Skip to main content
Top
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Antibiotic | Research article

Perceptions of appropriate treatment among the informal allopathic providers: insights from a qualitative study in two peri-urban areas in Bangladesh

Authors: M. Monaemul Islam Sizear, Herfina Y. Nababan, Md. Kaoser Bin Siddique, Shariful Islam, Sukanta Paul, Anup Kumar Paul, Syed Masud Ahmed

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

How the informal providers deliver health services are not well understood in Bangladesh. However, their practices are often considered inappropriate and unsafe. This study attempted to fill-in this knowledge gap by exploring their perceptions about diagnosis and appropriate treatment, as well as identifying existing barriers to provide appropriate treatment.

Methods

This exploratory study was conducted in two peri-urban areas of metropolitan Dhaka. Study participants were selected purposively, and an interview guideline was used to collect in-depth data from thirteen providers. Content analysis was applied through data immersion and themes identification, including coding and sub-coding, as well as data display matrix creation to draw conclusion.

Results

The providers relied mainly on the history and presenting symptoms for diagnosis. Information and guidelines provided by the pharmaceutical representatives were important aids in their diagnosis and treatment decision making. Lack of training, diagnostic tools and medicine, along with consumer demands for certain medicine i.e. antibiotics, were cited as barriers to deliver appropriate care. Effective and supportive supervision, training, patient education, and availability of diagnostics and guidelines in Bangla were considered necessary in overcoming these barriers.

Conclusion

Informal providers lack the knowledge and skills for delivering appropriate treatment and care. As they provide health services for substantial proportion of the population, it’s crucial that policy makers become cognizant of the fact and take measures to remedy them. This is even more urgent if government’s goal to reach universal health coverage by 2030 is to be achieved.
Appendix
Available only for authorised users
Literature
1.
go back to reference Sudhinaraset M, et al. What is the role of informal healthcare providers in developing countries? A systematic review. PLoS One. 2013;8(2):e54978.CrossRef Sudhinaraset M, et al. What is the role of informal healthcare providers in developing countries? A systematic review. PLoS One. 2013;8(2):e54978.CrossRef
2.
go back to reference Ahmed SM, Hossain MA, Chowdhury MR. Informal sector providers in Bangladesh: how equipped are they to provide rational health care? Health Policy Plan. 2009;24(6):467–78.CrossRef Ahmed SM, Hossain MA, Chowdhury MR. Informal sector providers in Bangladesh: how equipped are they to provide rational health care? Health Policy Plan. 2009;24(6):467–78.CrossRef
3.
go back to reference Ministry of Health and Family Welfare. Bangladesh Essential Health Service Package. Dhaka: Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh; 2016. Ministry of Health and Family Welfare. Bangladesh Essential Health Service Package. Dhaka: Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh; 2016.
4.
go back to reference Shah NM, Brieger WR, Peters DH. Can interventions improve health services from informal private providers in low and middle-income countries? A comprehensive review of the literature. Health Policy Plan. 2010;26(4):275–87.CrossRef Shah NM, Brieger WR, Peters DH. Can interventions improve health services from informal private providers in low and middle-income countries? A comprehensive review of the literature. Health Policy Plan. 2010;26(4):275–87.CrossRef
5.
go back to reference Ahmed SM, et al. Harnessing pluralism for better health in Bangladesh. Lancet. 2013;382(9906):1746–55.CrossRef Ahmed SM, et al. Harnessing pluralism for better health in Bangladesh. Lancet. 2013;382(9906):1746–55.CrossRef
6.
go back to reference May C, Roth K, Panda P. Non-degree allopathic practitioners as first contact points for acute illness episodes: insights from a qualitative study in rural northern India. BMC Health Serv Res. 2014;14(1):182.CrossRef May C, Roth K, Panda P. Non-degree allopathic practitioners as first contact points for acute illness episodes: insights from a qualitative study in rural northern India. BMC Health Serv Res. 2014;14(1):182.CrossRef
7.
go back to reference Salim H, et al. Turning liabilities into resources: informal village doctors and tuberculosis control in Bangladesh. Bull World Health Organ. 2006;84:479–84.CrossRef Salim H, et al. Turning liabilities into resources: informal village doctors and tuberculosis control in Bangladesh. Bull World Health Organ. 2006;84:479–84.CrossRef
8.
go back to reference Ahmed SM, Hossain MA. Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: implications for the HRH problem. Health Policy. 2007;84(2–3):332–43.CrossRef Ahmed SM, Hossain MA. Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: implications for the HRH problem. Health Policy. 2007;84(2–3):332–43.CrossRef
9.
go back to reference Adams AM, Islam R, Ahmed T. Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka, Bangladesh. Health Policy Plan. 2015;30(suppl_1):i32–45.CrossRef Adams AM, Islam R, Ahmed T. Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka, Bangladesh. Health Policy Plan. 2015;30(suppl_1):i32–45.CrossRef
10.
go back to reference Woolf SH, et al. Potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527–30.CrossRef Woolf SH, et al. Potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527–30.CrossRef
11.
go back to reference Nababan HY, et al. Improving quality of care for maternal and newborn health: a pre-post evaluation of the safe childbirth checklist at a hospital in Bangladesh. BMC Pregnancy and Childbirth. 2017;17(1):402.CrossRef Nababan HY, et al. Improving quality of care for maternal and newborn health: a pre-post evaluation of the safe childbirth checklist at a hospital in Bangladesh. BMC Pregnancy and Childbirth. 2017;17(1):402.CrossRef
12.
go back to reference WHO, Annex 1: Existing. WHO guidelines for preventing and treating diarrhoea in children. WHO recommendations on the management of diarrhoea and pneumonia in HIV-infected infants and children: integrated management of childhood illness (IMCI): World Health Organization; 2010. WHO, Annex 1: Existing. WHO guidelines for preventing and treating diarrhoea in children. WHO recommendations on the management of diarrhoea and pneumonia in HIV-infected infants and children: integrated management of childhood illness (IMCI): World Health Organization; 2010.
13.
go back to reference El Arifeen S, et al. Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study. Lancet. 2004;364(9445):1595–602.CrossRef El Arifeen S, et al. Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study. Lancet. 2004;364(9445):1595–602.CrossRef
14.
go back to reference DGHS. National Guidelines for Management of Hypertension in Bangladesh. Dhaka: Directorate General of Health Services, Ministry of Health and Family Affairs, Government of Bangladesh; 2013. DGHS. National Guidelines for Management of Hypertension in Bangladesh. Dhaka: Directorate General of Health Services, Ministry of Health and Family Affairs, Government of Bangladesh; 2013.
15.
go back to reference Chalker J, et al. STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers. Sex Transm Infect. 2000;76(4):299–302.CrossRef Chalker J, et al. STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers. Sex Transm Infect. 2000;76(4):299–302.CrossRef
16.
go back to reference WHO. Anonymous Proceedings of the Appropriateness in Health Care Services, 23–25 March 2000. Koblenz: World Health Organization; 2000. WHO. Anonymous Proceedings of the Appropriateness in Health Care Services, 23–25 March 2000. Koblenz: World Health Organization; 2000.
17.
go back to reference Asch SM, et al. Measuring underuse of necessary care among elderly Medicare beneficiaries using inpatient and outpatient claims. JAMA. 2000;284(18):2325–33.CrossRef Asch SM, et al. Measuring underuse of necessary care among elderly Medicare beneficiaries using inpatient and outpatient claims. JAMA. 2000;284(18):2325–33.CrossRef
18.
go back to reference Liu X, Mills A. Evaluating payment mechanisms: how can we measure unnecessary care? Health Policy Plan. 1999;14(4):409–13.CrossRef Liu X, Mills A. Evaluating payment mechanisms: how can we measure unnecessary care? Health Policy Plan. 1999;14(4):409–13.CrossRef
19.
go back to reference McGlynn EA, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.CrossRef McGlynn EA, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.CrossRef
20.
go back to reference Piers RD, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011;306(24):2694–703.CrossRef Piers RD, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011;306(24):2694–703.CrossRef
21.
go back to reference Schoen C, et al. In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Aff. 2009;28(1):w1–w16. Schoen C, et al. In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Aff. 2009;28(1):w1–w16.
22.
go back to reference Robertson-Preidler J, Biller-Andorno N, Johnson TJ. What is appropriate care? An integrative review of emerging themes in the literature. BMC Health Serv Res. 2017;17(1):452.CrossRef Robertson-Preidler J, Biller-Andorno N, Johnson TJ. What is appropriate care? An integrative review of emerging themes in the literature. BMC Health Serv Res. 2017;17(1):452.CrossRef
23.
go back to reference WHO. Promoting Rational Use of Medicines: Core Components-WHO Policy Perspectives on Medicines. Geneva: World Health Organization; 2002. WHO. Promoting Rational Use of Medicines: Core Components-WHO Policy Perspectives on Medicines. Geneva: World Health Organization; 2002.
24.
go back to reference WHO. The pursuit of responsible use of medicines: sharing and learning from country experiences. Geneva: World Health Organization; 2012. WHO. The pursuit of responsible use of medicines: sharing and learning from country experiences. Geneva: World Health Organization; 2012.
25.
go back to reference Atif M, et al. Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan. BMC Health Serv Res. 2016;16(1):684.CrossRef Atif M, et al. Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan. BMC Health Serv Res. 2016;16(1):684.CrossRef
26.
go back to reference Ulin PR, Robinson ET, Tolley EE. Qualitative methods in public health: a field guide for applied research. San Francisco, CA. 2005:94103–1741. Ulin PR, Robinson ET, Tolley EE. Qualitative methods in public health: a field guide for applied research. San Francisco, CA. 2005:94103–1741.
27.
go back to reference Guest G, Bunce A, Johnson LJFm. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef Guest G, Bunce A, Johnson LJFm. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef
28.
go back to reference Mignone J, et al. Formal and informal sector health providers in southern India: role in the prevention and care of sexually transmitted infections, including HIV/AIDS. AIDS Care. 2007;19(2):152–8.CrossRef Mignone J, et al. Formal and informal sector health providers in southern India: role in the prevention and care of sexually transmitted infections, including HIV/AIDS. AIDS Care. 2007;19(2):152–8.CrossRef
29.
go back to reference Bloom G, et al. Making health markets work better for poor people: the case of informal providers. Health Policy Plan. 2011;26(suppl_1):i45–52.CrossRef Bloom G, et al. Making health markets work better for poor people: the case of informal providers. Health Policy Plan. 2011;26(suppl_1):i45–52.CrossRef
30.
go back to reference Ahmed SM, et al. Changing health-seeking behaviour in Matlab, Bangladesh: do development interventions matter? Health Policy Plan. 2003;18(3):306–15.CrossRef Ahmed SM, et al. Changing health-seeking behaviour in Matlab, Bangladesh: do development interventions matter? Health Policy Plan. 2003;18(3):306–15.CrossRef
31.
go back to reference Moniruzzamani, A.T., et al. Prevalence of hypertension among the Bangladeshi adult population: a meta-analysis. Regional health forum. 2013. Moniruzzamani, A.T., et al. Prevalence of hypertension among the Bangladeshi adult population: a meta-analysis. Regional health forum. 2013.
32.
go back to reference Khanam MA, et al. Hypertension: adherence to treatment in rural Bangladesh–findings from a population-based study. Glob Health Action. 2014;7(1):25028.CrossRef Khanam MA, et al. Hypertension: adherence to treatment in rural Bangladesh–findings from a population-based study. Glob Health Action. 2014;7(1):25028.CrossRef
33.
go back to reference Cross J, MacGregor H. Who are ‘informal health providers’ and what do they do? Perspectives from medical anthropology. IDS Work Pap. 2009;2009(334):01–23.CrossRef Cross J, MacGregor H. Who are ‘informal health providers’ and what do they do? Perspectives from medical anthropology. IDS Work Pap. 2009;2009(334):01–23.CrossRef
34.
go back to reference Bloom G, et al. Engaging with health Markets in low and Middle-Income Countries. IDS Work Pap. 2014;2014(443):1–28.CrossRef Bloom G, et al. Engaging with health Markets in low and Middle-Income Countries. IDS Work Pap. 2014;2014(443):1–28.CrossRef
35.
go back to reference Rahman MH, et al. What do they do? Interactions between village doctors and medical representatives in Chakaria, Bangladesh. Int Health. 2014;7(4):266–71.CrossRef Rahman MH, et al. What do they do? Interactions between village doctors and medical representatives in Chakaria, Bangladesh. Int Health. 2014;7(4):266–71.CrossRef
36.
go back to reference Bangladesh Health Watch. Health Workforce in Bangladesh: Who Constitutes the Healthcare System? The State of Health in Bangladesh 2007. Dhaka: James P Grant School of Public Health, BRAC University; 2008. Bangladesh Health Watch. Health Workforce in Bangladesh: Who Constitutes the Healthcare System? The State of Health in Bangladesh 2007. Dhaka: James P Grant School of Public Health, BRAC University; 2008.
37.
go back to reference El-Saharty S, et al. The path to universal health coverage in Bangladesh: bridging the gap of human resources for health. Washington DC: The World Bank; 2015.CrossRef El-Saharty S, et al. The path to universal health coverage in Bangladesh: bridging the gap of human resources for health. Washington DC: The World Bank; 2015.CrossRef
38.
go back to reference Sieverding M, Beyeler N. Integrating informal providers into a people-centered health systems approach: qualitative evidence from local health systems in rural Nigeria. BMC Health Serv Res. 2016;16(1):526.CrossRef Sieverding M, Beyeler N. Integrating informal providers into a people-centered health systems approach: qualitative evidence from local health systems in rural Nigeria. BMC Health Serv Res. 2016;16(1):526.CrossRef
39.
go back to reference Bello G, et al. The effect of engaging unpaid informal providers on case detection and treatment initiation rates for TB and HIV in rural Malawi (triage plus): a cluster randomised health system intervention trial. PLoS One. 2017;12(9):e0183312.CrossRef Bello G, et al. The effect of engaging unpaid informal providers on case detection and treatment initiation rates for TB and HIV in rural Malawi (triage plus): a cluster randomised health system intervention trial. PLoS One. 2017;12(9):e0183312.CrossRef
40.
go back to reference Gwatkin DR, Bhuiya A, Victora CG. Making health systems more equitable. Lancet. 2004;364(9441):1273–80.CrossRef Gwatkin DR, Bhuiya A, Victora CG. Making health systems more equitable. Lancet. 2004;364(9441):1273–80.CrossRef
41.
go back to reference Pakenham-Walsh N, Bukachi F. Information needs of health care workers in developing countries: a literature review with a focus on Africa. Hum Resour Health. 2009;7(1):30.CrossRef Pakenham-Walsh N, Bukachi F. Information needs of health care workers in developing countries: a literature review with a focus on Africa. Hum Resour Health. 2009;7(1):30.CrossRef
42.
go back to reference Rowe AK, et al. Improving health worker performance: an ongoing challenge for meeting the sustainable development goals. BMJ. 2018;362:k2813.CrossRef Rowe AK, et al. Improving health worker performance: an ongoing challenge for meeting the sustainable development goals. BMJ. 2018;362:k2813.CrossRef
43.
go back to reference Garcia P, et al. Training pharmacy workers in recognition, management, and prevention of STDs: district-randomized controlled trial. Bull World Health Organ. 2003;81:806–14.PubMed Garcia P, et al. Training pharmacy workers in recognition, management, and prevention of STDs: district-randomized controlled trial. Bull World Health Organ. 2003;81:806–14.PubMed
44.
go back to reference Brennan N, et al. Trust in the health-care provider–patient relationship: a systematic mapping review of the evidence base. Int J Qual Health Care. 2013;25(6):682–8.CrossRef Brennan N, et al. Trust in the health-care provider–patient relationship: a systematic mapping review of the evidence base. Int J Qual Health Care. 2013;25(6):682–8.CrossRef
Metadata
Title
Perceptions of appropriate treatment among the informal allopathic providers: insights from a qualitative study in two peri-urban areas in Bangladesh
Authors
M. Monaemul Islam Sizear
Herfina Y. Nababan
Md. Kaoser Bin Siddique
Shariful Islam
Sukanta Paul
Anup Kumar Paul
Syed Masud Ahmed
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Antibiotic
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4254-3

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue