Success and Its Consequences: Bangladesh’s Health Report Card at 50

Muurlink, Olav; Durga, P. Kanaka; Awan, Nabil; Taylor‐Robinson, Andrew W.

doi:10.1007/978-981-16-5521-0_19

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…In fact, Bhola means 'forgotten place' (Hasan, 2016), and because of its location in the Bay of Bengal estuary, it is vulnerable to tidal incursions and natural disasters, and particularly to the consequent subsistence crises unleashed on the impoverished population (Hossain, 2018). The region is also one of the most cyclone-prone on the planet (Islam et al, 2015) and was hit in 1970 by the deadliest cyclone ever recorded, and which left a trail of devastation (Biswas & Daly, 2021;Muurlink, 2022;Rohde, 2014).…”

Section: Bhola Island Bangladeshmentioning

confidence: 99%

“…With the density, however, comes a greater public health burden (Jones et al., 2008): with around one‐tenth of the total expenditure on health as a proportion of GDP and a smaller absolute budget, Bangladesh relies heavily on public health measures rather than medicine to manage its health burden. These initiatives have resulted in remarkable improvements in health outcomes, notably sharp declines in birth and mortality rates, and life expectancy rising by a ratio of more than one full year for every two years elapsed since the nation was founded in 1971 (Chowdhury et al., 2013; Muurlink et al., 2022; WHO, 2017). Despite a higher expenditure on healthcare services, rural Australians are still at an objective health disadvantage: they experience worse health outcomes than do residents of metropolitan areas (Australian Institute of Health and Welfare 2018).…”

Section: Introductionmentioning

confidence: 99%

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Under the regulatory radar: Unregulated rural healthcare in Bangladesh and Australia

Durga

Caffery

Muurlink

et al. 2022

Health Social Care Comm

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This study examines health regulation under conditions of geographical constraint in two strikingly different settings, one on a remote island in Bangladesh and the other in an impoverished rural region in Australia. Both suffer from an absence of medically qualified professionals, which means that in the resultant vacuum, patients access alternative healthcare. The concept of regulation (or lack of regulation) is explored in terms of unconventional new responses to rural health deficits. The two cases show unexpected commonality, with policymakers facing shared challenges beyond physical remoteness. The difference in the degree of enforcement of regulation offers the greatest point of difference. This comparative study revealed a weak health regulatory system in the remote Bangladesh area of Bhola Island where ‘alternatives’ to formal clinical approaches have become the default choice. Brazen stop‐gap servicing is commonplace on Bhola Island, but in The Gemfields such practices only occur in the shadows or as a last resort. Each isolated location, one in a developing country and the other in a developed setting, exemplifies how geographical remoteness can present an opportunity for innovations in supply to emerge. Surprisingly, it is the developing world case that better leverages a regulatory void to respond to local healthcare needs.

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Section: Bhola Island Bangladeshmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Under the regulatory radar: Unregulated rural healthcare in Bangladesh and Australia

Durga

Caffery

Muurlink

et al. 2022

Health Social Care Comm

Self Cite

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Pregnancy, spousal connectedness, and young married women’s mental health: an analysis of the Bangladesh adolescent health and wellbeing survey

Khan

Muurlink

et al. 2023

Arch Womens Ment Health

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Village doctors: a national telephone survey of Bangladesh’s lay medical practitioners

Muurlink,

Uzzaman,

Boorman

et al. 2023

BMC Health Serv Res

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Background Bangladesh outperforms its Least Developed Country (LDC) status on a range of health measures including life expectancy. Its frontline medical practitioners, however, are not formally trained medical professionals, but instead lightly-trained ‘village doctors’ able to prescribe modern pharmaceuticals. This current study represents the most complete national survey of these practitioners and their informal ‘clinics’. Methods The study is based on a national Computer Assisted Telephone Interviewing (CATI) of 1,000 informal practitioners. Participants were sampled from all eight divisions and all 64 districts of Bangladesh, including 682 participants chosen from the purposively recruited Refresher Training program conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), supplemented with 318 additional participants recruited through snowball sampling. Primary and secondary outcome measures In addition to demographics, village doctors were asked about the characteristics of their ‘clinics’ including their equipment, their training, income and referral practices. Results Three quarters of the wholly male sample had not completed an undergraduate program, and none of the sample had received any bachelor-level university training in medicine. Medical training was confined to a range of short-course offerings. Village doctor ‘clinics’ are highly dependent on the sale of pharmaceuticals, with few charging a consultation fee. Income was not related to degree of short-course uptake but was related positively to degree of formal education. Finally, practitioners showed a strong tendency to refer patients to the professional medical care system. Conclusions Bangladesh’s village doctor sector provides an important pathway to professional, trained medical care, and provides some level of care to those who cannot afford or otherwise access the nation’s established healthcare system. However, the degree to which relatively untrained paramedical practitioners are prescribing conventional medicines has concerning health implications.

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Success and Its Consequences: Bangladesh’s Health Report Card at 50

Cited by 3 publications

References 38 publications

Under the regulatory radar: Unregulated rural healthcare in Bangladesh and Australia

Under the regulatory radar: Unregulated rural healthcare in Bangladesh and Australia

Pregnancy, spousal connectedness, and young married women’s mental health: an analysis of the Bangladesh adolescent health and wellbeing survey

Village doctors: a national telephone survey of Bangladesh’s lay medical practitioners

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