Bangladesh: Second Service Deivery Survey (HPSP), 2000

This follow-up to the 1999 baseline survey took place in late 2000, conducted by CIET in collaboration with local colleagues, under contract with the Ministry of Health and Family Welfare. More than 25,000 households were interviewed, in the same sites as the baseline survey (with a quarter re-selected), and 2000 government health workers were interviewed. The main findings were then discussed in over 200 community focus groups and with upazila health service provider teams.

There were some positive findings in the 2000 survey. Although only 10% of visits to government health services were for preventive purposes (such as immunisation or antenatal care), such visits were generally positively rated. Two thirds of government service users were satisfied overall, compared with half of users in 1999. However, use of government health services remains much lower than use of various private practitioners and services. Very poor households are less likely to use services. Focus group participants said this is due to perceived discrimination against poor people, lack of prescribed medicines and the need to pay bribes. At least a fifth of government service users in 2000 made an unofficial payment and prescribed medicines were fully available in only a fifth of visits (compared with a third in 1999). Analysis indicated that satisfaction of service users could be improved not only by ensuring full availability of medicines, but also by simply giving patients an explanation of their condition and the treatment. To achieve this, the attitudes of health service providers will have to change.

The preliminary report of the second service delivery survey was an input into the mid term review of the HPSP in late 2000. The report on this survey is available from the Library.