There are gaps in logistics, quality assurance procedures and the facilities suffer from high staff absenteeism, unskilled staff and inefficient use of supplies. CHAPTER – 3 Health care delivery systems of Bangladesh Distribution of public health care services and facilities follows similar pattern of administrative tiers, … These challenges must be resolved in order to improve the existing health system so that the disadvantaged and vulnerable people can get better access to basic health care services. The health system of Pakistan expands more than eighty percent of their health expenditures on medical products and pharmaceuticals [32]. However, during 2007-2013, a steady increase in the number of hospitals and beds is evident in both the public and private sectors. Pakistan is a located in South Asia encircled by Afghanistan, India, China, Arabian Sea and Iran. The MOHFW is not only responsible for setting entire policies and regulations but also for providing comprehensive health services, financing and health staff. The public health sector facilities in Bangladesh are poorly equipped with medical equipment and instruments. Community clinics, a flagship programme of the Government of Bangladesh, are health facilities set up to deliver primary health care, family planning and nutrition services to rural people at the grassroots level. Implementation research and the engagement of stakeholders in such research have become increasingly prominent in finding ways to design, conduct, expand and sustain effective and equitable health policies, programmes and related interventions. Today, doctor to patient ratio in Pakistan 1:1300, doctor nurse ratio is 1:2.7, and nurse-patient ratio is 1:20 (Nishtar, 2006). In 2010, the authority has been shifted to provincial government from federal, and it has four directional boards. NEW SUPPLEMENT: Innovation in health systems in low- and middle-income countries. The statistics of health professionals at Pakistan and Bangladesh is shown in Table 4. Over the 45 years after independence, the HCDS of Bangladesh has gone through a number of reforms and established an extensive health infrastructure [12]. Regardless, the widespread existence of VDs and their significance as an integral contributor of healthcare within rural communities in Bangladesh necessitates an effective regulatory arrangement that improves and ensures a minimum standard in the quality of services provided. Islam is the faith of eighty-five percent of the population, while Hindus, Buddhist, and Christians making up the most of remaining fifteen percent. In Pakistan, these LHVs, LHWs, and CMWs are attached to the government facilities, from which they receive training, and serve the community at the doorstep in order to get desired health outcomes. Though, no official figure exists for health expenditures and expert believes that 78.08% is contributed through the outof- pocket mechanism, general taxation is the major source of government’s financing for health [29]. Now, in this paper, we will discuss, compare, and analyze the HCDS of Pakistan in comparison to Bangladesh. Health systems encompass not only various elements but also the interactions and relationships between those elements and individuals within the system [25]. Moreover, the concept of e-health has been implemented in the rural areas of Pakistan e.g. Moreover, due to high population in Pakistan and Bangladesh, the health care professionals are less according to the population of the countries and also the existing professionals are untrained, underpaid, and depressed of important facilities for their practice. Bangladesh despite its challenging circumstances, has proven to be remarkably resilient and achieved significant human development gains, and impressive progress was made in health outcomes, especially in maternal and child health [20]. The majority of this population lives in the absolute poverty; they have to access public sector facilities, which are not providing satisfactory care [39]. Moreover, the HCDS of Bangladesh is challenged with governance, finances, human resources, service delivery, technology, manpower, and essential supplies like medicines [15]. To ensure proper care, need to set up an effective healthcare delivery system. The authors recommend that in order to improve the HCDS of Pakistan and Bangladesh several needs to be implemented. The paper emphasizes the importance of a multi-sectorial comprehensive approach to improve the health system. Furthermore, the steward of the health system must have a strategic vision and determination to improve and strengthen both the public and private health sectors of the country. The Pakistan HCDS is mixed, referring to the existence of multiple actors performing diverse roles and functions. In addition to internal resources, the main external funding agencies in Bangladesh are Global Alliance for Vaccines and Immunization (GAVI), Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), and USAID. Using Bangladesh’s two decades of experience with contracting out Urban Primary Health Care (UPHC), this paper identifies contextual, contractual, and actor-related … The Drug Regulatory Authority of Pakistan (DRAP) is the authority that set policies, rules, and control pharmaceutical companies. Despite, health profile of Pakistan is illustrated by high population growth rate, infant and maternal mortality rates, and dual burden of communicable and non-communicable diseases [17]. A small booklet with information on what to do and what not to do for eleven common illnesses was distributed as a source of future reference. According to a report published by the World Health Organization, the healthcare system in Bangladesh relies on four key components: the government, private sector, nongovernmental organizations (NGOs) and donor agencies. Improving Health Care Delivery in Bangladesh NGO representatives discuss health … The HCDS of both the countries is facing multiple challenges in services delivery to the population. The Bangladesh government health expenditures as a share of GDP grew to 4.7% in 2015 which was around 1% till 2007. The DHs, UHCs, and UHFWC contributing their part in secondary and tertiary care with more advanced facilities. Though these are not part of mainstream health system but a major health care provider to poor rural population, especially in remote and hard to reach an area. Currently, Bangladesh spends US$ 26.60 per capita in total [17]. Likewise, the most critical challenge faced by the health systems in Bangladesh is also in the arena of human resources. 3. Bangladesh health care services are shown in Table 3. The WHO suggests that doctor to patient ratio should be 1:1000 and doctor nurse ratio 1:4 is appropriate. Whereas, in the HCDS of the Bangladesh the Ministry of Health and Family Welfare (MOHFW) is the authoritative body, and little authority delegated to local levels as the comparison to the Pakistan. Pakistan is listed as one of 57 countries with critical health workforce deficiency [31]. Health Care Delivery System in Bangladesh Sardar Arif Uddin, Public Health Anthropologist Email: sa.uddin14@gmail.com Currently, National Tuberculosis Control Program, EPI programs, diagnostic kits for the HIV/AIDS program, and Hepatitis program is governed by donor agencies at Pakistan. The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. The private sector is largely focused on out-patient and in-patient curative care. The inadequacies of the formal healthcare sector in Bangladesh has resulted in a widespread increase in informal providers as an alternative source of care providing basic and essential outpatient health services to millions of poor people in the rural areas. In Pakistan, the Primary health care facilities are provided by Government Dispensaries (GD), Basic Health Units (BHU) at the village level, and Rural Health Centers (RHC) at the level of the town. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. Moreover, in the balanced health care system people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services, through the different levels and sites of care within the health system, and according to their needs throughout the life course [4]. Organization is the system of consciously coordinated activities, goal-directed efforts for the controlled performance of collective goals [26]. The fundamental premise of the HCDS is to value human life, promote, restore, and maintain the health of the population and that is focused and organized around the health needs and expectations of people [2]. The aim is to provide a stronger basis for the formulation of strategies for managing health system change in low- and middle-income countries. Health System of Bangladesh … Health care delivery is a daunting challenge area of the Bangladesh's healthcare systems. The optimal HCDS provides hope, relief to the individual, community, and population. Citation: Kumar S, Bano S. Comparison and Analysis of Health Care Delivery Systems: Pakistan versus Bangladesh. It is direct outlays of cash that may be later reimbursed [28]. Close proximity to clients, availability to the community day and night, sympathetic behavior, well established relations within the community, and flexible payment methods have made the village doctors a popular source of care. Regardless of settled goal and expectations Pakistan health system showed dissatisfactory progress and failed to achieve desired outcomes [23]. The core primary health care facilities in Bangladesh are CCs. They bring alternative perspectives to this issue, based on diverse local contexts and different types of innovation. You can edit the text in this area, and change where the contact form on the right submits to, by entering edit mode using the modes on the bottom right. The intervention will further link village doctors with formal healthcare providers for more complicated illnesses. A serious shortage and unequal distribution of qualified health personnel are major stumbling blocks: only 25% of health workers serve rural areas, but this is where 70% of the population lives. It occupies 147, 570 square kilometers. Table 1: Key Demographic and Health Indicators. Pakistan has a mixed health system that includes public, parastatal, private, civil society, philanthropic contributors, and donor agencies. In addition, an armed force hospital across the country has well-built infrastructure, HMIS, and proper technology utilization. This proven approach effectively identifies barriers to healthy pregnancy and ways that communities can improve access to health care. Moreover, Health cannot be separated from political, economic, social and human development contexts. And the six building blocks of a country’s health system are its health service delivery, information, workforce, financing, products, and governance. However, the use of CSC in health in Bangladesh has been limited. The Government of Bangladesh signs an agreement with CARE to begin scaling up our Community Support System approach in its community clinics. Bangladesh is committed to ensuring the health of its people, and its Constitution states that “Health is the basic right of every citizen of the Republic.” 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 … Currently, a pharmaceutical industry of Pakistan is rapidly developing and has 411 registered manufacturing divisions and 30 multinational companies across the country. Since 2010, the leading pharmaceutical companies have significantly increased the prices of drugs up to 8-10% including some common drugs on basis of raw material import become costlier [34]. The public health delivery system functions through a three layer approach primary, secondary, and tertiary (Figure 1). The author has argued that if the public hospitals could provide … Several organizations and donor agencies have made significant contributions to improve health outcomes in Pakistan for over last few decades. There is strong evidence that maternal iron deficiency anaemia increases the risk of adverse perinatal outcomes. Moreover, across the world the HCDS varies from country to country and focusing on improving access, coverage and quality of services, however, it depends on the key resources being available, organized, managed, and utilized effectively. The concept of health care system includes the involvement of the people, organizations, agencies, and resources that provide services to meet the health needs of the individual, community, and population [1]. J Hosp Med Manage. Figure 2: The interconnections among the health system building blocks. Population growth slowed considerably during the past thirty years and falling from 2.7 percent per year in the 1980s to around 1.3 percent in 2010 [21]. Copyright © 2006-2019, Future Health Systems. There is a growing interest in new technologies and innovative organizational arrangements as a means to improve a health system’s performance. NEW SUPPLEMENT: Engaging Stakeholders in Implementation Research: tools, approaches, and lessons learned from application, Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh, Feasibility, Acceptability and Initial Outcome Of Implementing Community Scorecard To Monitor Community Level Public Health Facilities: Experience From Rural Bangladesh, Accountability in Health Service Delivery: a Community Scorecard Exploration in Rural Bangladesh, Community scorecards: Engaging community and bringing in positive changes to health service delivery at community clinics in rural Bangladesh, Where girls are less likely to be fully vaccinated than boys: Evidence from a rural area in Bangladesh, Hanifi SM, Ravn H, Aaby P and Bhuiya A (2018), A community-based cluster randomised controlled trial in rural Bangladesh to evaluate the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality, Huda TM, Rahman MM, Raihana S, Islam S, Tahsina T, Alam A, Agho K, Rasheed S, Hayes A, Karim MA and Rahman QS (2018). List of Best Healthcare facilities Companies in Bangladesh, Top Healthcare facilities Companies in Bangladesh, Healthcare facilities Companies Near Me, Best Healthcare facilities Companies. Due to the high iron requirements for pregnancy, it is highly prevalent and severe in pregnant women. MEETING: Learning by doing: how to engage with stakeholders in implementation research? In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. All Published work is licensed under a Creative Commons Attribution 4.0 International License Copyright © 2020 All rights reserved. There is a large cadre of health care providers in the informal sector is evident in both Pakistan and Bangladesh. The process of certifying, licensing is weak and evaluation of the performance of health professional is not maintained across the country. Since the time of independence, HCDS of Pakistan has undergone major reforms start its journey from National Health Policy, Primary Health Care services, TB control, and Immunization Program [22]. However, most of the evidence is from observational epidemiological studies except for a very few randomised controlled trials. The HCDS of Pakistan is summarized in Figure 1. Similarly, Bangladesh as compared to other developing countries is poor in the field of infrastructure, and human resources, and has no specific written policy for infrastructure development in the health sector [36]. Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery: Home and community level. Recently, Bangladesh has made huge progress in immunization coverage. Simultaneously, the most critical challenge faced by the health systems in Bangladesh is in the arena of human resources, technology, and infrastructure [38]. Recently, Bangladesh has undergone considerable social and economic changes, economy dramatically accelerated and GNI increased from US$ 100 per capita in 1973 to US$ 700 in 2010 [8]. Healthcare facilities in Bangladesh. Table 4: Health professionals statistics. In addition, Maternity and Child Health Centers (MCHCs) play their part and provide basic obstetric care the community with the collaboration of lady health workers. On the other hand, Bangladesh has surpassed many neighboring countries in South Asia as well as other developing countries in terms of progress in achieving the health-related MDGs. The health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. In the light of the findings of this paper, it can be fairly argued that both Bangladesh and Pakistan faces a lot of challenges in its health system. Though, HCDS has expanded its reach despite the people of rural areas remains with little access to facilities [8]. As per the report of Bangladesh National Health Accounts (NHA), Bangladesh spends US$ 2.3 billion on health yearly, and approximately 64% of the amount comes from out-of-pocket payments. Bangladesh is one of the most densely populated South Asian countries. Moreover, Pakistan Nursing Council recommends that nurse-patient ratio in general area is 1:10, and in specialized are is 2:1. In Pakistan, health care delivery to the consumers is systematized through four modes of preventive, promotive, curative, and rehabilitative services. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low, where governance issues are not addressed. In addition to the internal resources, the external funding agencies in Pakistan are USAID, and Department for International Development, UK. Contracting-out (CO) to non-state providers is used widely to increase access to health care, but it entails many implementation challenges. In Bangladesh, supply-side financing has historically been the backbone of health care services as a strategy to improve the access of poor households to essential health care services. Pakistan; Bangladesh; Health care delivery system; Health indicators; Health issues. Furthermo… (2020) Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh, Int J Equity Health 19, 155, https://doi.org/10.1186/s12939-020-01265-6. Health Care Delivery System (HCDS) is a societal response to the determinants of health. In Pakistan and Bangladesh, there are massive inequalities in the accessibility of health services to the low socioeconomic population. In addition, the Ministry of Local Government, Rural Development, and Cooperatives play their part and manage the provision of urban primary care services. Poor access to quality health services and high costs threaten Bangladesh’s momentum towards universal health coverage. About 60% of the total government health expenditure is therefore accounted for in district budgets. Previously, provincial governments were responsible for health financing but currently as a result of political and administrative devolution empower district governments as important financial intermediaries. The balanced health care system delivers the quality of care, health, and facilities through efficient, effective, and fair manner. [ 17 ] set up an effective strategy to increase health system of Pakistan e.g,. Shown in Table 3 and the network to prematurity and health care delivery system in bangladesh asphyxia, UHCs and. Care system depends upon human, materials, finance, availability and of! 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