the status of healh of the poor people of gazipur district of bangladesh

8/7/2019 The Status of Healh of the poor people of Gazipur District of Bangladesh

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Chapter One: Introduction

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Chapter 1: Introduction

Introduction

The international conference on primary health care, meeting in Alma Ata, USSR in

September 1998, defined health as- a state of complete physical, mental and social

wellbeing and not merely the absence of disease or infirmity The conference maintained

that health is a fundamental human right and that, a main social target of governments,

international organizations and the whole community in the coming decades should be

the attainment by all peoples of the world by the year 2000 of a level of health that will

permit them to lead a socially and economically productive life. Primary healthcare is the

key to attaining this target as part of development in the spirit of social justice (Alma Ata

report, 1998, p,15) Primary healthcare as essential health care based on practical,

scientifically sound and socially acceptable methods and technology made Universally

accessible to individuals and families in the community through their full participation

and at a cost that the community and country can afford to maintain at every stage of their

development in the spirit of self reliance and self determination, It forms as integral part

both of the country health system, of which it is the central function and main focus, and

of the overall social and economic development of the community. Primary heath care is

the first-level contact of individuals, the family and community with the international

health system bringing healthcare as close and work and constitutes the first element of a

continuing health care process.

Primary health care addresses the main health problems in the community providing

primitive, preventive, curative and rehabilitative services accordingly and includes atleast : education concerning prevailing health problems and the methods of preventing

and controlling them: promotion of food supply and proper nutrition and adequate supply

of safe water and basic sanitation; maternal and child healthcare, Including family

Planning; immunization against the major infectious diseases; prevention and controls of

locally pandemic disease; appropriate treatment of common diseases and injuries and

provision of essential drugs.

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Though the definition and concept of primary health care encompasses a very wide field

of activities, inbuilt in the definition and concept of primary health care is the spirit of

social justice and community participation and self reliance and self-determination. The

concept is also based on intra and inter sectoral linkages and dependence and calls for

cooperation among all courtiers of the world and technical and financial support from the

developed countries and international agencies in support if the primary health care,

particularly in the developing countries.

1.0 Background:

The health is an important part of human being. It is the fundamental right of every

citizen of Bangladesh. The constitution of republic of Bangladesh has described the

fundamental rights of citizen. In this sense, It is essential to ensure the health of the

people all over the world. But the health facilities provided by the various government

and non-government are not adequate. So the health condition of sub cities and rural areas

are very poor especially women and children. So the illness and death rate are

comparatively in sub cities and rural areas. It is a vast issue in the present condition. Since

we are in the 21th century, it is first duty of every nation to ensure the fundamental rights

of citizen specially women. Because of they are being so much vulnerable among the

citizen. It is my desire to find out the primary health condition of women.

1.1 Statement of the problem:

Primary health care system in the world and Bangladesh is a major issue. The

importance of primary health care is importantly assed by the Ministry of health of

Bangladesh (200:15)-To create awareness among and enable every citizens 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 service on the basis of social justice

and reality trough ensuring every ones constitutional rights

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National concerns for providing health care have been reflected in the national

constitution, the planning commission documents, and in various international forums on

primary health care where Bangladesh participated. The constitution of Bangladesh, inter

alia, maintains that (constitution of Bangladesh,1972:15) It shall be a fundamental

responsibility of the state to attain a steady improvement in the material and cultural

standards of living of the people, with a view to securing to the citizens the provisions of

basic necessities of life, including food, clothing, shelter, education and medical care .

The second five year plan (1980-85) reflects the national objective of providing

Minimum care to all in the short run and Health for all by the year 2000 (Bangladesh

1983) Bangladesh is also one of the signatories to the south Asian charter of health, as

well as to the Alma-Ata Declaration on primary healthcare. The health policy of

Bangladesh is based on primary health care as its key approach to providing health care to

the masses of the population.

Though health services in Bangladesh is being provided for a long time, documentation

on health development plans and especially with reference to primary healthcare (PHC) is

of recent origin. A country health programming exercise in Bangladesh was undertaken

for the first time in 1973 focusing on selected health logistical problems (Bangladesh

1973). second country health programming exercise was done in 1977 focusing

comprehensively on healthcare facilities and needs (Bangladesh 1977). In 1980 national

strategies for health for all (HFA) by the year 2000 was formulated by the planning

commission/ ministry of health (Bangladesh 1980) The ministry of health/ planning

commission Director General of health services also formulated in 1981 a health

manpower planning exercise (Bangladesh 1981). Based on these documents and the

second five year plan (Bangladesh 1983), a number of projects have been formulated, and

the health wing of the ministry of health and population control has as of now, 79 projects

of which 39 projects fall under primary health care. Recently country resource utilization

on Bangladesh was published by world health organization (WHO 1983). Bangladesh

government also published a Bangladesh country report-on evolution of the strategies for

health for all by the year 2000. (Bangladesh 1985). But the access of health is not some

for all. Health access is different according to class, age, gender, Income. In this study an

at attempt will be made mainly to focus how primary health service is different according

to gender, economic status, environment of the clinic etc.

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The elements of PHC, it may be noted, are very comprehensive in coverage and include

such items as promotion of food supply and proper nutrition and adequate supply of safe

water and sanitation which are not traditionally covered under the Ministry of Health and

Population Control. The items included under the Ministry of Health and Population

Control are also very wide and their targets are intended to be reached by the year 2000

by the Ministry of Health and Population Control through the development of referral

system between primary, secondary and tertiary levels of health care mechanism,

intersect oral cooperation and coordination, and above ail through active participation of

the community in the delivery of PHC.

In the country paper on health for All by the Year 2000 of June 1980 (Bangladesh 1980)

there are 67 indicators on health status and health care delivery with their targets set for

five year periods ending in 1985, 1990,1995 and 2000. Out of these 67 indicators, over 40

indicators are directly relevant for PHC. The indicators are also very comprehensive in

1.2 Objectives of the study:

As the primary health care system is still in the formative stage of development, it would

be pre-mature and unrealistic to attempt for an impact evolution of primary health care

project. Our Job will be basically limited to a process evolution meaning to assess if right

things are in right place for attaining a right objective in terms of the delivery of primary

health care facility at the union level and below by the ministry of health and population

control.

The study will evaluate both the supply and demand as peels of primary health are and

family planning services and their limitations, especially in the rural areas of Bangladesh.

on the supply side of enquiry, the objective will be to review and assess the supply and

limitations of the services of the ministry of health and population control in the rural

areas. For this purpose a major emphasis to the study will consist of a thorough

investigation of selected union with respect to indoor, outdoor, mobile and domiciliary

services for primary healthcare and family planning as are provided to the renal

population and their limitations.

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The objectives of the study are follows:

1. To know the relationship between level of education and receiving health services.

2. To identify the administrative, financial and other issues at the centre that may

affect primary health care and family planning services.

3. To examine the knowledge about the existing medical and health service

providers, including maternal and child health centers.

4. To identify the knowledge about the existing medical and health service providers.

5. To know the status of family planning and other sources of contraceptive supplies

6. To know the attitudes of the providers toward the patients.

7. Infrastructural facilities and limitations of PHC.

1.3 Hypotheses:

1. There is a relationship between level of education and acceptance of health

service.

2. Poverty and health service are related.

3. Utilization of health care service depend on decision making power of women.

4. Primary health care service is depends on working status of wore.

5. Utilization of the healthcare service depends on environment of the clinic and

attitude of the providers.

1.5 Operational Definition

Operational definition of variables simply means defining the variables in term of specific

measurable indicators. For every variable that must be operational definition, the

researcher should first precisely define that variable that select specific indicators for

measuring the variable as defined. Operational definition is the development of specific

research procedures that will result in empirical observation representation those concepts

in the real world (Babbie1998). The operational definitions of the concepts used in this

study are given below.

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Health:

This is a state of complete physical, mental and social well being and not merely the

absence of diseases and infirmity.

Health care:

Services provided to individuals, families and communities by doctors hospitals, nurses

and other professionals to promote, restore, maintain and monitor health of all people in a

society.

Class:

A group of people with similar command over economic resources and almost commonlife- style.

Rural women:

There is a brought general consensus that the term rural refers empirically to population

living in areas of low density and to small settlements, (Encyclopedia of social science,

Vol-13-14: 582). Therefore rural women refer to those women living in rural areas.

Household:

A household is defined as a dwelling unit where one or more persons live and eat

together with common cooking arrangement. Persons living in the same dwelling unit but

having separate cooking arrangements constitute separate households.

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Chapter Two: Review of

Literature

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Chapter 2: Literature review

Introduction:

Literature Review is an important part of any research to understand the existing scenario

about the issue. It gives an idea about the issue.

2.0 Primary health care:

Health services in Bangladesh had been traditionally geared to curative care and urban

needs, and only in recent years attention has been focused on the requirements for the

rural areas. In 1961 the then Government of Pakistan introduced a scheme for setting up

Rural Health Centers (RHCs) in the rural areas. Under this scheme, one RHC was

envisaged to provide a comprehensive health care service for every thana (now upazila),

and three sub centers were envisaged to be attached to each UHC. The sub centers were

to be supported by the services of the RHC administratively and functionally. In addition,

three vertical projects, viz., malaria eradication, family planning and small-pox

eradication programs were also launched by the health sector. By 1970, 140 RHCs were

built.

After the liberation of the country in 1971, a Thana Health Complex Schemes was

approved, and the implementation of the Review of Primary Health Care.

Scheme commenced in 1972. The First Five Year Plan (1973-78) laid emphasis on

building a net work of thana Health Complex/ (THC). However due to the diversion of

the national efforts for reconstructing the war-torn economy, construction difficulties and

financing constraints, much headway could not be made in the construction of new THCs.

Due to show project performance and high inflation, a revised project proposal for the

THC was prepared and approved in 1976. According to the revised scheme, 356 THCs,

one in each of the rural thana (now 397 rural upazila), and 1,068 sub-centers were to be

established, either through new construction or conversion of the existing ones,1 by the

end of First Five Year Plan period (1973-78), for providing a number of primary health

care services to the rural population.

In August 1976, the Malaria Eradication Board was abolished and the malaria control

activities together with their grass roots level functionaries were integrated in the THC.

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By June 1980, 290 THCs, including conversion of 150 rural health centers, were made

operational with a total 3,800 beds, as against a target of 356 THCs with a total of 11,036

beds, indicating a target achievement of 84.3% for construction/conversion of THCs and

only 34.4% of operational beds. At that time 1,990 HFWC were in operation. The Second

Five Year Plan (1980-85) emphasizing on primary health care as the key approach to

ensure health for all by the year 2000 was launched in 1980-81. To materialize the above

national health objective, the main operational targets that were identified were as under:

Infrastructural development comprised the building of one health complex in each of the

397 rural upazilas by 1985, and building of one Union Health and Family Welfare Centre

(UHFWC) in each union by 1985. Each UHFWC was to cater to the basic institutional

facilities for PHC including family planning for the entire population under each union.

Upazila health complex has a three tier service delivery of health and family planning at

the (1) household (2) union and (3) upazila headquarters levels. The domiciliary services

at the household level include health education, family planning and maternal and child

health services, immunization, control of communicable and other endemic diseases, oral

rehydration etc. which constitute the kernel of primary health care. The services are

provided by FWAs and HAs at the grass roots level.

The Union Health and Family Welfare Centres (UHFWCs), conceived as the first

institutional health care facility, cover among operational responsibilities, medical care

for treatment of common and minor diseases, prevention of contagious diseases, maternal

and child health including nutrition and family planning. UHFWCs are headed by the

Medical Officer/Medical Assistant/Family Welfare Visitor.

Each UHC is to deliver three types of services: (1) in-patient facility including maternal

and child health care and family planning services (2) out-patient facility for general, as

well as, maternal and child health and family planning and (3) domiciliary services by

HAs in the health sector and by the FWAs in the population sector. In addition, there is

mobile health and family planning services organised from the UHC or higher level.

Following the administrative restructuring through decentralised administration in 1983,

the government adopted a policy to raise the status of erstwhile Thana Health Complex

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(THC) into Upazila Health Complex (UHC) with 31 functional beds with addition of

specialist services in medicine, surgery, gynecology and dentistry.

As of now, there are 2,200 UHFWCs which are currently functioning as the primary

health and family welfare centre at the union level and 341 rural upazila health complexes

which are functioning as the first referral level at the upazila. 2 At the second referral level

at the district headquarters, there arc 57 district hospitals. There are in addition 8 medical

colleges (in seven district headquarters), and -five post-graduate institutes with

specialized hospitals at the tertiary level.

There are nine elements of primary health care in Bangladesh.

1. Education concerning prevailing heath problems and methods of preventing and

controlling them.

2. Promotion of food supply and proper nutrition.

3. Adequate supply of safe water and sanitation.

4. Maternal and child health (MCH) including family planning (FP) services.

5. Immunization against major infectious diseases,

6. Appropriate treatment of common diseases and injuries.

7. Prevention and control of endemic diseases.

8. Provision of essential drugs.

9. Promotion of mental health care.

The delivery of primary health care is supposed, to be based on three main

complementary strategies (WHO 1983):

(1) Community participation

(2) Inter-sect oral cooperation and coordination, and

(3) Hospital support for PHC referral system.

nature and include such items as infant and child mortality rate, crude birth rate, crude

death rate, provision of specific services through static health centers, immunization

against and control of specific diseases, de-worming, prevention of blindness, family

planning services, food hygiene, health manpower of various cadres, availability of drugs,

health education, nutrition, water supply, sanitation, housing, education, employment and

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communication. Securing adequate information on them calls for reliable civil

registration /epidemiological surveillance and data generation /comprehensive

management information system on a regular continuous basis and a host of specialized

surveys.

2.1 Physical and Mental health:

Health is a basic need of human being. It is an important issue for both the government

and non- government organization. It is said that the purpose of evaluation in health

program and the services for delivering them. It is essential to perceive evolution as a

decision oriented tool, and to link the evolution pnocess closely with decision making,whether at the operational or policy level. Traditionally there are many research, report

and analyses about the problems, facilities and suggestions of primary health care:

It is important to understand both physical and mental health. Some matters are directly

related with the primary health (Majumder, 1999). He has pointed out both the physical

and mental health status of the people. He found that health problems affect some factors,

In his opinion: various social affecting healths of people. Such as

a) Socio-demographic factors.

b) poverty

c) Natural and environmental factor.

d) Occupational hazards etc.

In his opinion, poverty is the most important cause of the less access of the treatment. In

his opinion-in recording reasons for not seeking any treatment either for the person who

are sick or for the deceased who had died during last one year before the date of survey

within the specified reference periods, multiple reasons were registered with out any

order. While grouping the stated reasons under a few common categories, financial

incapacity of the people and the chronic of diseases inflicting long non-curable sufferings

upon patients were found to be the two major causes that led people in most occasions to

avoid treatment one of the important reasons is financial problem.

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2.2Health and Gender equality

At the policy level, the government would like to know if the health status of the people

is improving, and if revisions of health policy and strategy are required. At the managerial

and technical levels, those concerned would like to know (WHO, 2000), If relevant

programmers are being formulated and if corresponding facilities and activities for

implementing them are being adequately designed.

It discusses (Kabeer, 2005), the third millennium development goal (MDG) on gender

equality and womens empowerment and higher ways in which the indicators associated

with this goal womens access to education can contribute in health service.

There is much discusses much on the empowerment of women (Storomquist, 2002). He

discusses how the concept of empowerment has been applied in health sector. He

identified that prevalence of sickness is more with the rural females than with rural sick

malls were recoded. More than 17.0 Percent (17.4%) of the female as against 15.0 percent

of male were contently suffering at the time of the survey from various diseases in rural

areas.

2.3 Health and diseases

Although an innumerable member of diseases are known to medical science (Khan,

2000), a handful to them primarily give rise to the sicknesses to the rural people in

Bangladesh. Infectious diseases arising out of unhygienic environment, poor living

condition and poor personal hygiene play the majorrole and most of these diseases have

significant scope for prevention through appropriate public health measures.

There are some other scholars have done on this issue. In their articles showed that the

most serious health problems of mothers and children as a whole result from various

irrigated conditions, malnutritions infection, closely spaced and too frequent

pregnancies and the lack of healthcare and other social and economic condition

(Nazmunnessa Mahtab and parveen Ahmed,1999).

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2.4 Changes in health behavior:

There is also found that (Alauddin and Islam 2000), there has been some tangible changes

in the areas of sanitation, health and nutrition in the Project villages. The project has been

successful in improving the situation of safe drinking water supply and use of low cost

sanitary latrine. Besides these positive changes in preventive promotional health, a

significant contribution is the training of village health workers from among the villagers

who are responsible for health and nutrition education, child, and maternal promotion and

immunization and their activities, knowledge and consciousness of child health. This has

strengthened breast feeding practice and has increased nutritious supplementary food

intake of children and thereby has created a better health status of children. It is notablethat the contribution of the project to the promotion of health, sanitation, hygiene and

nutritional status of the village population has been reflected in the lower rates of

mortality and morbidly of the mothers and children in the project Village.

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Chapter Three:

Theoretical Framework

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Chapter 3: Theoretical framework

From the sociological point of view, social factors evaluate whether a person is healthy

or sick. In the preamble of its 1946 constitution, the world health organization defines

health as a state of complete physical, mental and social well-being and not merely the

absence of diseases and infirmity and of our continuum respondents, an ideal rather than

a precise condition. Alongside the continuum, people define themselves as a healthy or

sick based on the criteria determined by each individual, relatives, friends, colleague and

medical practioners, because health is related to various socio-political, cultural issues,

we can consider how it varies in different situations or cultures. (schaefer, 2002: 391).

This chapter attempts to expatiate upon some theoretically significant sociological

perspectives amenable to the topic so that the study entails some pertinence that the study

entails some pertinence

3.0 Germ theory of disease:

Traditionally, health has been viewed as an absence of diseases and if one was free

from disease, then the person was considered healthy. This concept known as the

biomedical concept has the basis in the germ theory of disease by Louis pasteur

(1822-1895), which dominated medical thought at the turn of the 20th country. The

emphasis had shifted from empirical causes (e.g .... bad air) to microbes as the sole cause

of disease. The concept of cause embodies in the germ theory of disease is generally

referred to as a one to one relationship between causal agent and disease. The diseasemodel accordingly is:

Disease agent Man Disease

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The germ theory of disease, though it was a revolutionary concept, is many

epidemiologists to take one sided view of disease causation. That is, they could not think

beyond the germ theory of disease. It is now recognized that a disease is rarely caused by

a single agent alone, but rates depends upon a number of factors which contribute to its

occurrence. Such as

a) Heredity

b) Environment

c) life style

d) socio economic conditions

e) Healthy and family welfare servicesf) Other factors.

3.1 Conflict theory:

The Marxian theory of class conflict appears to be relevant to the social class differences

in health and illness behavior the poor are sicker than the affluent (Maykovich, 1980:46).lower class people are likely to be exposed to physical hazards, such as: over crowded

living, poor sanitation, malnutrition. Where poverty, illiteracy, unconsciousness and

deprivation are more, there the prevalence of various diseases and related sigma and

deprivation are higher.

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3.2 Conceptual Framework:

Fig: Conceptual Framework of the study

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Age

Income

Class

Occupation

Decision making

power of women

Education

Working status of

women

Cost of services

Environment of the

clinic

Attitudes of doctors

First Aid

Free medicine

Family planning counseling

Free contraceptive supply

Delivery care

Child care

Aged people care

Adolescence care

primary healthcare servicesSocio-economic &

demographic Variables


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Dependent Variable:

Primary health care services (First aid, Free medicine, Family planning counseling, Free

contraceptive, Delivery care, child care, Aged people care).

Independent variables:

Age, class, gender, Income, occupation, cost of the service, decision making power of

women, Education, working status of women and many other may other important factors

are found as the independent variables.

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Chapter Four: Methodology

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Chapter 4 : Methodology

Quantitative technique has been used for study. A structured questionnaire has been used

to collect data. Household level samples were selected by using simple random sampling

procedure. Data were analyzed using the SPSS computer program

4.0 Why Quantitative method?

Quantitative research was developed to ensure and expanded the human relationships in

quantitative way. It is usually uses survey method and presents the data in tables, graphs,

charts, etc. It is also analyses the relationships between independent and dependent

variables by measuring various statistical ways. Thus, scientifically the hypotheses can be

tested and analyzed. From the very recent stages of development of technology,

quantitative research was popular for its numerical analysis and easy to present data. The

logic of quantitative research comes in an inductive way but in the time of generalization

it uses deductive formula. It directly generalizes the whole relations as hypotheses and

then tests every probable sample. Thus, quantitative research is more scientific, logical

and easy to conduct.

4.1 Study site and population:

This study was conducted on two unions under kapasia thana in Gajipur District,

Quantitative data were collected from every household under this village who takes

primary health care facilities from the community clinic or union health complex.

4.2 Sampling and sample size:

Sampling is the process of selecting a subset of observations from among many possible

observations for the purpose of drawing conditions about that longer set of possible

observation. (Babbie1998).

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Since sampling is an essential part of are scientific procedure, the key principle in

sampling is representative ness. The purpose of scientific sampling is to selected a few

who can be taken to represent the many,

In this study, 103 respondents were selected to collect information about the research.

They have been selected following simple random sampling procedure. Every household

of that area considered as observation unit of study. The women of each household were

the respondents of this study, on whose, it was conducted.

4.3 Sample Instruments

For conducting survey, a 39- questions structured questionnaire was used. The topics

within the questionnaire included.

o Knowledge about health issues of customary health practices.

o Knowledge about diseases and pattern of medicine use.

o Spousal Health practices based on customary health materials.

o Opportunities of modern Health facilities.

o Perception and Consequences of using customary health.

o Measuring the components of Health Belief Model.

4.4 Pre-test

Pre-testing of Questionnaires adhered to the following procedures:

o

I designed the draft questionnaire and also completing pre-testing.o Based on the pre-test findings I checked the translation, consistency and integrity

of the questionnaire. I finalized the questionnaire and showed it to my supervisor

for final approval.

o After approval of the Bengali questionnaire I then printed the Bengali

questionnaire and translated it later into English.

During pre-testing of the survey instruments, the following issues were considered:

o

The probing techniqueso The language necessary to address specific patterns and customary practices.

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o The sequences of the study

o The techniques/methods/ options for documenting responses

o Providing appropriate skips in the questionnaire.

4.5 Techniques of data collection:

Every research methods have their own instrument of date collection. In this study the

method of interview survey was adopted. This is because ease interview survey can be

used for descriptive, explanatory purpose. A well- structured interview is better than an

oral questionnaire. Interview was conducted in face-to-face situations.

4.6 Data Collection Procedures

Questionnaire was used as the main instrument for collection of data of the study.

The collection data in this study depended on the survey.

4.6.1 Administering Survey

The field work for present study was conducted for 2 days and involved quantitative

techniques and. The researcher himself along with two interviewers administered the

survey to respondents according to the sampling plan discussed above. Before

approaching the respondents, the interviewers informed the respondents that they want to

collect on customary health practices and wanted the cooperation of them.

4.7 Data Processing and Analysis

4.7.1 Quantitative Data Processing

Quantitative data processing involved the following steps:

Questionnaire registration and editing

Edit verification

Listing of open-ended responses and classification

Coding and Code transfer

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Verification of Coding and code transfer

Development of data entry structure

Data entry and entry verification

Entering data as per questionnaire structure in SPSS 16.0 version

Verifying the logic and accuracy of the data as per filled up questionnaire

Keeping and maintaining data back ups

Tabulating as per objective and recruitment in Quantum ( an upgraded version of

SPSS), also tabulating data in SPSS 16.0 version

Development of analysis plan

Program development as per the analysis plan

Program running and report generation.

4.8 Limitations of the Study:

Naturally the topics covered are very broad, and funds allocated for the study was rather

small. So, the great strides were made to obtain the best possible results through

designing of a scientifically efficient survey. Though the total size of the households

interviewed and the upazilas covered under the survey were not large, the stratification

system was so designed as to give reliable and efficient national estimates. There may,

however, still be some sampling error because of the smallness of the sample size, but the

non-sampling errors have been greatly reduced through training and retraining of the

project staff for obtaining reliable information and maintaining adequate supervisory

control on them. Possible errors at data processing stage have also been greatly reduced

through adequate planning of table design, training and supervision of the data processingstaff on a continuous basis.

Given the nature, scope and volume of the work, the project was also completed in a

reasonably short period. The project involving such a voluminous work of primary data

collection and analysis was really .J. completed within a short period of time. Because of

the nature and scope of the work and most importantly due to financial and time

constraint, some issues like investment of NGOs in the primary health care and family

planning projects and the evaluation of the multi-sect oral projects could not be

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adequately investigated. But the scope of such topics is so large that, for example,

each of the primary health care and family planning projects under the Ministry of

Health and Population Control, and other ministries/agencies may call for independent

evaluation. As the primary health care in Bangladesh is still at an infant stage, we

primarily limited our analysis to "process evaluation" with some element of "impact

evaluation". A detailed evaluation, involving assessment of some of the major indicators

for Health for All by the Year 2000 calls for further studies at a future date.

The indicators on health status and health delivery care, as set forth in the Country Paper

on Health for All by the Year 2000, are very comprehensive in nature,8 and securing

adequate information on them calls for reliable vital registration/epidemiological

surveillance/comprehensive management information system, and a host of specialized

surveys.

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Chapter Five:

Results of the study

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Chapter 5 : Results of the study

5.1: Socio-Demographic Characteristics of Respondents

Table no 1: Distribution of the respondents by age.

From the above table, it is evident that 18 of the respondents belong to age group 15-20,

31 of the respondents belong to age group 21-26 and 29.1% of the respondents belong to

age group above 32.

Frequency Percent

15-20 18 17.5

21-26 31 30.1

27-32 24 23.3

Above 32 30 29.1

Total 103 100.0

Table no 2: Distribution of the respondents by religion.

The above chart shows that 75.7% of the rerspondents are Muslim, 18.4% of the

respondents are Hindu and 5.8% of the respondents are Christian.

Frequency PercentIslam 78 75.7

Hindu 19 18.4

Christian 6 5.8

Total 103 100.0

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Table no 3: Distribution of the respondents by Educational qualification.

From the table it is evident that 18.4% of the respondents are illiterate, 21.4% of the

respondents are educated from class 1-5, 12.6% of the respondents are class 5-8, 22.3% of

the respondents are class 9-10, 25.2% of the respondents are above class 10

Frequency Percent

Illiterate 19 18.4

Class 1-5 22 21.4

Class 5-8 13 12.6

Class 9-10 23 22.3

Above class 10 26 25.2Total 103 100.0

Table no 4: Distribution of the respondents by family income

From the above figure it shows that 18.4% of the respondents have family income

between 1000-3000 taka, 63.1% of the respondents have 3001-6000 taka, 12.6% of the

respondents have 6001-9000 taka and 5.8% are above 9000 taka

Frequency Percent

1000-3000 taka 19 18.4

3001-6000 taka 65 63.1

6001-9000 taka 13 12.6

Above 9000 taka 6 5.8

Total 103 100.0

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Table no 5: Distribution of the respondents by occupation

The above table shows that 5.8% of the respondents are service holder, 88.3% are

Housewife and 5.8% are belong to other services.

Frequency Percent

Service 6 5.8

House wife 91 88.3

Others 6 5.8

Total 103 100.0

Table no 6: Distribution of the respondents by the occupation of the family head.

18.4% of the family head are service holder, 52.4% of the family head are Agriculture,

16.5% are Businessman, and 12.6% are others.

Frequency Percent

Service 19 18.4

Agriculture 54 52.4

Business 17 16.5

Others 13 12.6

Total 103 100.0

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5.2: Knowledge about Primary Health Care Center

Table no 7: Distribution of the respondents by having knowledge about Community

Clinic

The table shows that 100% of the respondents know about the clinic.

Frequency PercentYes 103 100.0

No 0 0

Total 103 100.0

.

Table no 8: Distribution of the respondents by taking health service from clinic

It shows that 100% of the respondents have taken the service.

Frequency Percent

Yes 103 100.0

No 0 0

Total 103 100.0

Table no 9: Distance of the clinic from home

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The table shows that 65% of the respondents home are distance from clinic and 35% of

the respondents home are near to clinic.

Frequency Percent

Yes 67 65.0

No 36 35.0

Total 103 100.0

5.3: Decision making power of Respondents about Health access

Table no 10: Distribution of the respondents by the permission of their husband.

The above chart shows that 47.6% of the respondents are permitted to 90 clinic, 40.8% of

the respondents are permitted from time to time, 11.7% are not permitted.

Frequency Percent

Yes 49 47.6

From time to time 42 40.8

Never permit 12 11.7

Total 103 100.0

Table no 11: Taking permission of husbands from the respondents

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From the table it is evident that 30.1% husbands take permission from their wife and

51.5% do not take permission, 18.4% take from time to time.


No 53 51.5

From time to

time19 18.4

Total 103 100.0

5.4: Primary Health facilities

Table no 12: First Aid Facilities

58.3% of said that they get first aid from clinic, 18.4% do not get and 23.3% get from

time to time.


No 19 18.4

From time to time 24 23.3

Total 103 100.0

Table no 13: Family Planning Counseling

78.6% get family planning counceling and 21.4% do not get from clinic.

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Frequency Percent

Yes 81 78.6

No 22 21.4

Total 103 100.0

Table no 14: Free contraceptive Supply.

66.0% of the respondents get free contraceptive from the clinic and 34.0% do not get.

Frequency Percent

Yes 68 66.0

No 35 34.0

Total 103 100.0

Table no 15: Child Care Facilities

77.7% of the respondents said that there are child care facilities and 22.3% said there are

no child care facilities.

Frequency Percent

Yes 80 77.7

No 23 22.3

Total 103 100.0

.

Table no 16: Antenatal Care Facilities.

89.3% of the respondents get Antenatal facilities and 10.7% do not get

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Frequency Percent

Yes 92 89.3

No 11 10.7

Total 103 100.0

Table no 17: Delivery facilities

54.4% of the respondents said that they get delivery facilities from the clinic and 45.6%

do not get.

Frequency Percent

Yes 56 54.4

No 47 45.6

Total 103 100.0

Table no 18: Infant Health facilities

76.7% of the respondents said that there are infant health facilities in the clinic and 23.3%

said no infant facilities in the clinic

Frequency Percent

Yes 79 76.7

No 24 23.3

Total 103 100.0

Table no 19: Adolescent facilities

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60.2% of the respondents said that there are adolescent facilities in the clinic and 39.8%

said no adolescent facilities in the clinic


No 41 39.8

Total 103 100.0

Table no 20: Aged Care Facilities.

55.3% of the respondents agree that there are aged care facilities and 44.7% disagree.

Frequency Percent

Yes 57 55.3

No 46 44.7

Total 103 100.0

Table no 21: Environment of the Clinic.

The chart shows 59.2% said that the environment of the clinic is healthy and 40.8% said

the unhealthy environment.

Frequency Percent

Yes 61 59.2

No 42 40.8

Total 103 100.0

Table no 22: Environmental situation of clinic for child and women

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59.2% 0f the respondents said that the environment is suitable for child and women

another 40.8% said the environment is not suitable.

Frequency Percent

Yes 61 59.2

No 42 40.8

Total 103 100.0

Table no 23: Free Medicine Supply.

12.6% of the respondents get free medicine from clinic, 87.4% of the respondents do notget.

Frequency Percent

Yes 13 12.6

No 90 87.4

Total 103 100.0

Table no 24: Instrument Facilities.

The table shows 12.6% of the respondents said that there are necessary instruments in

hospital and 52.4% said there is no instrument and 35% do not know.

Frequency Percent

Yes 13 12.6No 54 52.4

Don't know 36 35.0

Total 103 100.0

Table no 25: Free Diagnosis Test Facilities.

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The chart shows that 17.5% of the respondents get free test facilities and 82.5% of the

respondents do not get.

Frequency Percent

Yes 18 17.5

No 85 82.5

Total 103 100.0

Table no 27: Attitudes of the Doctors.

The chart shows that 30.1% of the respondents are satisfied about the behavior of the

doctors and 69.9% are not satisfied.

Frequency Percent

Yes 54 52.4

No 49 47.6

Total 103 100.0

Table no 28: Complain against the Doctor

47.6% of the respondents have objection against the doctor and 52.4% do not have any

objection.

Frequency Percent

Yes 49 47.6

No 54 52.4

Total 103 100.0

Hypothesis no 1: There is a relationship between level of education and acceptance

of health care service.

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Cross tabulation

Educational qualification

TotalIlliterat

eClass1-5

Class5-8

Class 9-10

Aboveclass 10

Do you

receive

necessar

y service

from

your

local

health

care

centre?

Yes 19 11 0 17 13 60

No 0 0 13 0 6 19

From

time to

time

0 11 0 6 7 24

Total 19 22 13 23 26 103

Directional Measures

Value

Asymp

. Std.Error(a

)

Approx

. T(b)

Approx.

Sig.

Nominal

by

Nominal

Lambda Symmetric .250 .074 3.011 .003

Q12

Dependent.302 .070 3.857 .000

Q3

Dependent.221 .095 2.089 .037

Goodman

and

Kruskal

tau

Q12

Dependent.388 .025 .000(c)

Q3

Dependent .166 .030 .000(c)

A Not assuming the null hypothesis.

B Using the asymptotic standard error assuming the null hypothesis.

C Based on chi-square approximation

Symmetric Measures

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Value Approx. Sig.

Nominal by

Nominal

Phi.925 .000

Cramer's V .654 .000

ContingencyCoefficient

.679 .000

N of Valid Cases 103

A. Not assuming the null hypothesis.

B. Using the asymptotic standard error assuming the null hypothesis.

Hypothesis no 2: poverty and health care service are related.

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Cross tabulation

Monthly family income Total

1000-3000

taka

3001-

6000

taka

6001-

9000

taka

Above

9000

takaPrimary

health

from

commu

nity

clinic

Ye

s

19 35 6 0 60

No 0 13 0 6 19

Fr

o

mti

me

to

ti

me

0 17 7 0 24

Total 19 65 13 6 103


Value

Asymp. Std.

Error(a

)

Appro

x. T(b)

Approx.

Sig.

Nominal

by

Nominal

Lambda Symmetric .086 .050 1.626 .104

Q12

Dependent.163 .093 1.626 .104

Q4

Dependent.000 .000 .(c) .(c)

Goodman

and

Kruskal

tau

Q12

Dependent.227 .021 .000(d)

Q4

Dependent.095 .021 .000(d)



C. Cannot be computed because the asymptotic standard error equals zero.

D. Based on chi-square approximation

Symmetric Measures

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Value Approx. Sig.

Nominal by

Nominal

Phi.687 .000


ContingencyCoefficient

.566 .000




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Hypothesis no 3: Access to primary health care service depends on working

status/professional status of women.

Cross tabulation

Occupation of the

respondent

TotalService

House

wife Others

Primary

health

care

from

commun

ity clinic

Yes 0 54 6 60

No 6 13 0 19

From

time to

time0 24 0 24

Total 6 91 6 103


Value

Asym

p. Std.

Error(a) Approx. T(b) Approx.Sig.

Nominal

by

Nominal

Lambda Symmetri

c.109 .037 2.524 .012

Q12

Dependen

t

.140 .053 2.524 .012

Q5

Dependen

t

.000 .000 .(c) .(c)

Goodman

andKruskal

tau

Q12

Dependent

.139 .012 .000(d)

Q5

Dependen

t

.132 .067 .000(d)



C. Cannot be computed because the asymptotic standard error equals zero.

D. Based on chi-square approximation

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Symmetric Measures

Value Approx. Sig.

Nominal byNominal Phi .558 .000


Contingency

Coefficient.487 .000




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Hypothesis no 4: utilization of health care depends on environment of the clinic and

attitudes of the service providers.

Cross tabulation

Environment of the

community clinic

TotalYes No

Primary

healthcare

from

communit

y clicnic

Yes 48 12 60

No 13 6 19

From time

to time 0 24 24

Total 61 42 103


Value

Asym

p. Std.

Error(

a)

Appro

x. T(b)

Approx.

Sig.

Nominalby

Nominal

Lambda Symmetric

.424 .093 3.685 .000

Q12

Dependen

t

.279 .118 2.040 .041

Q21

Dependen

t

.571 .076 5.594 .000

Goodman

and

Kruskaltau

Q12

Dependen

t

.246 .063 .000(c)

Q21

Dependen

t

.449 .066 .000(c)



C. Based on chi-square approximation

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Symmetric Measures

Value Approx. Sig.

Nominal byNominal

Phi .670 .000


Contingency

Coefficient.557 .000




45


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Chapter 6: Discussion

In a low income country like Bangladesh where illiteracy and endemic poverty are too

predominant and the general health standard of the population is too low resulting in high

mortality (both infant and child and adult) and incidence of diseases are also widespread,

the government assumes the responsibility to provide basic health care facilities to the

vast majority of rural population at a low and acceptable cost. Thus along with the

government's stated objectives of providing primary health care to the population, a large

number of projects and programmes have recently surfaced which are national in

character.

Although an innumerable number of diseases are known to medical science, a handful of

them primarily give rise to the Sicknesses to the rural people in Bangladesh. Infectious

diseases arising out of unhygienic environment, poor living condition and poor personal

hygiene play the major role and most of these diseases have significant scope for

prevention through appropriate public health measures.

For older people aged 55 and above, the earlier five diseases as mentioned in Section

6.22.come up again as the most important causes of sicknesses. The additional cause of

suffering to the elderly is the complicacies due to old age. For older people rheumatism is

the most important cause of sufferings followed by lungs and respiratory diseases, old age

complicacies and diarrhea diseases. Skin disease accounting for a major cause of

sufferings of all persons assumes a low significance for the older people.

In recording reasons for not seeking any treatment either for the persons who were sick or

for the deceased who had died during last one year before the date of survey within the

specified reference periods, rnultjple reasons were registered without any order. While

grouping the stated reason sounder a few common categories, financial incapacity of the

people and the chronicity of diseases inflicting long non-curable sufferings upon patients

were found to be the two major causes that led people in most occassions to avoid

treatment. Of the total reasons stated 42.6 per cent fall under the category of financial

problem and 31.0 percent in the other category of chronicity or non-curable nature of the

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diseases. Looking closely into the reasons for non-treatment, financial problems figure

out as the over whelming reason for the same. Besides financial, all other reasons may be

basically classified as "attitudinal".

In theory the demand for health care services to a population should be universal. The

attack of a disease bring enormous mental and physical pressure upon a person. Illness

can result into loss of working days and inefficiency in work performance, and financial

loss, as well, for the working adult persons. Thus, an onset of disease logically calls for

treatment to control the ill effects of the disease.

Ideally, therefore all sick persons should seek treatment for recovery. But in reality it may

not follow in some societies due to a few practical situations. The situations that can lead

to lack of demand for treatment could be both subjective and objective. Cultural

disapproval for medicine or for any deliberate effort exist in some societies causing non-

treatment to the sicknesses. Or it may be that people who believe in medicine are eager to

receive it while they fall sick but a few objective conditions do not allow them to take any

treatment, Under both circumstances, the actual demand for medicine for treatment could

be substantially below the demand that ideally should be.

In rural areas of Bangladesh the cultural barriers to treatment still seem to persist. Besides

other reasons which can be classified as cultural, 5,0 per cent of the reasons reflected

disapproval for the medical treatment. The pervasive objective condition for not seeking

treatment for ailments centre around financial problem.

The above discussion indicates to a fact that alongwith the need for treatment there is

large latent demand for treatment in the rural area of Bangladesh, Both socio-cultural and

financial problems had helped to sustain a low demand for health services. A low demand

for health services. Through adoption of appropriate policy measures the demand for

health services in rural Bangladesh can be greatly increased.

Community participation, though an essential ingredient of primary health care including

family planning, is still in a very rudimentary stage in Bangladesh. Instead of standing on

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their own legs and trying to influence their own and community's destinity through their

own initiatives, people have on the whole been passive recipient of aid and victims of

decisions taken for them from the top. People's participation in health and family

planning has also been miscarried through "village health and family planning

committees" and the NGO activities. The village level population committees in most

cases have either not been formed or have remained inactive. The major reasons for non-

functioning of population control committees are lack of financial or other incentives.

Lack of decentralized authority and clear cut responsibilities of the committee members

also serve as contributing factors for non-functioning of the population control

committees. At the union level or below there is no health committee at all.

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Chapter Seven:

Conclusion and Recommendation

Chapter 7: Conclusion and Recommendation

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Conclusion:

To ensure health facilities all is one of the main tasks of the government. Good health

means not only absence of diseases; it also includes physical, mental and social fitness.

Bangladesh government time and again tried to assure the minimum health service to the

people but it is due to uncontrolled population growth, poor economy, wealth, no

significant progress in the health service could have been guarantee for the majority of the

population. However, in connection with the utilization of health centers in rural areas a

few observations are worth mentioning. If is observed that lower landholding size groupand the females utilize the government health centers in higher proportion than the higher

landholding size groups and males, respectively. Reasons behind the situation are that the

rich people of rural areas and males are economically independent and they can go abroad

without any hindrances. But poor people especially females are usually depends on their

male member of family for their basic needs including health service. Presumably the

higher income group resorts to private practice group resorts to private practice of the

government doctors with the expectation of receiving a larger share of the limited

facilities from the government health centers. It is also worth noting that the private

qualified practitioners are more popular in relative proportions among the middle class

people. It is worth noting that the government doctors play a government role in the

private sector providing quality health services. This indicates in rural areas has benefited

most the unprivileged or disadvantaged group in the society.

Recommendation:

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Although this study was carried out among the women of particular localities in Gajipur,

Kapasia but finding of this study are found very important. The findings of the concerned

report may be summarized in the following manner:

1. From the headquarters level down to the institute/ training area level, the program

should be more properly coordinated with a rigorous management thrust.

Supervision should be frequent and a system of monitoring and feedback should

be instituted and maintained on a continuous basis. Among with other things, a

proper project information system should be devised and be strictly adhered to.

Standard methods of training evolution and programming should be evolved.

2. Lack of transport facilities is a major constraint to take delivery of supplies from

the district to the upazila, transportation condition should be better.

3. The total responsibility of the action program for health and family planning

including MCH will be vested on the ministry of Health, and the ministry will

recognizes itself to meet its mew obligations effectively.

4. Keeping in view the resource constraints of our country, free medical care can not

be provided to all people. So we recommended the imposition of a system of cost

sharing by the well to do people. We also recommended to; examine the cost

feasibility of the installation of mini generator in the health complex for regular

supply of electricity.

5. A large majority of the health complex badly suffer from inadequate supply of

stationary goods and furnitures, pen, ink, paper, chair, table, admiral, type writer,

calculators. Functional x-ray machines, ambulance and blood-bank are almost

totally non-existence. There should be adequate provision of maintenance of all

equipments and furniture.

6. There are so many complain that the attitude and behavior of the providers (Nurse,

doctor) is irritating towards. That the patients do not fell comfort to get services.

So, the behavior of the providers should be changed.

7. Women must have the rights to get services according to their own demand.

8. The institutes do not have sufficient logistics and staff strength and another

significant shout coming of the program is that the trainers not sufficiently skilled

and are not duly motivated.

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References

53


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References

Khan, M.R (2000) Evaluation of primary health care and family planning facilities in

rural areas of Bangladesh, Bangladesh institute of rural development studies.

Ruth, Simons (1999), Strengthening government health and family planning

programmes: findings from an action research project in rural Bangladesh, In studies in

family planning, vol.15.N.5

Babbie, Earl (1990), Survey research methods, Califronia: world worth publishing

company.

Constitution of the Peoples Republic of Bangladesh (1972),The Bangladesh Gazette,

Extraordinary, part IV, October.

Bangladesh Ministry of health and family planning (1976), Health division,

Establishment of Thana health complex, 1976: A plan for Delivery of Basic health care to

the people of Bangladesh, P:69.

Bangladesh country report (1985), Evaluation of the strategies for health for all by the

year 2000 using a common framework and format, Dhaka.

Hossain, Zakir (1998) , Population growth and health needs in ESCAP, Population of

Bangladesh, country monograph series No.8, unifiednations, New York.

Giddens, Anthony (2006) , Sociology; Vol 1; p:172

Anwar, M: Rob, U (2006) , Inequalities in healthcare utilization in rural Bangladesh

International Quarterly of Community Health Education, Vol-27, No.4

Khan, M.A (2000), Health services structure of BangladeshBangladesh Development

Studies, Vol-xII, No, 1,p:65

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Majumder, M.A(2000), Physical and mental status of the people The Internet Journal

of Health 2009, Vol-8, No.2. p:56

Aziz, K.M.A (1999), Recent trends in medical consultation prior to death in rural

Bangladesh Bangladesh Medical Journal, Vol- 6, No- 1,P;58-60

Beguem, Sharifa(2009), Status of primary health care in Bangladesh specially in the

rural areas The Internet Journal of Health , Vol-08, No-2,p:44

Haque, N,(2006) Demand for health care service Middle Journal of Family

Medicine.Vol-7,p:21

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Appendix

Di`vxi bvgtb^

i

ck Di

1. Avcbvi eqm KZ? 15-20 .................1

56


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21-26..................227-32 .................332 Gi Dci..........4

2. Avcbvi ag wK? Bmjvg ..................1

wn`y .....................2wLvb ...................3e ....................4Abvb ..................5

3. wkvMZ hvMZv AwkwZ ................1

1g -5gkYx ..........25g- 8gkYx ..........39g- 10gkYx .........410g kYxiDci ......5

4. cwievii gvwmK Avq 1000-3000UvKv......13001-

6000UvKv ......26001-9000UvKv .....39000 nvRviiDci ..4

5. Di`vxi ckv PvKzwi.......................1Mwnbx ......................2KwlKvR....................3Abvb .....................4

6. cwievi cavbi ckv PvKzwi ......................1Kwl .........................2eemv.......................3

Abvb .....................4

57


58/61

7. Avcbvi GjvKvq wK Kvb KwgDwbwUwKwbK AvQ?

nvu ..........................1bv ...........................2Rvwbbv................

.......38. Avcwb wK mLvb KLbv mev wbZ

wMqQb?nvu ...........................1bv ............................2

9. wKwbKwU wK Avcbvi evmv _K `~i? nvu ...........................1bv ............................2

10. wKwbK hvIqvi Rb Avcvbvi ^vgx wK

AvcbvK memgq AbygwZ `b?

nvu ....................

....1gvSgvS`b ........

...2KLbv `bbv ..........3

11. wKwbK hvIqvi Rb Avcbvi ^vgx wKKLbv Avcbvi KvQ _K AbygwZ bb?

nvu ........................1bv .........................2gvSgvSbb............3

12. mLvb _K wK Avcwb cqvRbxqcv_wgK wPwKrmv cq _vKb?

nvu .........................1bv ..........................2gvSgvS ................3

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13 mLvb _K wK cwievi cwiKvbvicqvRbxq civgk Ìqv nq?

nuv .........................1bv ..........................2

14. mLvb _K cwievi cwiKbvi cqvRbxqmvgMx wK Ìqv nq?

nvu .........................1bv ..........................2

15. mLvb _K wK wkì cqvRbxqwPwKrmv Ìqv nq?

nvu .........................1bv ..........................2

16. wKwbK _K wK MfKvjxb Kvb mevÌqv nq?

nvu ..........................1

bv ...........................217. mLvb _K wK cmeKvjxb mev c`vb

Kiv nq?nvu ..........................1bv ...........................2

18. bveRvZK wk i wK cqvRbxq mev Kivnq?

nvu ...........................1bv ...........................2

19 mLvb _K wK wKkvix i Kvb mev

c`vb Kiv nq?

nvu ....................

......1bv ...........................2

20. mLvb wK eq jvKi Kvb wPwKrmvieev AvQ?

nvu ..........................1bv ...........................2

21 ^v Kì cwiek wK ^v mZ? nvu ..........................1bv ...........................2

22. ^v Kè cwiek wK bvix I wkeve? nvu ...........................1bv ............................2

23 mLvb _K cqvRbxq Jlya wK webvg~j mieivn Kiv nq?

nvu ...........................1bv ............................2

24 mLvb wK chv cwigvb hcvwZAvQ?

nvu ...........................1

bv ............................2

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Rvwbbv ......................3

25 mLvb wK webvg~j cixv Kiv nq? nvu ...........................1bv ........................

....226 ^vmev c`vbKvix wPwKrmv c`vbi

ci wK LuvR Lei bb?nvu ...........................1bv ............................2

27 Avcwb ^vmev c`vbKvixi AvPibmK wK m?

nvu ...........................1bv ............................2

28 Zvi AvPib mK wK Avcbvi Kvb

AwfhvM AvQ?

nvu ....................

.......1bv ........................

....229 AwfhvM Kij wK Kvb DcKvi cvIqv hvq? nvu ....................

......1bv ...........................2

Acknowledgements

I received understanding support for writing this monograph from different sections. I am

very much grateful to them for their utmost help and substantial support. I express my

profound gratitude to Dr. Shah Ehsan Habib who is my course teacher. It is he, without

whose proper guidelines, it was not possible to complete this research work successfully.

He always allowed me for the access to him in expenses his valuable time for any sort of

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my need relating to my research work, when required, His scholarly instructions shall

remain in my heart for ever.

In acknowledge highly my indebtedness to my teacher for his cooperation, guidance, and

advice. When I was in trouble he sincerely and cordially helped me to understand.

I would like to extend my heartful thanks to the respondents of this.

Finally I thanks all those who helped me divergently and indirectly in my work.

Date 19-12-09

the status of healh of the poor people of gazipur district of bangladesh

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