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Rahman, Syed Azizur
Languages: English
Types: Doctoral thesis
This thesis is about the Utilisation of \ud Maternal \ud and \ud Child \ud Health Care \ud Services (MCH) in \ud Rural Bangladesh. Investigations have been made to identify the \ud underlying \ud causes of \ud low \ud use \ud of the MCH services provided through the \ud public sector \ud health \ud care \ud facilities, \ud which \ud is \ud a \ud major concern for the government of Bangladesh. This thesis focuses \ud on \ud the factors that \ud are \ud affecting the use of MCH services both from \ud population \ud and provider perspectives. \ud Socio-economic condition of people, their knowledge and attitudes towards the \ud public \ud sector \ud health \ud care services are considered as population \ud factors, \ud while \ud different \ud aspects \ud of quality of public \ud health services, access to the service facilities and \ud provider's \ud behaviour \ud are \ud explored \ud as the \ud providers' factors. \ud Aims: The aim of this research was to \ud provide policy recommendations \ud for improving \ud utilisation of the public health services at the \ud primary \ud health \ud care \ud level by \ud redesigning \ud more \ud accessible, acceptable and quality health care services, especially \ud for \ud rural women and \ud children. \ud Scope: Maternal health services: antenatal care; tetanus \ud vaccination; place \ud of child \ud delivery; \ud and postnatal care are considered in this study. \ud While two \ud major \ud killer diseases: \ud diarrhoea \ud and \ud acute respiratory infections, and immunisation of children under \ud five \ud years of \ud age are \ud included as child health care services. \ud Methods: A combination of qualitative and \ud quantitative methods \ud are used to \ud collect \ud data /information from 360 mothers, 28 formal and \ud informal \ud community \ud leaders, 44 \ud various \ud types \ud of health care providers and 22 public sector \ud facilities in \ud a \ud rural \ud area \ud of \ud Bangladesh. \ud The \ud World Health Organisation (WHO) recommended \ud 30 \ud cluster \ud sampling method \ud was used \ud in \ud sample design. Household survey, in-depth interview, informal \ud and \ud formal \ud discussion, \ud participant observation and document analysis \ud have been \ud carried \ud out to \ud obtain \ud necessary \ud information/data. \ud Data analyses: The quantitative data have \ud been \ud analysed \ud by \ud using \ud STATA \ud and \ud SPSS \ud statistical computer programme, performing \ud descriptive, bivariate \ud and \ud logistic \ud regression \ud analysis. The qualitative information has been \ud analysed \ud in \ud a \ud descriptive \ud way. \ud Results: The results show that the use of government \ud health facilities: \ud THC, \ud FWC \ud and \ud VHCP \ud is generally very low with an exception of \ud the \ud use \ud of \ud VHCP for \ud TT\ud vaccination \ud to \ud women \ud and \ud child immunisation. The use of VHCP is \ud encouraging \ud for the \ud government \ud policy makers and \ud planners. THC is partially meeting the \ud health \ud care need \ud of rural \ud people \ud and mainly \ud serving the \ud interest of people of relatively high socio-economic condition. \ud FWC is the \ud most unused \ud health care facility at the rural areas of Bangladesh. \ud The \ud majority \ud of people \ud (86%) \ud received \ud health \ud care from non - qualified health care providers. \ud Among the socio-economic factors \ud - \ud family \ud education \ud and \ud income \ud were \ud found to \ud be \ud significant both individually and jointly with the \ud variations of use \ud of \ud MCH \ud services. \ud The majority of the sample population \ud does \ud not \ud have knowledge \ud about the \ud MCH \ud service \ud availability and possessed negative attitudes \ud towards the \ud public \ud sector \ud MCH \ud services. \ud These \ud are attributable to the under utilisation problem. \ud Nine \ud gaps \ud have been identified \ud between \ud peoples' `reasonable expectation' and the `existing' MCH \ud service \ud delivery \ud system. \ud Peoples' \ud involvement in the health service organisation at the thana \ud and union \ud level \ud was \ud found \ud almost \ud nil. However their involvement in the operation of \ud VHCP \ud was encouraging. \ud Low \ud (2-3 \ud minutes) consultation time, lack of privacy \ud in treatment, \ud unregulated \ud involvement \ud of public \ud sector provider in private practice, lack of \ud accountability, \ud supervision and \ud improper behaviour \ud of providers deteriorating the quality \ud of services \ud hence decreases the \ud use \ud of \ud public sector \ud facilities. Unavailability of drug was found to \ud be the \ud single most \ud important \ud reason that \ud deters \ud people from using public facilities. Difficulties in \ud access to \ud quality services \ud were \ud found to \ud be \ud a major problem than access to the service \ud facilities. \ud Conclusions: This thesis suggests that giving priority \ud to improving the \ud service \ud qualities of \ud the \ud existing facilities rather than construction/development \ud of additional \ud facilities \ud at \ud PHC level. \ud It also suggests the initiation of behaviour change \ud programmes \ud for \ud public \ud sector \ud health \ud care \ud providers. Secondly an effective mechanism needs \ud to \ud be developed to \ud ensure \ud peoples' \ud involvement in the management and operation of public \ud health \ud care \ud facilities to \ud enhance \ud accountability of public sector provider \ud to the \ud population and reduce \ud the \ud gap \ud between them. \ud Initiatives could be taken to improve the \ud quality \ud of non-qualified \ud health \ud care \ud providers, \ud as \ud they are the main source of health care \ud for the \ud majority of population. \ud Finally, increasing the \ud education level of rural population particularly \ud for \ud women \ud could \ud increase the \ud use of \ud health \ud services.
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