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Making Health Care More Cost Effective and Available in Bangladesh

  • Project Name: Secondary Urban Primary Health Care Project
  • Region/Country: South Asia/Bangladesh
  • Sector and Themes: Health
  • Year: 2005
  • Project Leaders: Brian Chin
Making Health Care More Cost Effective and Available in Bangladesh
Urban primary Health Care was a neglected sector in Bangladesh.

The proportion of women from the slums coming to the center for delivery and other Health Care services has doubled to more than 70% in the last few years.

—Kazi Nurun Nabi, physician and program director, Al-Haj Jahurul Islam Matri Sadan Maternity Center

Development challenge

Until recently, urban primary Health Care was a neglected sector in Bangladesh relative to other South Asian countries. Health indicators of the urban poor were declining and were sometimes even worse than those of the rural poor.

Solution

The Secondary Urban Primary Urban Health Care Project sought to make public Health Care services more available and cost effective to the urban poor, especially by reducing child and maternal mortality and morbidity. The project aimed to increase use of urban primary Health Care services; improve the quality of urban primary care services in the project area; and improve the cost-effectiveness, efficiency, and institutional, and financial sustainability of primary care to meet the needs of the urban poor.

urban primary Health Care
Through behavioral change communications, marketing, capacity building and policy support, the project brought about a change in mindset and lifestyle with regard to urban primary Health Care.

The project achieved this by building reproductive and primary Health Care centers to provide maternal and child care to poor urban communities. Each reproductive Health Care center was staffed with an ambulance service and employed 32 staff, including a physician, a pediatrician, and four medical officers. The primary Health Care centers have 10 staff. A special feature of the project was the contracting of primary Health Care services to 12 nongovernment organizations (NGOs) through 24 partnerships between the NGOs and city corporations and municipalities. The partner NGOs provided essential services including HIV and sexually transmitted infection control and supplementary nutrition.

Knowledge products and services delivered

The project focused on the provision of primary Health Care through partner NGOs. Emphasis was placed on behavioral change communication and marketing, and on building capacity and policy support for urban primary care. The project supported involvement of beneficiaries, health staff, and government officials in the preparatory stage. It trained nearly 3,000 people, half of whom were women, in clinical or management aspects. The project specifically targeted women and young children.

Impact and results

The project brought about a change in mindset and lifestyle. The project had a target population of 9.41 million, approximately 23% of the urban population of Bangladesh. From 2005 to 2012, 10.22 million individual clients attended project-supported clinics, of whom 78% were female. Overall, the project saw an increase in cumulative service contacts as well as increase in utilization among the poor.

Primary health service delivery
Public⁠–private partnerships proved to be effective and innovative in primary health service delivery among urban poor, especially women and children.

Lessons learned

Public–private partnerships for primary health service delivery among the urban poor, and particularly women and children, proved to be a replicable, effective, and innovative approach. Pro-poor targeting proved difficult without necessary and adequate provisions and safeguards in the bidding process for selection of partner agencies. Efficient cash and fund flows were essential for the smooth operation of the private partner agencies.

Public⁠–private partnerships
Public⁠–private partnerships proved to be effective and innovative in primary health service delivery among urban poor, especially women and children.

We believe our health centers have contributed to a substantial reduction in maternal deaths in Bangladesh.

—Kazi Nurun Nabi, project manager, Progoti Samaj Kallyan Protisthan, an NGO operating Health Care centers in Dhaka