Factors affecting the healthcare utilization from Shasthyo Suroksha Karmasuchi scheme among the below-poverty-line population in one subdistrict in Bangladesh: a cross sectional study

Hasan, Zahid; Ahmed, Minhajuddin; Mehdi, Gazi Golam; Khan, Jahangir; Islam, Ziaul; Chowdhury, Mahbub Elahi; Ahmed, Sayem

doi:10.1186/s12913-022-08254-1

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…Geographic exclusion encompasses social and physical dimensions, an aspect that social protection programs often overlook in program designs. Despite its seemingly obvious role in accessibility, eight initiatives failed to consider how the lack of transportation and long distances to access points might limit uptake by the poor [ 32 , 39 , 54 , 61 , 64 , 68 , 69 ]. The program designs of India’s Targeted Public Distribution System and the Nepal Food Corporation required the destitute to travel to far, often centrally-located, ration shops at their own expense, incurring high transaction costs [ 38 , 43 , 46 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

South Asia’s unprotected poor: A systematic review of why social protection programs fail to reach their potential

Javed,

Mumtaz

2024

PLOS Glob Public Health

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The incongruity between South Asia’s economic growth and extreme poverty has led to a growing interest in social protection and subsequent implementation of anti-poverty initiatives. However, many programs have consistently fallen short of their full potential in reaching the poor. We reviewed the literature to understand the factors behind this failure. A search of EconLit, Global Health Database, MEDLINE and SocINDEX, supplemented by an external search, yielded 42 papers evaluating 23 programs. Inclusion criteria included social and political determinants of program outcomes. Articles were assessed for quality using the GRADE and GRADE CERQual criteria and analyzed using Thomas & Harding’s thematic synthesis approach. We identified five themes: (1) structurally flawed program theories overlook the complexities of poverty and are rooted in simplistic cause-and-effect approaches; (2) elite capture through appropriation of benefits, powerful positioning in program implementation, and gatekeeping through relationships of patronage; (3) insufficient targeting strategies to reach the poorest; (4) neglect of gendered restrictions, hidden costs, lack of legal documentation, and physical and social exclusion; (5) active self-exclusion from social protection to maintain dignity, a perception that programs are substandard, and a lack of resources required. The review highlights the well-documented disconnect between South Asian social protection program designs and the ground realities of their ‘ideal’ beneficiaries. This stems from a dominance of Western-led poverty discourse that disregards the influence of caste, the challenge of effective engagement with a group whose identity remains unclear, and fast-paced funding calls that do not lend themselves to meaningful identification and collaboration with the invisible poor. We suggest this disconnect is intentional and reflects a broader power dynamic rooted in geopolitical interests and national priorities. Study limitations reflect the shortcomings of the existing literature, which largely uses quantitative research methods that fail to capture the multidimensional experiences of the poor.

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Section: Resultsmentioning

confidence: 99%

South Asia’s unprotected poor: A systematic review of why social protection programs fail to reach their potential

Javed,

Mumtaz

2024

PLOS Glob Public Health

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“…Geographic exclusion encompasses social and physical dimensions, an aspect that social protection programs often overlook in program designs. Despite its seemingly obvious role in accessibility, eight initiatives failed to consider how the lack of transportation and long distances to access points might limit uptake by the poor [34,38,43,53,68,71,77]. The program designs of India’s Targeted Public Distribution System and the Nepal Food Corporation required the destitute to travel to far, often centrally-located, ration shops at their own expense, incurring high transaction costs [37,54,63,64].…”

Section: Resultsmentioning

confidence: 99%

South Asia’s unprotected poor: a systematic review of why social protection programs fail to reach their potential

Javed,

Mumtaz

2023

Preprint

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The incongruity between South Asia’s economic growth and extreme poverty has led to a growing interest in social protection and the subsequent implementation of anti-poverty programs. These work to promote inclusive growth and ensure that the poor do not get left behind. However, many programs have systematically failed to achieve their full potential in reaching the poorest of the poor. We reviewed the literature to understand the determinants behind this inequity in South Asia.A search of four databases, EconLit, Global Health Database, MEDLINE, SocINDEX, supplemented by citation tracking and an external search, yielded 42 papers evaluating 23 social protection programs. All articles were assessed for quality using the GRADE and GRADE CERQual criteria. Data were analyzed using Thomas & Harding’s thematic synthesis approach to generate new higher-order interpretations.Our analysis identified five themes underscoring program processes that stop resources from reaching the poor. These include: (1) structurally flawed program theories that overlook the complexities of poverty and are instead rooted in simplistic cause-and-effect approaches overestimating the poor’s gain from participation; (2) elite capture of program resources through the direct appropriation of benefits, their powerful positioning in program implementation, and their ability to dictate the poor’s accessibility through relationships of patronage and withholding of information; (3) insufficient targeting strategies to reach the poorest and a subsequent redirection of resources toward the rich; (4) program designs that overlook gender-based restrictions, hidden costs, the poor’s lack of legal documentation, and their physical and social exclusion; (5) some of the poorest households actively choosing self-exclusion from social protection due to a desire to maintain dignity, a lack of capital, and a perception of programs as substandard.The review highlights the disconnect between social protection program designs and the ground realities of their ‘ideal’ beneficiaries: the poorest of the poor. We propose the persistence of this well-documented disconnect may stem from three sources. First, there is an unclear understanding of who the poor are in South Asia, with definitions overlooking the historical influence of the caste system. Western perceptions of poverty continue to dominate the discourse. The second challenge is effective engagement and co-production of knowledge with the poor. Lastly, despite encouragement of international collaboration, fast-paced funding calls do not allocate sufficient time to build relationships with the poor primary stakeholders. We suggest the possibility that maintenance of this disconnect is intentional, reflecting a broader power dynamic in which the global and local elite dictate the lives of the poor based on geopolitical interests and national priorities.

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“…The mean satisfaction score in our study was higher than that in a study conducted to assess satisfaction with the service quality of UzHCs among the uninsured population (3.17 vs 2.75) [ 44 ]. The SSK scheme provides health care to members through selected UzHCs; however, compared with nonmembers, insured patients are supposed to receive all prescribed medicines and diagnostic services from private providers contracted by the scheme [ 13 ]. The situation is different for other UzHCs where the SSK scheme is not being implemented.…”

Section: Discussionmentioning

confidence: 99%

“…Although the scheme provides free inpatient care services to the member households, the health care utilization under the SSK scheme is notably low. A study revealed that less than half of the beneficiary households used health care services under the SSK scheme [ 13 ]. Several factors may contribute to this low utilization rate.…”

Section: Introductionmentioning

confidence: 99%

Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study

Hasan,

Rabbani,

Akter

et al. 2024

JMIR Form Res

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Background Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients’ experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients’ socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians’ behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses’ behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility.

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Factors affecting the healthcare utilization from Shasthyo Suroksha Karmasuchi scheme among the below-poverty-line population in one subdistrict in Bangladesh: a cross sectional study

Cited by 8 publications

References 33 publications

South Asia’s unprotected poor: A systematic review of why social protection programs fail to reach their potential

South Asia’s unprotected poor: A systematic review of why social protection programs fail to reach their potential

South Asia’s unprotected poor: a systematic review of why social protection programs fail to reach their potential

Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study

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