On request of the Government of Bangladesh the third CIET Service Delivery Survey (SDS) process began at the end of February 2003. Headed by a technical steering group, chaired by the Joint Chief (Planning) of the Ministry of Health and Family Welfare, this third cycle of the SDS process took into account government health sector priorities and provided updated information on the public use, experience and perception of health and population services. It contributes to the evaluation of the Health and Population Sector Programme (HPSP) as well as providing inputs for the planning of the Health, Nutrition and Population Sector Programme (HNPSP).

Local partnerships for capacity development were a strong component of the third SDS. CIET independently conducted the survey in collaboration with three key national government academic/research organisations: National Institute of Preventive and Social Medicine (NIPSOM), Institute of Epidemiology, Disease Control and Research (IEDCR) and National Institute of Population Research and Training (NIPORT).

Data collection and analysis took place in 2003. The survey was conducted in same panel of communities as in the previous cycles and included more than 25,000 households as well as reviews of health service facilities and interviews with service providers. The findings were discussed in community focus groups in the more than 200 sample communities, as well as with upazila health and family planning teams and with medical and nursing professional bodies.

Analysis of the findings from the three cycles revealed that the public perceptions of government health services had deteriorated over the five years, with 38% rating the services as good in 1999, compared with only 10% in 2003. The public increasingly turned away from government treatment services, mainly towards unqualified practitioners. By 2003, 60% of recent contacts with services for treatment were with unqualified practitioners, while only 13% were with government services. Some 66% of those who used government services for treatment were satisfied with providers’ behaviour in 2000 and only 56% in 2003. Satisfaction with private and unqualified practitioners was much higher. The problem of lack of medicines available in government facilities persisted. The picture was much better for preventive services, mostly provided by government, and nearly all who used these services were satisfied. However, few people used these preventive services. There was also evidence of a steady increase in use of modern contraception.

The report includes recommendations for actions based on the evidence and discussion of the findings with key stakeholders. The MOHFW convened a dissemination workshop in Dhaka at the end of September 2004, to discuss the findings and recommendations and launch the report.