The intervention will further link village doctors with formal healthcare providers for more complicated illnesses. Health systems rely a great deal on health technologies; the limited use of information technology, record maintenance, and unfitting infrastructure can be observed in the health system of Pakistan [35]. NEW SUPPLEMENT: Innovation in health systems in low- and middle-income countries. The health system of Pakistan expands more than eighty percent of their health expenditures on medical products and pharmaceuticals [32]. In addition, Maternity and Child Health Centers (MCHCs) play their part and provide basic obstetric care the community with the collaboration of lady health workers. Since the time of independence, HCDS of Pakistan has undergone major reforms start its journey from National Health Policy, Primary Health Care services, TB control, and Immunization Program [22]. J Hosp Med Manage. Bangladesh aims to provide all citizens and communities with the health services they need, at a price they can afford, by 2032. However, only a small proportion of the many investments in innovations have been shown to have an impact on health system performance at scale. Simultaneously, the most critical challenge faced by the health systems in Bangladesh is in the arena of human resources, technology, and infrastructure [38]. drugs, instruments, supplies, and technologies [11]. Currently, National Tuberculosis Control Program, EPI programs, diagnostic kits for the HIV/AIDS program, and Hepatitis program is governed by donor agencies at Pakistan. FHS is pleased to announce the publication of a new supplement in BMC Globalization and Health, titled Innovation in health systems in low- and middle-income countries. Bangladesh is one of the most densely populated South Asian countries. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. Furthermo… However, utilisation of CC services is still very low. In addition, the Ministry of Local Government, Rural Development, and Cooperatives play their part and manage the provision of urban primary care services. However, poor access to services, low quality of care, and high rate of mortality and poor status of child health still remain as challenges of the health sector of Bangladesh [24]. Major challenges include: an overly- centralized health system, weak governance structure and regulatory framework, weak management and institutional capacity in the Ministry of Health and Family Welfare (MoHFW), fragmented public service delivery, inefficient allocation of public resources, lack of regulation of the private … However, some donors pool their fund and channel that through government system while other donors directly through project not channeling the government system [30]. Pakistan has a mixed health system that includes public, parastatal, private, civil society, philanthropic contributors, and donor agencies. Moreover, most of the health care educational institutions have limited tools and technology to prepare the health professionals. The primary objective of the authority is to ensure the quality, effectiveness, drug safety, implementing the policies and guidelines. It is the ninth most populated country in the world, in 2013 had a population of 156.6 million that is expected to increase to around 218 million by 2030 [7]. The health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. Citation: Kumar S, Bano S. Comparison and Analysis of Health Care Delivery Systems: Pakistan versus Bangladesh. Health care delivery system in Bangladesh Bangladesh healthcare systems are mentioned in the below: Presently, Pakistan has Gross Domestic Product (GDP) stagnant at 4.71%, Gross National Income (GNI) per capita is approximate US$ 1550, and is categorized as low-income country and positioned at 65th among 102 developing countries. The WHO suggests that doctor to patient ratio should be 1:1000 and doctor nurse ratio 1:4 is appropriate. However, during 2007-2013, a steady increase in the number of hospitals and beds is evident in both the public and private sectors. In the early phase, the health system of Bangladesh was primarily focused on providing curative services but at present with the involvement of United Nations, private sectors, NGOs, and donor agencies the health system has shifted its emphasis equally both on curative and preventive services [14]. The UNDP ranked Bangladesh as 146th out of 187 countries in terms of HDI. Moreover, the financing for health expenditures in Bangladesh comes from the different sources via different mechanism and payments. There is a growing interest in new technologies and innovative organizational arrangements as a means to improve a health system’s performance. The authors recommend that in order to improve the HCDS of Pakistan and Bangladesh several needs to be implemented. Health Care Delivery System in Bangladesh Sardar Arif Uddin, Public Health Anthropologist Email: sa.uddin14@gmail.com Dispensing of medicines will be part of the profit made by village doctors and will provide them with a financial incentive. Pakistan is a located in South Asia encircled by Afghanistan, India, China, Arabian Sea and Iran. Whereas, in the HCDS of the Bangladesh the Ministry of Health and Family Welfare (MOHFW) is the authoritative body, and little authority delegated to local levels as the comparison to the Pakistan. The health care service delivery in Bangladesh starts from the Community Clinics (CC) in villages, Union Health and Family Welfare Centers (UHFWC) at unions (collection of villages), Upazila Health Complexes (UHC) at the sub-district level, and backed by District Hospital (DH). Though, no official figure exists for health expenditures and expert believes that 78.08% is contributed through the outof- pocket mechanism, general taxation is the major source of government’s financing for health [29]. At the national level, USAID programs work with public health leaders to improve policy and planning, financial management, monitoring and evaluation, procurement, and logistics. Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan, Received date: December 22, 2016; Accepted date: January 09, 2017; Published date: January 14, 2017. Contracting-out (CO) to non-state providers is used widely to increase access to health care, but it entails many implementation challenges. Voice and accountability mechanism are almost non-existent. Table 4: Health professionals statistics. In Pakistan, the Primary health care facilities are provided by Government Dispensaries (GD), Basic Health Units (BHU) at the village level, and Rural Health Centers (RHC) at the level of the town. The Bangladesh government health expenditures as a share of GDP grew to 4.7% in 2015 which was around 1% till 2007. IFA supplements have also been found to reduce the preterm delivery rate and neonatal mortality attributable to prematurity and birth asphyxia. The private sector is largely focused on out-patient and in-patient curative care. The core primary health care facilities in Bangladesh are CCs. Dr. Moyukh Chowdhury, SNIH Advisory Board Coordinator, Umea University Dr. Shuchesmita Das, Medical officer and Clinic Manager, Urban Primary Health Care Services Delivery Project, Bangladesh Prologue: Mental well-being is a fundamental component of WHO’s definition of “health” and one of the major public health … Over the 45 years after independence, the HCDS of Bangladesh has gone through a number of reforms and established an extensive health infrastructure [12]. Bangladesh gets 8% of total health expenditures from donor agencies since 2007. Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery: Home and community level. Health care delivery is a daunting challenge area of the Bangladesh's healthcare systems. The author has argued that if the public hospitals could provide … There is a large cadre of health care providers in the informal sector is evident in both Pakistan and Bangladesh. All rights reserved. The MOHFW has Directorates of General and Health Services (DGHS) and Family Planning (DGFP) that manage the dual system of general health and family planning across the country. The basic food requirement and health are problems for the people, the paper by Nishtar [18] indicated that malnutrition is worst in the rural areas of Sindh, and Baluchistan with 20-30% children are being retarded, and high infant mortality is as a result of malnutrition, diarrhea, and pneumonia. The main internal NGOs and agencies contributing in the health system are HANDS, Shiffa Foundation, and Aga Khan Health Services Pakistan (AKHSP). All the above activities will be ensured and supervised by the project. It comprised of unqualified allopathic providers (e.g., rural doctors, drug shop retailer), traditional healer, faith healer, Unani, and semi qualified allopathic providers (e.g., medical assistants, technician, and community health worker). In addition, Bangladesh has four different HMIS under the supervision of directorates but there is a poor linkage between them but all provide summarized data to the MHFW [37]. Gilgit-Baltistan with the help of COMSATs university, and Association of Pakistani Physicians of North America [3]. However, the use of CSC in health in Bangladesh has been limited. Over the 45 years after independence, the HCDS of Bangladesh has gone through a number of reforms and established an extensive health infrastructure [12]. Bangladesh has National Drug Policy Act 1982 whose prime objective is to provide the quality essential drug at an affordable price. A reporting system has been set up to monitor the number of LA patients identifi ed, the number of HBCs issued, and ... make health care accessible for people who cannot pay for services. In the first phase, FHS Bangladesh established the ShasthyaSena intervention, which employed a combination of three strategies to improve healthcare services in rural Chakaria, Bangladesh. The optimal HCDS integrates the different health services encompasses the management and delivery of quality and safe health services [3]. The provision of basic health services in Bangladesh is pluralistic with four key actors that define its structure and function: government, private, non-governmental organizations (NGOs), and donor agencies [13]. Previously, provincial governments were responsible for health financing but currently as a result of political and administrative devolution empower district governments as important financial intermediaries. Academia.edu is a platform for academics to share research papers. This study analyses the responsiveness of outpatient care to assess the quality of urban primary health care among all 5 types of health care providers in Bangladesh, namely, the Urban Primary Health Care Services Delivery Project, the NGO Health Services Delivery Project (NHSDP), NGOs, private hospitals, and the Ministry of … Now, in this paper, we will discuss, compare, and analyze the HCDS of Pakistan in comparison to Bangladesh. From 1981 to 1991 the price of drugs was increased only 20% in local currency. These challenges must be resolved in order to improve the existing health system so that the disadvantaged and vulnerable people can get better access to basic health care services. The public sector in urban Bangladesh is limited to the provision of tertiary level care, and a handful of marginally functional urban health dispensaries. Poor access to quality health services and high costs threaten Bangladesh’s momentum towards universal health coverage. To complement the monitoring mechanism of community clinics, the Future Health Systems (FHS) Bangladesh team at icddr,b aimed to implement a community scorecard (CSC) to ensure community participation and provider accountability in the local health system. The health system of Bangladesh and Pakistan desperately needs a dynamic leadership, governance that is prepared to design and enforce evidence-based policies and programs and taking care of the system. As per the report of Bangladesh National Health Accounts (NHA), Bangladesh spends US$ 2.3 billion on health yearly, and approximately 64% of the amount comes from out-of-pocket payments. The health system of Bangladesh relies heavily on the government or the public sector for financing and setting overall policies and service delivery mechanisms. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low, where governance issues are not addressed. A health care system consists of all organizations; people and actions that promote restore or maintain health. The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. Iron-deficiency is the most common nutritional deficiency globally. Recently, Bangladesh has set National Five Year Strategic Investment Plan (SIP) in order to improve the health of the population, reforming the institutions, and improving performance. The majority of this population lives in the absolute poverty; they have to access public sector facilities, which are not providing satisfactory care [39]. A memorandum of understanding outlining the responsibilities and objectives of SS was signed between each joining member and the network. Implementation research and the engagement of stakeholders in such research have become increasingly prominent in finding ways to design, conduct, expand and sustain effective and equitable health policies, programmes and related interventions. Private facilities which are steadily growing now provide mainly for-profit curative services and handle more than half of all facility birth deliveries. The state religion in Pakistan is Islam, practiced by 95-97% of the population, and remaining 3-5% practice Christianity, Hinduism, and other religions. Currently, Bangladesh spends US$ 26.60 per capita in total [17]. The concept of health care system includes the involvement of the people, organizations, agencies, and resources that provide services to meet the health needs of the individual, community, and population [1]. Due to the high iron requirements for pregnancy, it is highly prevalent and severe in pregnant women. Table 1: Key Demographic and Health Indicators. A serious shortage and unequal distribution of qualified health personnel are major stumbling blocks: only 25% of health workers serve rural areas, but this is where 70% of the population lives. A “learning-by-doing” approach, using tools and techniques that are inclusive, participatory, and flexible, can help engagement and learning in different contexts to improve the delivery of health services. The public health delivery system functions through a three layer approach primary, secondary, and tertiary (Figure 1). Close proximity to clients, availability to the community day and night, sympathetic behavior, well established relations within the community, and flexible payment methods have made the village doctors a popular source of care. CHAPTER – 3 Health care delivery systems of Bangladesh Distribution of public health care services and facilities follows similar pattern of administrative tiers, … Using Bangladesh’s two decades of experience with contracting out Urban Primary Health Care (UPHC), this paper identifies contextual, contractual, and actor-related … Health Care Delivery System (HCDS) is a societal response to the determinants of health. In addition to the internal resources, the external funding agencies in Pakistan are USAID, and Department for International Development, UK. Health Care Delivery System (HCDS) is the arrangement that serves best to any country’s population with effective, efficient, fair distributions of resources, and funds for organized infrastructure to thrive well. If acceptability and efficacy of the intervention can be shown, a stronger case can be made that shows that using informal healthcare providers will be profitable in a country that has a huge shortfall in the health workforce. Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. The operationalization of the policies and laws lies on the provisional and local governments. Stakeholders are not fully aware of clinics' purposes and there is weak communication and lack of involvement of local government institutions. The inadequacies of the formal healthcare sector in Bangladesh has resulted in a widespread increase in informal providers as an alternative source of care providing basic and essential outpatient health services to millions of poor people in the rural areas. Recently, Bangladesh has undergone considerable social and economic changes, economy dramatically accelerated and GNI increased from US$ 100 per capita in 1973 to US$ 700 in 2010 [8]. Above all Pakistan and Bangladesh should immediately translate its health policies into action to benefit the people of the countries by ensuring humanity, equity, accessibility, and disease alleviation [41]. Recently, Bangladesh has made huge progress in immunization coverage. Huda TM, Rahman MM, Raihana S, Islam S, Tahsina T, Alam A, Agho K, Rasheed S, Hayes A, Karim MA and Rahman QS (2018) A community-based cluster randomised controlled trial in rural Bangladesh to evaluate the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality: the Shonjibon trial, BMC Public Health, 18(1):816, DOI: 10.1186/s12889-018-5713-1. The Government of Bangladesh has made a substantial commitment to provide comprehensive health care to its people. Yet, Bangladesh is still a long way from achieving universal health coverage. The study has shown that training and branding has acceptability among village doctors although their behaviour has had no drastic changes due to the lack of financial incentives. Presently, the Ministry of National Regulations and Services plays a key role in the formulation of policies, strategies, setting a vision, and planning. FHS is pleased to announce the publication of a new BMC Health Research Policy and Systems supplement , titled Engaging Stakeholders in Implementation Research: tools, approaches, and lessons learned from application. There are now also some demand-side financing mechanisms, such as a maternal health voucher scheme implemented in … There is strong evidence that maternal iron deficiency anaemia increases the risk of adverse perinatal outcomes. The ministry and government should carefully allocate the available resources among the rural and urban population. The MOHFW is not only responsible for setting entire policies and regulations but also for providing comprehensive health services, financing and health staff. Despite the widespread establishment of the community clinics, challenges such as shortage of supply, provider absenteeism, lack of properly defined roles and responsibilities of human resources, poor behaviour towards patients, weak accountability and governance, and absence of active participation from community in healthcare delivery restrict efficient use of these facilities and available resources. In the health care arena of Bangladesh, the doctor to patient ratio is 0.58:1000, and nurse-patient ratio is 0.3:1000 (Bangladesh Health Watch 2008; WHO, 2009). The paper emphasizes the importance of a multi-sectorial comprehensive approach to improve the health system. Thereafter, from 1992 to 2009 price was increased by 15%. Immunization is one of the most successful and effective health intervention to reduce vaccine preventable diseases for children. 3. Moreover, the HCDS of Bangladesh is challenged with governance, finances, human resources, service delivery, technology, manpower, and essential supplies like medicines [15]. The balanced health care system delivers the quality of care, health, and facilities through efficient, effective, and fair manner. Health System of Bangladesh 1. HCDS of both countries hugely relies on private organizations and these organizations provide the more advanced facilities but the whole population of the countries cannot afford these facilities. This will show and guide the informal healthcare providers how to treat and manage many common illnesses through the use of computer-based diagnostic algorithms. The private sector attends 70% of the population through a diverse group of trained health team members to traditional faith healers [10]. 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