Cooperative societies : a sustainable platform for promoting universal health coverage in Bangladesh

Achieving Universal Health Coverage is among the core objectives of the health Sustainable Development Goals, and making healthcare affordable to everyone is fundamental to achieving Universal Health Coverage. ▸ Cooperative societies are autonomous groups of persons who voluntarily cooperate for their common economic interest, based on the values of self-help, self-responsibility, democracy and equality, equity and solidarity. ▸ There are 190 360 cooperatives in Bangladesh, and the total individual enrolees are 10 333 310 (with about 160 million people covered when spouses or dependents of enrolees are taken into account). Given this large pool, cooperative societies could be a platform to engage a large number of people regarding healthcare financing. ▸ Cooperative societies act as a risk management strategy for members, working on the basic principle of risk pooling during illness. This risk pooling mechanism can mitigate the consequences of dependence on out of pocket payments to finance healthcare, thereby facilitating the move towards Universal Health Coverage

Assessing the determinants of rice farmers' adaptation strategies to climate change in Bangladesh

Purpose - This paper examines rice farmers' selection of adaptation strategies to cope with and offset the effects of climate change and the determinants of those selections in Rajshahi, a severely drought-prone district of Bangladesh. Design/methodology/approach - Farm level micro-data was obtained from 550 rice growers in the 2010-2011 farming season. A multinomial logit (MNL) model was utilised to assess the determinants of adaptation strategies practised by farmers in response to climate change. Findings - Results from the MNL model indicate that gender, age, education of household heads, household assets, annual farm income, farm size, tenure status, farmer-to-farmer extension, access to credit, access to subsidy, and access to electricity, all affect farmers' selection of adaptation strategies for climate change. Originality/value - This is the first study of its kind to analyse the determinants of adaptation strategies for climate change by farmers in drought-prone areas of Bangladesh. This study provides direction for policy makers in order to strengthen the adaptation strategies of farmers and guide policies accordingly. These strategies have the potential to minimise the adverse effects of climate change

Small-Scale Turkey Farming in Bangladesh: Farming Practices, Profitability and Supply Chain Mapping

The study was conducted to know the existing turkey production system, supply chain mapping, and identifying the prospects and problems of turkey rearing in some selected areas of Bangladesh during October 2019 to December 2019. A total of 100 turkey raisers were surveyed following convenience method of sampling technique. The primary data were collected, analyzed accordingly and tabular presentation method was applied with the help of simple descriptive statistical measures e.g. frequency distributions, percentage, sum and means to illustrating the results. Profitability analysis was done on the basis of variable cost, fixed cost, return by using arithmetic means and percentages. The study revealed that 87 male and 13 female respondents were surveyed, of them cent percent found educated. About 56% turkey keeper’s main occupation was business, 27% service and 12% in farming while 88.57% involved with farming as secondary sources of income. Average landholding for homestead, cultivable and non-cultivable was 24.40, 129.71 and 29.47 decimal, respectively. About 59% farms started for commercial purpose, 32% for non-commercial purpose and 9% for both. About 60% respondents kept less than 50 turkeys and only 2% kept 501-1000 turkeys. Among the surveyed farms55% stopped their operation and 45% farms found running their business. Among the running farms cent percent were small-scale group. The average feed intake was 192.13 grams per day per bird at 20 weeks of age. Turkey laid on an average 139 eggs a year irrespective of variety and for hatching poults, the fertility and hatchability rate found between 65 to 100% and 50 to 90%, respectively. About 28% farmers experienced the deaths of turkey because of Cold, Pox, Ranikhet, Bird flu and unknown cases and 69.47% farmers took veterinary advice from Upazila Livestock Hospital and rest from other sources. Farmers to consumers were the most common and widely used marketing channel for egg, chick and adult turkey. The market intermediaries of turkey farm carried out different marketing functions e.g. buying and selling, pricing, transportation, sorting, distribution and market information. The average net return and benefit-cost ratio was BDT 127838.04 and 1.38, respectively for 50 turkeys per year. In the study, turkey rearing found some comparative benefit over chicken and ducks e.g. higher weight gain, forage eater, lower diseases rate and suitability for the country. The main problem of turkey rearing identified as market instability, lack of quality turkey feed, higher feed price, lack of proper marketing facility and training on turkey farming. In conclusion, the small-scale turkey farming could be a viable source of income for the rural people of Bangladesh after taking some remedial steps by the Government of Bangladesh for the aforesaid hindrances faced by the turkey farmers

Drivers and distribution of the household-level double burden of malnutrition in Bangladesh : analysis of mother-child dyads from a national household survey

Objective: The double burden of malnutrition (DBM) has become an emerging public health issue in many low-and middle-income countries. This study aims to provide important evidence for the prevalence of different types of DBM at the national and subnational levels in Bangladesh. Design: The study utilised data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017–18. Multivariable logistic regression was performed to identify the socio-demographic factors associated with DBM. Participants: 8,697 mothers aged 15 to 49 years with Setting: Nationally representative cross-sectional survey. Results: The overall prevalence of the DBM was approximately 21%, where the prevalence of overweight mother (OWM) & stunted child/wasted child/underweight child (SC/WC/UWC) and underweight mother (UWM) & overweight child (OWC) was 13.35% and 7.69%, respectively, with a higher prevalence among urban households (OWM & SC/WC/UWC =14.22%; UWM & OWC=10.58%) in Bangladesh. High inequality was observed among UWM & OWC dyads, Concentration Index (CI)= -0.2998 while low level of inequality of DBM were observed for OWM & SC (CI= 0.0153), OWM & WC (CI= 0.1165) and OWM & UWC (CI= 0.0135) dyads. We observed that the age and educational status of the mother, number of children, fathers’ occupation, size and wealth index of the household, and administrative division were significantly associated with all types of DBM. Conclusions: Health policymakers, concerned authorities, and various stakeholders should stress the prevalence of DBM issues and take necessary actions aimed at identifying and addressing the double burden of malnutrition in Bangladesh

Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage

Background: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country. Objectives: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh. Methodology: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by ‘self-reported illness and symptoms’) across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used. Results: An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t-value = 9.50). Healthcare benefits from private providers (CI = 0.237, t-value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t-value = 2.98) and NGO (CI = 0.095, t-value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits. Conclusion: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable

Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment

Community-based Health Insurance (CBHI) schemes are recommended for providing financial risk protection to low-income informal workers in Bangladesh. We assessed the problem of adverse selection in a pilot CBHI scheme in this context. In total, 1292 (646 insured and 646 uninsured) respondents were surveyed using the Bengali version of the EuroQuol-5 dimensions (EQ-5D) questionnaire for assessing their health status. The EQ-5D scores were estimated using available regional tariffs. Multiple logistic regression was applied for predicting the association between health status and CBHI scheme enrolment. A higher number of insured reported problems in mobility (7.3%; p = 0.002); self-care (7.1%; p = 0.000) and pain and discomfort (7.7%; p = 0.005) than uninsured. The average EQ-5D score was significantly lower among the insured (0.704) compared to the uninsured (0.749). The regression analysis showed that those who had a problem in mobility (m 1.25–2.17); self-care (OR = 2.29; 95% CI: 1.62–3.25) and pain and discomfort (OR = 1.43; 95% CI: 1.13–1.81) were more likely to join the scheme. Individuals with higher EQ-5D scores (OR = 0.46; 95% CI: 0.31–0.69) were less likely to enroll in the scheme. Given that adverse selection was evident in the pilot CBHI scheme, there should be consideration of this problem when planning scale-up of these kind of schemes

Prevalence and health care–seeking behavior for childhood diarrheal disease in Bangladesh

In Bangladesh, the burden of diarrheal diseases is significant among children <5 years old. The objective of this study is to capture the prevalence of and health care–seeking behavior for childhood diarrheal diseases (CDDs) and to identify the factors associated with CDDs at a population level in Bangladesh. We use a logistic regression approach to model careseeking based on individual characteristics. The overall diarrhea prevalence among children <5 years old was found to be 5.71%. Some factors found to significantly influence the health care–seeking pattern were age and sex of the children, nutritional score, age and education of mothers, wealth index, and access to electronic media. The health care service could be improved through working in partnership with public facilities, private health care practitioners, and community-based organizations, so that all strata of the population get equitable access in cases of childhood diarrhoea

The effectiveness of introducing Group Prenatal Care (GPC) in selected health facilities in a district of Bangladesh: study protocol.

Background Despite high rates of antenatal care and relatively good access to health facilities, maternal and neonatal mortality remain high in Bangladesh. There is an immediate need for implementation of evidence-based, cost-effective interventions to improve maternal and neonatal health outcomes. The aim of the study is to assess the effect of the intervention namely Group Prenatal Care (GPC) on utilization of standard number of antenatal care, post natal care including skilled birth attendance and institutional deliveries instead of usual care. Methods The study is quasi-experimental in design. We aim to recruit 576 pregnant women (288 interventions and 288 comparisons) less than 20 weeks of gestational age. The intervention will be delivered over around 6 months. The outcome measure is the difference in maternal service coverage including ANC and PNC coverage, skilled birth attendance and institutional deliveries between the intervention and comparison group. Discussion Findings from the research will contribute to improve maternal and newborn outcome in our existing health system. Findings of the research can be used for planning a new strategy and improving the health outcome for Bangladeshi women. Finally addressing the maternal health goal, this study is able to contribute to strengthening health system