Monograph Series 67 Inequity in Health Services in Different Areas under the Essential Healthcare Programme of BRAC



The Essential Health Care (EHC) programme, one of the key development efforts of BRAC, provides an integrated package of preventive and basic curative services through community health workers (CHWs). The programme aims to improve health and nutrition of women and under-five children in rural Bangladesh. However, impression about regional variation and inequity in use of services from both public and private sectors is needed to identify the gap and further intensify the programme. A community-based cross-sectional study was conducted in 30 upazilas (sub-districts)in rural Bangladesh during March 2013. This covers seven working regions (Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur and Sylhet) of the EHC programme. A total of 1,200 married women with a child aged 1-2 years were interviewed. Data on socio-demographic characteristics; maternal health service indicators, such as family planning (FP), antenatal care (ANC), delivery care, postnatal care (PNC); newborn care; infant and young child feeding (IYCF) practices; immunisation; management of morbidities of children; and knowledge on hygiene and sanitation were collected through a pre-structured questionnaire. A score was used to identify women who received continuous care between pregnancy and postnatal period from a medically trained provider (MTP) including doctor, nurse, FWV, midwife and paramedic. With respect to this score a very low proportion of women in Rajshahi were using all the services from an MTP. Use of maternal health services from MTPs was in general associated positively with household income-expenditure level and maternal literacy; while compared to Dhaka, other areas were associated negatively. Even in Rajshahi IYCF practice was worse than other comparing regions. IYCF indicators were also associated positively with income and literacy. In addition, regular home visits by CHWs significantly improved micronutrient powder intake by the under-two children. Although, only half of the families with a child who suffered from diarrhoea sought treatment from an MTP, for ARI they sought treatment from a non-medical professional. Findings of this study suggest that the gaps in maternal and under-five child health services among the poor and illiterate give the room for implementing door–to-door services of EHC programme through the CHWs. In addition, it needs to be ensured that the target people may get all the services consistently, especially in Rajshahi.

Related information

  • Writer Name: Saira Parveen Jolly Anita Sharif Chowdhury Tridib Roy Chowdhury Ariful Alam Soheli Rahman Mahfuzar Rahman
  • Published Date: Monday, 17 October 2016
  • Country: Bangladesh