Impact evaluation of contracting primary health care services in urban Bangladesh

Abstract

Background: The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness. Methods: The effect of the project was estimated through propensity score matching between project and nonproject areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation. Results: Over the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased. Conclusions: UPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.

Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review

“…NGOs increased population access to health services, particularly for vulnerable and poor or people with a specific disease, by using strategies and interventions through community participation. Seventy-tree studies focused on population coverage [ 29 – 102 ] by NGO’s participation. Out of this, 18 focused on population coverage through community participation, and 69 studies explicitly related to service provision for vulnerable and poor or patients with a specific disease.…”

“…NGOs have improved and promoted the health of their communities through the establishment of primary health centres, laboratory service, training community health workers to screen for and manage chronic hypertension, providing maternal and newborn health services, providing medical services for children with cancers, providing mental health services through community-based rehabilitation, prevention and treatment groups received growth monitoring, referrals to public health facilities, home-based counselling and providing mid-day meals for primary school students and adolescents [ 34 , 51 , 70 , 71 , 74 , 91 , 93 , 95 , 96 , 99 ]. For example, in Bangladesh, NGOs provided clinical education, vaccination, reproductive health (antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections), child and infants health services (child diarrhoea), acute respiratory infection and HIV/AIDS awareness [ 29 , 35 , 36 , 47 ]. In India, an NGO was contracted to deliver basic health services, including simple curative care, referral for more complex cases, identification and registration of pregnant women, perinatal care, referral for a complicated pregnancy or high-risk births, essential child health care, assistance with immunisation and other national programmes, and the conduct of health camps for outreach and health education provided [ 45 ].…”

“…In many countries, the poor still have limited access to essential health care, and NGOs are increasing access to health services because of their ability to design population-based projects. NGOs are also in a position to implement prevention programs with the potential to reach vulnerable social populations, and the use of innovative approaches such as the caregiver approach can be a promising alternative to existing strategies to provide critical health care to disadvantaged communities [ 29 , 30 , 32 , 56 ]. NGOs have sought to fill a gap in the Pakistani public sector due to a lack of healthcare providers’ access.…”

The Awareness and Attitude of Contracted Service Among General Medical Practitioners in Community Health Service Centers in Urban China: A Cross-Sectional Study

“…CS for improving primary healthcare is implemented not only in China but also in other places, such as Bangladesh ( 11 ), Tanzanian ( 12 ), and Brazil ( 13 ). However, there are obvious differences in CS between these countries and China.…”

Economics of healthcare access in low-income and middle-income countries: a protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents

“…The Urban Primary Healthcare Programme project, implemented by the government of Bangladesh, has positively influenced health outcomes for the urban poor in the country. 25 NGOs have frequently led the way in providing healthcare services for slumdwellers, leading to some reduction in intraurban disparities, particularly in terms of reproductive health. 26 While this pluralism of providers may improve physical access of poor urban communities to healthcare, several studies have described the barriers faced by slum-dweller on the pathway to health services.…”