Related News:

What did we learn at the Inspiring Communities workshop?
17 June 2017

Revolutions in the economics of health systems: iHEA Congress 2017
13 June 2017

Inspiring communities in global health: Community Health Workers and Universal Health Coverage
26 May 2017

How does community health relate to wider development discourse?
08 May 2017

Emerging issues related to gender and community health workers
27 March 2017

Women in the changing world of community health work
17 March 2017

What does trust have to do with Community Health Workers and the Sustainable Development Goals?
06 March 2017

Community health workers – optimizing the benefits of their position between communities and the health sector
23 February 2017

Achieving Equity: Women at the interface of community health systems
15 February 2017

REACHOUT at the Kampala Community Health Worker conference
11 February 2017

Online discussion on community health workers: Join in
04 January 2017

Four tips for embedding quality improvement in community health worker programmes
09 December 2016

Community health workers: great potential for resilient and responsive health systems
28 November 2016

Close-to-community providers and menstrual regulation
25 November 2016

Indigenous knowledge and intersectionality: “Incremental radicalism” and front line health workers
23 November 2016

REACHOUT at the 2016 Global Symposium on Health Systems Research
23 August 2016

Exploring lessons learnt from Close-to-Community Health Worker Programmes: A symposium
20 June 2016

How equitable are Community Health Worker programmes?
31 May 2016

Working with what we’ve got – an(other) reflection on human resources for health
16 February 2016

Webinar: Community health workers - the gender agenda #HSGGENDER
08 February 2016

Panel on community health workers at the Prince Mahidol Award Conference
07 January 2016

Putting the politics into international public health
05 January 2016

Quality improvement cycles to strengthen close-to-community services: REACHOUT reflections
10 December 2015

A learning agenda and “NICE guys”: reflections on capacity
16 November 2015

REACHOUT at the Canadian Conference on Global Health
03 November 2015

Alignment, engagement and collaboration: approaches to ensuring Quality Improvement is embedded
02 November 2015

Why we use a group supervision approach in REACHOUT
22 September 2015

Global Strategy on Human Resources for Health: How can it support close-to-community providers?
10 September 2015

Announcing a new research collection on community health workers
08 September 2015

Research can be a challenge: Reflections on ethical and practical dilemmas faced by our team in Bangladesh
25 June 2015

Innovation alive and well in Bangladesh and embodied in REACHOUT
18 June 2015

James P. Grant School of Public Health Reaching out and building strength
30 May 2014

Related Resources:

Find more resources relating to Bangladesh

Bangladesh: current situation

Bangladesh is facing rapid urbanisation.The limited number and quality of public health providers, and the poor availability of drugs and equipment, has led to under-use of government services and to high levels of use of community health workers and other private services in a wide variety of settings. The role of community health workers in providing preventive and curative care to the population is enormous and diverse. One single non-governmental organisation (NGO), BRAC, employs 80,000 community health volunteers, providing basic health services and contributing to improving population health outcomes. Close-to-community providers are recognised as having potential in Bangladesh, but they need to adapt to an environment in which they must compete with other providers and prove their competence.  There are about 62,000 unregistered pharmacies in the country. Overall, the health system accommodates multiple forms of practice with varying degrees of legitimacy.

Bangladesh: health systems priorities and baseline knowledge gaps

The need to understand the interactions between the many diverse close-to-community providers is becoming a health priority.In Bangladesh’s evolving and pluralistic health system, the interactions between community health workers and informal private practitioners, particularly in urban areas, are unclear. Informal practitioners vary significantly according to their knowledge and the position they hold in the broader health market supply chain, and in their interactions with community health workers. It is thought that in urban slums it is poor and marginalised communities in particular that access informal practitioners for stigmatised health issues, such as sexually transmitted diseases and sexual and reproductive health. It is important to better understand access to services and interactions between slum communities, informal private practitioners, and community health workers.

Informal practitioners, including community health workers, lack the necessary training and capacity to provide basic curative services rationally.  They also have poor knowledge about drugs. Sometimes they provide unnecessary and harmful medications, or fail to refer serious cases. Although there have been some studies of their knowledge and treatment practices, information is still inadequate to develop appropriate intervention programmes to minimise harmful practices.

Bangladesh: initial baseline capacity assessment

At the provider level community health workers and informal providers are embedded within communities and can contribute significantly to implementing health promotion programmes and disease prevention programmes. However to date their opportunities to participate in capacity development and training has been limited. Community health workers lack professional qualifications, and the volunteering system has created a problem of high turnover which has had an impact on the quality of services delivered. Very little is known about the incentive mechanisms, referral processes, and links between informal and private providers as the first line in health care provision. A comprehensive assessment of quality assurance and monitoring and evaluation is needed to tackle these issues.

At the policy level, Bangladesh needs to strengthen the links between research, policy and practice. Research can be uncoordinated, leading to duplication and replication. Policy makers are not always aware of what is going on at local level and community level. There is no engagement with health information providers and there is a clear need to develop the evidence base and policy on this.

Bangladesh: what REACHOUT research and capacity development will add

Focusing on sexual and reproductive health, REACHOUT will map close-to-community services in urban slums and then develop monitoring and evaluation tools to gain insight into the perspectives and interactions of community health workers and informal practitioners. The aim is to provide better support to enable community health workers to provide good quality services for slum communities. REACHOUT will also explore how human resource management strategies can work in a pluralistic healthcare environment characterised by high turnover. By engaging policy makers, researchers, and other stakeholders involved in the health system REACHOUT will try to develop appropriate standardised training and workshops to improve the knowledge and treatment practices of informal providers. This approach will develop the capacity of the health system to meet the needs of slum communities.

 

This project is funded by the European Union.
This project is funded by the European Union.