Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #116123

Fadia Sultana, MD¹, Nizam Uddin Ahmed, MD¹, Ferdousi Begum, MBBS, MPH², Mohammed Mahbub Alam², Farhana Ahmed², and Md Imtiazul Islam². (1) Bangladesh, Pathfinder International, 9 Galen St, Suite 217, Watertown, MA 02472, 617-824-7200, mkane@pathfind.org, (2) Pathfinder International-Bangladesh Office, 9 Galen Street, Suite 217, Watertown, MA 02472

BACKGROUND:

The NGO Service Delivery Project (NSDP) in Bangladesh is making significant progress in both identifying and reaching those living in extreme poverty. A focus on the poor is one of NSDP's mandates. NSDP seeks to give services a pro-poor orientation.

A qualitative study was conducted with several objectives: to identify the poorest of the poor; to isolate and comprehend the barriers they face in accessing services, to design ways to overcome those barriers; and to improve communication between the poor and NGO service providers.

METHODS:

The qualitative analysis took place at NGO sites between June and September 2003. Participatory rapid appraisal (PRA) applied. The study included poor men and women, service users and non-users and hard-to-reach individuals.

RESULTS:

The study identified several barriers and proposed adjustments to overcome the following: limited range of essential health services package; high cost of services and medicines; perception of clinics as only serving the rich; service provider bias against poor customers; and treatment exclusively focusing on women and children.

Use of clinics by the poor increased significantly, and their opinions on improving quality were taken into consideration. The existing clinical support group was reorganized to ensure the poor were well represented. New partnerships between facilities and their communities developed, along with innovative care financing schemes to open up access for the poor, including free service provision and a deferred payment mechanism.

CONCLUSIONS: The study findings strongly suggest the continuation of participatory processes to address the needs of the poor.

Learning Objectives:

• Participants attending this session will be able to
• 1. Implement strategies to identify the least advantaged among poor communities using three techniques of Participatory Rural Approaches (PRA).
• 2. Explain the importance of involving community and facilities in identifying gaps in access to the Essential Services Package (ESP).
• 3. Identify means of involving poor communities in designing pro-poor services through strengthening community-based forums.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Handout (.ppt format,