CUS  Vol.1 No.4 , December 2013
Exploring the Roles, Practices and Service Delivery Mechanism of Health Service Providers Regarding TB in Two Urban Slums of Dhaka
Abstract: Tuberculosis (TB) is a major health care burden in developing countries. With a high number of population living in an environment with high congestion, controlling TB in Bangladesh especially in urban areas has been a big challenge. The current study aims to identify the perception and treatment practice of formal and informal health service providers regarding TB in terms of treatment, referral system and to find out the partnership mechanism and also community perception and their health seeking behavior in two urban slums of Dhaka city. This is a cross-sectional study utilizing mixed methods approach and was conducted in two urban slums, namely, Slum A and Slum B of Dhaka city. Health service providers both formal and informal, community people and TB patients were selected as study population. In the quantitative part a survey was carried out where all the existing health service providers were interviewed. These health service providers were identified through 12 PRA (Participatory Rapid Appraisal) Social Mapping. Seven Focus Group Discussions (FGD) were conducted with this community. Popular Health service providers were identified through PRA matrix ranking during the FGDs and were selected for in-depth interview. TB patients were identified during FGD for in-depth interview. Community in urban slums is well aware of the infectious, contagious characteristics of TB. However, the long duration of DOTS program has been a major cause of high rate of drop-out. Generally drug sellers, traditional healers, homeopath and allopath (MBBS) practitioners are the primary point of contact of TB patients. They know where to refer to diagnosis and treatment. The referral system based on informal relationship sometimes leads to referring patients to wrong service providers. The mechanisms of TB programs in urban areas of Bangladesh should seriously consider arranging regular training and monitoring of health workforce, setting up formal partnership between formal and informal health service providers and generate information that policy-makers could use to scale up TB control program.
Cite this paper: Hasib, E. , Khan, T. , Sarker, M. , Islam, S. , Islam, A. , Husain, A. and Rashid, S. (2013) Exploring the Roles, Practices and Service Delivery Mechanism of Health Service Providers Regarding TB in Two Urban Slums of Dhaka. Current Urban Studies, 1, 139-147. doi: 10.4236/cus.2013.14015.

[1]   Ahmed, N. U., Alam, M. M., Sultana, F., Sayeed, S. N., Pressman, A. M., & Powers, M. B. (2006). Reaching the unreachable: Barriers of the poorest to accessing NGO healthcare services in Bangladesh. Journal of Health Populnutr, 24, 457-465.

[2]   Cases in Global Health Delivery (2011). Tuberculosis in Dhaka: BRAC’s urban TB program.

[3]   Cavalcante, S. C., Soares, E. C. C., Pacheco, A. G. F., Chaisson, R. E., Durovni, B., & the DOTS Expansion Team (2007). Community DOT for tuberculosis in a Brazilian favela: comparison with a clinic model. The International Journal of Tuberculosis and Lung Disease, 11, 544-548.

[4]   Croft, R. A., & Croft, R. P. (1998). Expenditure and loss of income incurred by tuberculosis patients before reaching effective treatment in Bangladesh. The International Journal of Tuberculosis and Lung Disease, 2, 252-253.

[5]   David, A. M., Mercado, S. P., Becker, D., Edmundo, K., & Mugisha, F. (2007). The prevention and control of HIV/AIDS, TB and vectorborne diseases in informal settlements: Challenges, opportunities and insights. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 84, 65-74.

[6]   Floyd, K. (2003). Costs and effectiveness—The impact of economic studies on TB control. Tuberculosis, 83, 65-74.

[7]   Harvard Medical School, Brigham and Women’s Hospital (2011). Tuberculosis in Dhaka: BRAC’s urban TB program.

[8]   Hurtig, A. K., Pande, S. B., Baral, S. C., Newell, J., Porter, J. D., & Bam, D. S. (2002). Health Policy And Planning, 17, 78-98.

[9]   Islam, M. A., May, M. A., Ahmed, F., Cash, R. A., & Ahmed, J. (2011). Making Tuberculosis History. Dhaka: The University Press Limited.

[10]   Karim, F. (2009). Gender matters Understanding of access barriers to community-based tuberculosis care in Bangladesh.

[11]   Karim, F., Islam, M. A., Chowdhury, A. M. R., Johansson, E., & Diwan, V. K. (2007). Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy and Planning, 22, 329-334.

[12]   Mushtaq, M. U., Shahid, U., Abdullah, H. M., Saeed, A., Omer, F., Shad, M. A., et al. (2011). Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan’s Punjab province. International Journal for Equality in Health, 10, 2-7.

[13]   Nolan, C. M., Schecter, G., Mase, S. R., Jereb, J., Navin, T. R., Posey, D. L., et al. (2007). Evaluation of tuberculosis program services for Burmese refugees in Thailand resettling to the United States, June 2007.

[14]   Patel, R. B., & Burke, T. F. (2009). Urbanization—An emerging humanitarian disaster. The New England Journal of Medicine, 361, 741-743.

[15]   Public Health Watch (2006). TB policy in Bangladesh.

[16]   Rahman, K. A., Kamsrichan, W., & Keiwkarnka, B. (2008). Factors related to acceptance of tuberculosis case detection among urban slum population in Mohammadpur, Dhaka city corporation, Bangladesh. Journal of Public Health & Development, 6, 82-88.

[17]   Rashid, S. F. (2009). Strategies to reduce exclusion among populations living in urban slum settlements in Bangladesh. Journal of Health Population Nutrition, 27, 574-586.

[18]   Rashid, S. F., Akram, O., & Standing, H. (2011). The sexual reproductive health care market in Bangladesh: where do poor women go? Reproductive Health Matter, 19, 21-30.

[19]   Ravichandran, N. (2004). Tuberculosis control in developing countries: A generalized community health worker based model.

[20]   Salim, M. A. H., Declercq, E., Deun, A. V., & Saki, K. A. R. (2004). Gender differences in tuberculosis: A prevalence survey done in Bangladesh. The International Journal of Tuberculosis and Lung Disease, 8, 952-956.

[21]   Salim, M. H., Uplekar, M., Daru, P., Aung, M., Declercq, E., & Lonnroth, K. (2006). Policy and Practice Turning liabilities into resources: Informal village doctors and tuberculosis control in Bangladesh. Bulletin of the World Health Organization, 84, 479-484.

[22]   Shah, N. M., Brieger, W., & Peters, D. H. (2010). Can interventions improve health services from informal private providers in low and middle-income countries? A comprehensive review of the literature. Health Policy and Planning, 26, 276-285.

[23]   Standing, H., Rashid, S. F., & Akram, O. (2013). Informal markets in sexual and reproductive health services and commodities in rural and urban Bangladesh.

[24]   Ullah, A. N. Z., Newell, J. N., Ahmed, J. U., Hyder, M. K. A., & Islam, A. (2006). Government-NGO collaboration: The case of tuberculosis control in Bangladesh. Government—NGO Collaboration in TB Control.

[25]   Vissandjee, B., & Pal, M. (2007). The socio-cultural challenge in public health interventions: the case of tuberculosis in India. International Journal of Public Health, 52, 199-200.

[26]   Wikstrom, G. (2011). Women’s perspectives on pathway to diagnosis of pulmonary tuberculosis women voices from community level in Uganda. Nordic School of Public Health.

[27]   World Health Organization (2011). Tuberculosis prevention, care and control A practical directory of news advances. Geneva: World Health Organization.

[28]   World Health Organization (2008). Global tuberculosis control 2008: surveillance, planning, financing. Geneva: World Health Organization.

[29]   World Health Organization (2007). Tuberculosis Prevalence Surveys: A handbook. Geneva: World Health Organization.

[30]   World Health Organization (2004). Tuberculosis and health sector reforms in Bangladesh. Geneva: World Health Organization.