Strategies for providing healthcare services to street-dwellers in Dhaka city: evidence from an operations research

eDakterBari: A human-centered solution enabling online medical consultation and information dissemination for resource-constrained communities in Bangladesh

A well-accessible healthcare system is an important measure of the progress of a country, as access to adequate healthcare is one of everyone's very basic human rights. When a community lives below the poverty line, unfortunately, it gets deprived of the basic human rights like healthcare, which is a reality to many resource-constrained communities around the world. The number of such resource-constrained communities in developing countries is large. Orphans present a prominent example in this regard in the context of Bangladesh. Orphans suffer greatly from many diseases due to their resource-constrained environment of livings and they are unable to take a minimum care of their own health. Their lack of resources, inadequate literacy skills, and limited (or no) access to technology leave them in such a position that they are ignorant of healthcare services available for them directly or through technological means. Considering all these unavoidable real aspects and the fact that such resource-constrained communities are very little focused in the literature for aiding them in getting bare minimum healthcare services, in this study, we leverage technology and relevant appropriate intermediaries to bridge the gap between the orphans in the orphanages and healthcare services offered by medical doctors. To accomplish so, we conduct a series of field studies over the intended communities. The orphanage teachers and administrators, being in proximity, are the most effective ones to operate as intermediaries for the orphan children, as revealed through our field studies. Therefore, we use these intermediaries to help the orphans to get basic healthcare services via an Android healthcare app called 'Shastho-sheba'. We also use our findings from the field study to specifically tailor and modify the application for intermediaries to use on behalf of the orphans so that health professionals can provide direct healthcare services to them over the Internet. Finally, we look into our proposed techno-social solution in the context of HCI to ensure that the service is used more effectively.

Family planning for urban slums in low- and middle-income countries: a scoping review of interventions/service delivery models and their impact

Background

Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings.

Methods

We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings.

Results

The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls’ club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services.

Conclusions

This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01518-y.

Health, illness and healthcare-seeking behaviour of the street dwellers of Dhaka City, Bangladesh: qualitative exploratory study

OBJECTIVE

This study explored the illness experiences and healthcare-seeking behaviour of a cross-section of street dwellers of Dhaka City for designing a customised intervention.

DESIGN

A qualitative exploratory study of a sample of street dwellers of Dhaka City.

SETTING

Samples were taken from three purposively selected spots of Dhaka City with a high concentration of the target population.

PARTICIPANTS

Fifteen in-depth interviews and six informal group discussions with 40 street dwellers (≥18 years), and key informant interviews with service providers (n=6) and policymakers (n=3) were conducted during January-June 2019 to elicit necessary data.

PRIMARY OUTCOME MEASURES

Qualitative narrative of illness experiences of the sampled street dwellers, relevant healthcare-seeking behaviour and experiences of interactions with health systems.

RESULTS

We focused on three main themes, namely, reported illnesses, relevant healthcare-seeking behaviour and health system experiences of the street dwellers. Findings reveal that most of the street dwellers suffered from fever and respiratory illnesses in the last 6 months; however, a majority did not visit formal facilities. They preferred visiting retail drug shops for advice and treatment or waited for self-recovery. Formal facilities were visited only when treatment from drug shops failed to cure them or they suffered serious illnesses or traumatic injury. The reproductive-age women did not seek pregnancy care and most deliveries took place in the street dwellings. Lack of awareness, financial constraints and fear of visiting formal facilities were some of the reasons mentioned. Those who visited formal facilities faced barriers like the cost of medicines and diagnostic tests, long waiting time and opportunity cost.

CONCLUSIONS

The street dwellers lacked access to formal health systems for needed services as the latter lags far behind to outreach this extremely vulnerable population. What they need is explicit targeting with a customised package of services based on their illness profile, at a time and place convenient to them with minimum or no cost implications.

Improving Health Care Management in Primary Care for Homeless People: A Literature Review

BACKGROUND

Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant.

METHODS

We performed a literature review that included articles which described and evaluated primary care programs for homeless people.

RESULTS

Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community's health.

CONCLUSIONS

Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.

Utilization of research findings for health policy making and practice: evidence from three case studies in Bangladesh

Background

In striving to contribute towards improved health outcomes, health research institutions generate and accumulate huge volumes of relevant but often underutilized data. This study explores activities undertaken by researchers from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), an international research institution that promotes the utilization of their findings in the policymaking processes in Bangladesh.

Methods

The study used an exploratory case study design and employed qualitative methods to explore activities implemented to promote research utilization and the extent to which researchers felt that their findings contributed to the policymaking process. Data were collected between September and December 2011 through key informant interviews, focus group discussions with study investigators, and database and document reviews. We reviewed findings from 19 reproductive health studies conducted and completed by icddr,b researchers between 2001 and 2011. We interviewed 21 key informants, including 13 researchers, two policy makers, and six programme implementers. Data were entered into Microsoft Word and analyzed manually following a thematic framework approach. Following the World Health Organization/Turning Research into Practice (WHO/TRIP) framework, three case studies of how research findings were utilized in the policymaking processes in Bangladesh were documented.

Results

Activities implemented to promote research utilization included conducting dissemination workshops, publishing scientific papers, developing policy briefs, providing technical assistance to policymakers and programme implementers, holding one-on-one meetings, and joining advocacy networks. The majority of the researchers (12 of 13) reported that their study findings were utilized to influence policymaking processes at different levels. However, some researchers reported being unaware of whether and how their findings were utilized. As regards actual utilization of research findings, the evidence from the three case studies indicate that research findings can be utilized instrumentally, conceptually and symbolically, and at different stages within the policymaking process, including agenda setting and policy formulation and implementation.

Conclusions

The results show that research findings from icddr,b were promoted and utilized in health policymaking processes in Bangladesh using a variety of utilization approaches. These results suggest a need for using multiple approaches to promote utilization of research findings in health policymaking processes.