Improving ailability of and access to an essential health services package in urban Dhaka, Bangladesh

Abstract

Objective: Improve access to and the availability of essential health services, and also improve the use of individual clinics and overall use at the zone level by reorganizing the government and non-govemmental organization (NGO) facilities. The urban primary healthcare (PHC) facilities are managed by multiple organizations, i.e. two directorates of the Government; NGOs; Dhaka City Corporation; Ministry of Local Government, Rural Development and Cooperatives; and the for-profit commercial sector. In the government and NGO facilities, clients rarely obtain a combination of essential services. The distribution of these facilities is not optimal and results in some areas with "excess" of facilities often providing similar services while other areas are underserved, resulting in less access to service, creation of missed opportunities, and increase in cost of service provision and use. Methodology: The Urban Extension Project (UEP) of ICDDR.B implemented an intervention in two zones of the Dhaka City Corporation (DCC). The UEP developed a methodology as a part of this intervention for reorganizing the government and NGO facilities in the two zones. The methodology was based on the locally available data (inventory, mapping, service use) and participatory workshops involving managers and decision-makers of the government and NGO facilities. The workshop for Zone 3 was held in August 1996 and that of Zone 8 in November 1996. The workshops resulted in specific ward-wise redistribution plans which had four elements: (1) relocation of certain facilities, (2) bringing facilities and/or services preferably under one roof, (3) expansion of the range of services, and (4) improving referral among the neighbouring facilities. A mid-term evaluation was recently conducted. Results: The findings of the evaluation indicate that reorganization is possible using a participatory planning methodology. Six of the 14 specific recommendations for changes have already been implemented in Zone 3, whereas 7 of the 14 specific recommendations have so far been implemented in Zone 8. Improvement in service use was also observed, which indicates the possibility of improving the use of facilities at the clinic and the zone level after the reorganization of facilities. Conclusion: Redistribution plans of the PHC facilities based on the intervention methodology can significantly reduce inadequacies, gaps and overlaps of essential services, and improve access to and the availability of essential services in the urban areas.