206995 Local practice helped achieve MDGs, the lessons in Bangladesh

Wednesday, November 11, 2009

Md. Mujibul Alam Khan , Independent Researcher, Taipei 100, Taiwan
Yu-Hwei Tseng , Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
Background: Gonoshasthaya Kendra (GK), a non-governmental organization in Bangladesh, was one of the world's pioneers and best practices in integrated primary health care (PHC). In addition to its innovative adoption of women paramedics, traditional birth attendants (TBAs) complimented its performance.

Objectives: To understand how TBAs contributed to achieving Millennium Development Goals (MDGs) and identify the consequences of ignoring them.

Methods: Information was obtained through multiple methods, including literature review, in-depth interviews and participatory observations in rural healthcare settings.

Results: Case study of GK revealed that trained TBAs played multi-faceted functions in achieving MDGs more than maternal and child health. Inclusion of TBAs in GK's PHC referral mechanism was a pragmatic approach to address the shortage of skilled manpower at rural level, utilize lay knowledge and local wisdom, enhance gender equity and empower women (MDG 3), as well as prevent HIV/AIDS (MDG 6). However, medicalization of birthing and commercialization of health services resulted in denouncing TBAs. It might lead to (1) undermining the community's social capital; (2) further marginalizing the poor in accessing and affording health services; (3) inducing demand for and cost of healthcare, and (4) alienating the grassroots from participation in their health activities, thus widening the gap between people and health providers.

Conclusion and implications: Health workers in collaboration with TBAs could enhance health system in terms of delivery and promotion. Attention should be redirected from facilities and health commodities to adequate utilization of local resources.

Learning Objectives:
demonstrate the contribution of TBAs in achieving MDGs in Bangladesh analyze the impact of medicalization and commercialization of health services discuss the benefit of local knowledge and practices.

Keywords: International MCH, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a consultant to NGOs in Bangladesh by conducting independent field research and evaluation programs. I am also an advocate for primary health care and community empowerment.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.