Responsiveness of the urban primary health care delivery system in Bangladesh: A comparative analysis

Abstract

This study analyses the responsiveness of outpatient care to assess the quality of urban primary health care among all 5 types of health care providers in Bangladesh, namely, the Urban Primary Health Care Services Delivery Project, the NGO Health Services Delivery Project (NHSDP), NGOs, private hospitals, and the Ministry of Health and Family Welfare (MOHFW). Other than some public-private comparisons, there is an absolute knowledge gap regarding responsiveness in urban health systems, particularly in the context of Bangladesh, and this gap motivates this study. The study used primary data collected from 810 randomly selected outpatients. The survey used a structured questionnaire on all 7 domains of responsiveness of outpatient care suggested by the World Health Organization. The estimated mean responsiveness score reveals that overall, approximately 33% of the patients rated the responsiveness of the system as poor. In reported responsiveness, the NHSDP was ranked at the top and the MOHFW at the bottom. The latter is quite expected. Overall, prompt attention and autonomy were the worst-performing domains, and choice of provider, dignity, and clear communication were the better-performing ones. The results suggest the need to improve the degree of responsiveness of all domains, especially those that are more concerned with access to health care, namely, prompt attention, dignity, clear communication, and confidentiality. The Ministry of Health and Family Welfare facilities should give additional consideration to promote prompt attention, autonomy, and quality of basic amenities. Private facilities should also provide additional stress on improving prompt attention and autonomy. The nontherapeutic quality of health care needs to be emphasized in the medical education system. Further research based on household surveys could be worthwhile to measure responsiveness more comprehensively.

Assessment of Clients’ Perceived Satisfaction and Responsiveness of Outpatient Health Care Services Within the National Health Insurance Scheme at University of Nigeria Teaching Hospital, Enugu State, Nigeria

“…Similarly, as observed by previous studies in the country, this study found that the respondents in this survey rated their contentment with this domain highest in the NHIS. In accordance with previous reports elsewhere, the domain of dignity assures users of health care services that they would receive care in a respectful, caring and non-discriminative manner (Liabsuetrakul et al, 2012;Yakob & Ncama, 2017;Chao et al, 2017;Daneshkohan et al, 2018;Hamid & Begum, 2018). Thus, the findings of this study indicate that the clients were treated with some respect by providers of health care services at UNTH.…”

“…This is consistent with reports in other parts of Nigeria where communication was found to be of high importance to clients (Adesanya et al, 2012;Ughasoro et al, 2017). Studies in Ethiopia, China and Bangladesh also rated this domain high (Chao et al, 2017;Yakob & Ncama, 2017;Hamid & Begum, 2018). Furthermore, previous reports indicate that this communication need to be carried out using a comprehensive approach which allows the patient to seek further clarifications through follow-up questions (Marcus, 2014;Frankel & Sherman, 2015).…”

“…Previous studies in different parts of Nigeria reports that clients highly rate the autonomy domain to be very important but they are poorly scored (Ughasoro et al, 2017). Similarly, the autonomy domain was rated worst by clients in Bangladesh and Iran (Hamid & Begum, 2018;Bazzaz et al, 2015;Daneshkohan et al, 2018). The poor performance of autonomy occurs because there is high information asymmetry in the level of knowledge between patients and health workers.…”

Doctor‐patient relationship: Evidence from Bangladesh

“…Similar findings are found in a previous study. 29 There is little emphasis on the medical education curriculum in Bangladesh to orient the students regarding these crucial factors. People also perceive that physicians are involved in various malpractices, including the irrational prescription of a diagnostic test, medicine, cesarean section, and ICU in private healthcare facilities.…”

HB-HTA as an implementation problem in Polish health policy

“…According to Ostrom, public responsiveness reflects "the capacity to satisfy the preferences of citizens" [8]. The subject of responsiveness in healthcare has been discussed in recent years by, among others, Forouzan et al (2016) [9], Chao et al (2017) [10], Daneshkohan et al (2018) [11], and Hamid and Begum (2019) [12].…”