Health care delivery system in Bangladesh 1234

Health Care Delivery SystemHealth Care Delivery System in Bangladeshin Bangladesh

Dr. Md. Salequr Rahman (Shuvo)MBBS, MPH (CM) NIPSOM

DR. SIRAJUL ISLAM MEDICAL COLLEGEdrmdshuvo@gmail.com

Health is a fundamental Health is a fundamental human righthuman right

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Current Criticism of Health Care Services

(Provided by the Governments)

Predominantly urban oriented

Mostly curative in nature

Limited Access

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What is Health Care

It is more than Medical CareIt embraces a multitude of services provided to individuals and families by health professionals to promote, monitor and uphold the status of their health.Medical care is a subset of health care.

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Appropriateness (relevance): whether the service is needed at all in relation to essential human needs, priorities and policies.

1. Comprehensiveness: whether there is an optimum mix of preventive, curative and promotional services.

2. Adequacy: Whether the service is proportional to the requirement.

3. Availability: Ratio between the population and health facility, e.g. population per center, doctor – population ratio.

Characteristics of health care:

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4. Accessibility: This may be geographical accessibility, economic accessibility or cultural accessibility.

5. Affordability: The cost of the health care should be within the means of the individual and the state.

6. Feasibility: Operational efficiency of certain procedures, logistic support, manpower and material resources.

Characteristics of health care: Characteristics of health care: (Con…..)(Con…..)

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Levels of Health CareLevels of Health Care

Primary Health CareSecondary Health CareTertiary Health Care

Health care delivery system in Bangladesh are usually organized

at three levels:

•Each level is supported by a higher level to which the patient is referred.

Primary health care: This is the first level of contact between the individual and the health system where essential health care i.e. Primary health care is provided. This level of care is closest to the people. Majority of the health service needs can be efficiently dealt with at this level.

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Primary health care: (Con..)In Bangladesh,

Upajlla / (Thana) health complex and below, i.e. Union sub-centers, Family welfare centers, Community Clinic And Satellite clinics provide primary health care.

Trained auxiliary health personnel under the supervision of professionals can provide the service efficiently.

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Secondary health care: In Bangladesh, this level of services are provided in In Bangladesh, this level of services are provided in District hospitals. District hospitals. This is the This is the first level of referral servicesfirst level of referral services, and , and more complicated services are dealt with which is more complicated services are dealt with which is beyond the scope and capacity of the primary level. beyond the scope and capacity of the primary level. This level is assigned to provide some specialist This level is assigned to provide some specialist services particularly in Internal Medicine, General services particularly in Internal Medicine, General Surgery, Obstetrics and Gynaecology, and Surgery, Obstetrics and Gynaecology, and Paediatrics.Paediatrics.

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Tertiary level:Tertiary level: This level deals with highly specialized services provided at regional or central level hospitals, Such as teaching hospitals. Super specialized hospitals like NICVD, NIO, BIRDEM, Cancer Hospital, Chest Hospital, Infectious Disease Hospital, Mental Disease Hospital are also included in this level. These institutions provide referral support to primary and secondary level health care.

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Community Clinic in Community Clinic in Bangladesh Bangladesh

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Background and History Background and History Community Clinic (CC) is the innovation of Hon’ble Prime Minister Sheikh Hasina to extend Primary Health Care to the doorsteps of rural people all over rural Bangladesh. At present 13136 CCs are on board as June 2016 and number is gradually increasing.

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Service Providers: Service Providers:

Community Health Care Provider (CHCP); Health Assistant; (HA)Family Welfare Assistant; (FWA)

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Available services: Available services: Maternal & neonatal health care services (ANC/PNC); Integrated Management of Childhood Illness (IMCI); Reproductive Health and FP services; EPI; Nutritional education and micro-nutrient supplements;

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Available services: Available services: Health education & counseling; Screening of Chronic Non Communicable Diseases Treatment of minor ailments, common diseases & first aid Establishing referral linkage with higher facilities

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Community level or Ward level : Community Clinic .Community Clinic . CHCP, HA & FWA

Union levelHealth & Family welfare Centre (H & FWC) or Union Sub-center. This is the first static facility, which is headed by a physician or a Medical Assistant.

Primary level

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Upajlla or Thana level Upajlla Health Complex (UHC); 50 or (31 bedded hospital, 25 for general patients & 6 for MCH service.)

Primary level (Cont.)

Services provided at Upajlla Health Complex (UHC);

ImmunizationGrowth monitoringNutritional educationVitamin-A distributionTreatment of minor

diseases and injuriesFamily planning

services

Services provided at Upajlla Health Complex (UHC);

(Cont…)

Antenatal and post natal care through MCH services

Blood smear collection for malaria

Health educationRecording of births and

deaths.

Why it is called complex ?

Outdoor and indoor services Administration and technical supportTraining and suppliesReferral

District hospital, the secondary referral hospital

with 100-250 beds.

Secondary level

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National level hospitals and Institutes Medical college hospital, Postgraduate

hospital & specialized hospital are the tertiary referral hospitals.

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Tertiary level

8 villages = 1 ward; 3 ward = 1 union1 union = 24 villages

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MOHFW

Secretary

DGHS DGFP

Directors

Deputy Directors

Assistant Directors / Civil Surgeons

Hea

lth

Syst

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of

Bang

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Gov

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Organizational Chart of Ministry of Health and Family Planning

UHFPO

MO

MA / SACMO

HA / FWA

Hea

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Syst

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of

Bang

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Gov

t.)

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Responsibilities of UH&FPO

Technical and administrative supervision Allocate duties amongst the medical officers

and filed workersVisit the unions and village for the supervision

of the health programs Responsible for the proper utilization of storesCollaboration with government and

non- government organizations

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Responsibilities of HA

Front line (Grass-root level) staff of DGHS Undertake monthly domiciliary visitsGive treatment for simple ailmentRefer cases Give health education Participate in EPICollect information on vital statisticsDistribution of family planning materials,

ORS . Vitamin A capsule etc

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