societies etc. will be integrated with the country’s health service system.

xiii.Need-based medical education and training will be made more people- oriented and updated.

xiv.Arrangements will be mode for institutional training, on such issues as management and administration, for improving the doctors’ management capabilities.

xv.Regular training will be provided to the medical practitioners, teachers, nurses, paramedics and other staff at all levels in both public and private sectors through a specific institution. The following types of courses will be offered from here:

- Reoriented Course,

- Continuing Medical Education Program,

- Administrative and Management Courses etc. In order to create the required facilities for offering such training, a National Training Institute will be established.

xvi.To ensure efficient health services, the management of the medical colleges/institutions and related hospitals will be improved, and higher levels of financial and administrative power will be delegated to them.

xvii.Nutrition and health education will be emphasized, as these are the major driving forces of health and family planning activities. There will be one nutrition education unit and one health education unit in each upazilla, so that they can reach every village of Bangladesh.

Information on health education will be disseminated the people through incorporating the community leaders and other departments or organizations of the government in the health service system. One of the goals of the health service system will be to improve the nutrition status of the people.

xviii. The government hospitals and clinics will charge a minimum fee from the patients, but there will also be provision for cost-free medical treatment to the poor and the disabled.

xix.NGOs and other private organizations will be encouraged to perform a role complementary to those of the government in the light of the governmental rules and policy.

xx.Infrastructure and transportation will be developed to minimize the disparity in access to health services between rural and urban populations. In order to ensure presence of every officer and staff of the health service system at their respective workplaces and their efficient services, development of education facilities and improvement of the social environment in those neighborhoods will be made.

xxi.Arrangements will be made to pay non-practicing allowances to the government doctors/trainee doctors who act as full-time and resident doctor thus making them refrain from private medical practice.

Doctors working at a government medical college, hospital or health center opting for private medical practice using the facilities at the medical college, hospital or health center, will be

allowed to do so only under a clear policy.

xxii.Accountability of all concerned in the health service system will be ensured. An adequate procedure will soon be designed to strengthen accountability and ensure quick and strict legal disposal of cases relating to negligence of duties.

xxiii.A national level health-and-population council will be formed under the leadership of the Head of the Government. This council will provide support and advice on the implementation of the National Health Policy and will ensure effectiveness and accountability of the health service system. The local and regional councils will monitor the health-related activities in their respective areas, including review of composition, application and supervision of the primary health care provided to the people

xxiv. Inter-sectoral coordination and linkages will be strengthened way of utilizing the resources at the disposal of concerned sectors for quick solution of the health-related problems.

xxv.Research on various management styles and their effectiveness, clinical services, approach to diagnoses, social and behavioral aspects of human beings, epidemics etc. will be encouraged by the government.

Information dissemination system will be strengthened, especially by involving the private organizations, in order to make IEC (information, education and communication) reach the grassroots level.

A sound referral system will be designed and installed, and its usage will be strictly supervised, so that a linkage can be established among primary health care activities at various tiers ultimately increasing the efficacy of this system.

xxv1.Duplication of activities from different projects, programs and activities will be avoided. In this connection, a policy-planning cell will be established in the Ministry of Health and Family Welfare, through which effective and sustainable coordination may be ensured.

xxvii.To goal of the Health Policy will be to provide personal or client-centered health and reproductive health service, so that an individual can have the opportunity to select services according to his/her personal needs. This pattern of services-delivery will be considered an important approach of the National Health Policy and will contribute to a reduction in the rate of unwanted pregnancies.

xxviii..Governmental allocation of expenditure budget for health centers from the districts to the community level may be redistributed within reasonable flexibility. This redistribution of expenditure budget will provide increased benefits to the poor and destitute communities. As a result, expenses will be optimized and health service will be easily available.

xxix.Alternative health service systems, such as ayurvedic, unani and homeopathic practices will be incorporated into the National Policy. Encouragement will be given to the principle of making these three

disciplines of medical science more scientific and time-worthy towards enabling the practitioners in these disciplines to contribute to the country’s health service. Government will provide appropriate support to these systems through enhancing grants and arranging proper training in these areas, and ensure monitoring of the quality of services rendered through these systems.

xxx.The arrangement for delivery of Essential Services Package (ESP) among the people from a single one-stop health service center will be considered the appropriate strategy for provision of primary health care. This will be introduced throughout the country. For this purpose, well-planned and useful training will also be arranged at the upazilla health complexes.

xxxi. All development activities in the health sector will be conducted through a sector-wide management system.

xxxii.. In order to bring every citizen of the country under coverage of his health service system, one community clinic will be established to serve every 6,000 persons. An MBBS-doctor will be deployed in each Union Health and Family Welfare Center, and each of these centers will also equip with residence facilities for the doctor.

Multi-dimensional problems at various tiers of the physical and technical infrastructures of the health service system and among the manpower employed have been creating bottlenecks towards effective provision of health services. These colossal problems accumulated over a long period of time and cannot be solved in a day. Therefore, a comprehensive plan for efficient solution of the existing problems must be formulated urgently after elaborate consideration of the issues involved. Only way to an effective health service system lies in timely modification, reform and correction of the country’s traditional health service through adoption and implementation of a transparent health policy.

A CASE STUDY OF CHANDPUR SADAR POURASHAVA:Organization at a Glance:

Name of the Institution : Chandpur Sadar Health complex, Chandpur

Location : Chandpur

Type of organization : Government

Date of establishment : 1897

Date of visit : 01.12.15

ACTIVITIES OF THE ORGANIZATION:Existing health facilities in the Upazila

Facility Type

Upazila Health Complex

No. of Union Sub-Centres

No. of Union Health and Family Welfare Centres

No. of Rural Dispensaries

No. of Community Clinics

No of Trauma Centres

No. of MCWC

No. of Chest Disease Clinic (TB clinic)

No. of Private Clinics

No. of NGO Clinics

FOLLOWING SERVICES REGARDING FAMILY PLANNING ARE PROVIDE AT HOSPITAL AND FIELD LEVEL: Free distribution of family planning maternal like oral pill and condom. Insertion of Cu.T. Tubectomy and vasectomy MR Motivating people to take family planning methods antenatal services including

referring high risk mothers.

STUDY AREA:

Chandpur sadar pourashava (in Chandpur district) was selected as the study area. It was established in 1897. It has an area of 8.77 sq km and bounded by Tarpur Chandi union on the north, Ishali union on the south, Baghadi union on the east and Meghna River on the west. The town has a population of 94821 where male are 50.77% and female are 49.23%. Literacy rate of the town people is 66.4% (BBS, 2011). Main rivers are lower Meghna and Dakatia. There are substantial numbers of health care centers in Chandpur sadar pourashava provided by the government, non-government, private and other organization. The number of doctors, nurses, medical assistants, beds and staffs available during the study in Chandpur sadar pourashava were 80,

ACTIVITIES OF THE ORGANIZATION:Existing health facilities in the Upazila

Total No. of Beds

1 0

1 0

No. of Union Health and Family Welfare Centres 12 0

0 0

40 0

0 0

1 20

No. of Chest Disease Clinic (TB clinic) 1 0

19 210

3 30

FOLLOWING SERVICES REGARDING FAMILY PLANNING ARE PROVIDE AT FIELD LEVEL:

Free distribution of family planning maternal like oral pill and condom.

Tubectomy and vasectomy

Motivating people to take family planning methods antenatal services including referring high risk mothers.

Chandpur sadar pourashava (in Chandpur district) was selected as the study area. It was established in 1897. It has an area of 8.77 sq km and bounded by Tarpur Chandi union on the north, Ishali union on the south, Baghadi union on the east and Meghna

on the west. The town has a population of 94821 where male are 50.77% and female are 49.23%. Literacy rate of the town people is 66.4% (BBS, 2011). Main rivers are lower Meghna and Dakatia. There are substantial numbers of health

sadar pourashava provided government, private and

other organization. The number of doctors, nurses, medical assistants, beds and staffs available during the study in Chandpur sadar pourashava were 80,

No. of Beds

20

210

30

FOLLOWING SERVICES REGARDING FAMILY PLANNING ARE PROVIDE AT

Motivating people to take family planning methods antenatal services including

162, 35, 392 and 725 respectively

OBJECTIVES:

The main objectives of this research are as follows:

To find-out the location pattern of health care facilities in the study area; To determine the health care facilities provided by the study centers; To find-out the utilization pattern of health care facilities in the study area; Service provided by the health care centre in the study area are given below:

FIELD SERVICES:This section is headed by UHFPO. Under his supervision there are health Inspector (HI), Assistant Health Inspector (AHI) and health Assistant (HA).Provided services are- Health education Control of communicable disease Distribution of Vitamin-A capsule Distribution of oral contraceptive pill (Shukhi) and condom. Sanitation: Provided by a sanitary Inspector whose function is to supervise the hygienic

condition of food and drink, to send suspicious samples to the Institute of Public Health (IPH), Dhaka.

Co-ordination with NGOs and other health related sector Registration of births and deaths Immunization of static clinics and outreach centers Collection of blood sample from pt’s suffering from prolonged fever to detect material

parasite.

STATUS OF HUMAN RESOURCES (CATEGORY WISE):

Manpower

Community Clinic

USC/UHFWC/RD UHC OthersIMCI trained

Basic EOC trainedSanctioned

Filled-up

SanctionedFilled-up

SanctionedFilled-up

SanctionedFilled-up

Physician 0 0 14 12 3 2 0 0 0 0

Nurse 0 0 0 0 0 0 0 0 0 0

Medical Assistant

0 0 1 1 13 13 0 0 0 0

SERVICE PROVIDED BY THE HEALTH CARE CENTRE IN THE STUDY AREA:

The hospitals of this area deal with comparatively more complicated diseases, which is beyond the scope and capacity of the primary level. Most of the hospitals in the study area are curative in nature. These hospitals are assigned to provide some specialist services particularly in internal medicine, general surgery, obstetrics and gynecology and pediatrics.

SERVICE PROVIDED BY THE HEALTH CARE CENTRE IN THE STUDY AREA IS GIVEN BELOW:

Type of Available diagnostics Services provided by the hospital

Hospital and other facilities

1. Government

CT angiogram, USG. stress

Child disease, General Surgery, Gout, Fever,

Anemia,

Hospitals thaleum test,Measles, Elderly disease, Circumcision, Hypertension,

X-Ray,Gastric, Diabetes, Chest pain, Tuberculosis, Influenza,

Alta sonogram, E.C.G,Diarrhoea, Hepatitis, ENI problem, Stroke, Eyes

CT Scan, Therapy,problem,

Gynecology& obstetricproblem,

Pathologicallab(Urine,Headache, Skin problem, Accident & injuries

disease,

stool, cough, blood etc.)Cytica, Rheumatic fever, Immunization, Dentaldisease etc.

2.

Organizational

Computer to determine the

Eye disease & injuries, Antenatal & postnatal care to

Hospitals eyes problem, Differentmothers,

Childdisease, General

surgery,

types of instrumentsGynecological problem,

Immunization etc.

related with eyes. Altasonogram, E.C.G,

Pathologicallab(Urine,

stool, cough, blood etc.),

3.

PrivateAltra sonogram

Surgery, Child disease, Delivery, Gout, Fever,

Clinic/Hospitals

E.C.G, Pathological labScabies, Anaemia Measles, Elderly disease, Asthma

(Urine, stool, cough, blood

Circumcision, Hypertension, Gastric, Diabetes, Chest

etc.)pain, Influenza, Diarrhoea, Hepatitis, ENT problem,Stroke, Appendicitis, Headache, Dysentery,

Chicken

pox, Cardiovascular disease etc

Chandpur sadar hospital arrange the Expanded Programme on Immunization (EPI) with the help of Canadian International Development Agency (CIDA), United Nations Children’s Fund (UNICEF), United States Agency for International Development (USAID), World Health Organization (WHO), Government of Japan, Rotary International (RI). Some medicine is provided free of charge. Food is also provided free for indoor patients. Matrimongol hospital provides services for pregnant women (during Antenatal & postnatal period). It provides services under Emergency Operation Camp (EOC). Chandpur Tuberculosis (TB) Hospital provides services only for Tuberculosis patients.

The diagnostic facilities provide services only for outpatients for laboratory (Urine, stool, cough, blood, E.C.G, Alta sonogram, X-Ray, Therapy etc) tests. They have no surgical or bed facilities. The diagnostic centers provide services under the supervision of Chandpur sadar hospital. After the introduction of modern system of medicine the traditional system of health care has been gradually decreasing. Now-a-days the old and comparatively less educated patients avail of the traditional health care facilities.

HEALTH CARE UTILIZATION PATTERN IN THE STUDY AREA

Present study observed that 30.8 percent patients availed government hospitals for their treatment due to its being free of cost and easy excess. Only 13.5 percent patients avail private clinics / hospitals due the availability of expert and good behavior. About 25 percent patients avail Allopathic pharmacy, 5.8 percent patients availed homeopathic Allopathic pharmacy and kabiraj whereas only 1.9 percent patients used Unani. Occupations of the cases also have influence in utilization of health care facilities. Among the Rikshaw-pullers 33.3 percent used government facilities, kabiraj and homeopathic medicines. 100 percent driver/ transport labour, fishermen and hotel boy usages government facilities whereas 20 percent service holder use it. 60 percent students availed government facilities whereas 75 percent housewives, 40 percent

advocates, 50 percent hawker and 16.7 percent day labourers use government facilities. 100 percent small business men /women, 60 percent government service holders, 60 percent private employees, 66.7 percent teachers, 20 percent students and 25 percent housewives met private doctors during the last 6 months, (all data given from Chandpur sadar hospital report book)

CONCLUSIONS:

There seems to be a distinct spatial variation in the patterns of attendance between low and high income people, between low and high education level. The low income peoples mostly avail of public health care facilities and they are experiencing much longer travel to primary care services than other respondents. The high income people mostly use the private doctor’s facilities. The poorer households have no choice to undertake frequently lengthy journey often to crowded hospitals or public clinics. In the study area most of the respondents use Rikshaw as mode of transportation. There are some high income respondents with private vehicles at their disposal. Long waiting at the health centers discourages the people who consider it as potential loss of wages or work hours. Many of the respondents did not be use the nearest facility due to reason not explained. This is understandable in the context of Bangladesh, in mixed health care system, spatial proximity does not necessarily equate with social or economic access. The reasons given by respondents for not using the nearest facility are varied. If the poor class of patients do not use public health facility nearby , they need to travel a long distance to get treatment which is many case become impossible. The high income respondents traveled to doctors with whom a good relationship is already established and who are situated either in the study area or outside the study area.

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