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