M Hafizur Rahman1, Smisha Agarwal2, Susan Tuddenham2, Heather Peto2, Mohammad Iqbal3, Abbas Bhuiya3, David H Peters2. 1. Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA hrahman@jhu.edu. 2. Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. 3. International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka 1000, Bangladesh.
Abstract
BACKGROUND: Informally trained village doctors supply the majority of healthcare services to the rural poor in many developing countries. This study describes the demographic and socio-economic differences between medical representatives (MRs) and village doctors in rural Bangladesh, and explores the nature of their interactions. METHODS: This study was conducted in Chakaria, a rural sub-district of Bangladesh. Focus group discussions and in-depth interviews were conducted, along with a quantitative survey to understand practice perceptions. Data analysis was performed using grounded theory and bivariate statistical tests. RESULTS: We surveyed 43 MRs and 83 village doctors through 22 focus group discussions and 33 in-depth interviews. MRs have a higher average per capita monthly expenditure compared to village doctors. MRs are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less (p<0.001). MRs are the principal information source about new medications for the village doctors. Furthermore, incentives offered by MRs and credit availability influence the prescription practices of village doctors. CONCLUSIONS: MRs being the key player in providing information about drugs to village doctors might influence their prescription practices. Improvements in the quality of healthcare delivered to the rural poor in informal provider-based health markets require stricter regulations and educational initiatives for providers and MRs.
BACKGROUND: Informally trained village doctors supply the majority of healthcare services to the rural poor in many developing countries. This study describes the demographic and socio-economic differences between medical representatives (MRs) and village doctors in rural Bangladesh, and explores the nature of their interactions. METHODS: This study was conducted in Chakaria, a rural sub-district of Bangladesh. Focus group discussions and in-depth interviews were conducted, along with a quantitative survey to understand practice perceptions. Data analysis was performed using grounded theory and bivariate statistical tests. RESULTS: We surveyed 43 MRs and 83 village doctors through 22 focus group discussions and 33 in-depth interviews. MRs have a higher average per capita monthly expenditure compared to village doctors. MRs are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less (p<0.001). MRs are the principal information source about new medications for the village doctors. Furthermore, incentives offered by MRs and credit availability influence the prescription practices of village doctors. CONCLUSIONS: MRs being the key player in providing information about drugs to village doctors might influence their prescription practices. Improvements in the quality of healthcare delivered to the rural poor in informal provider-based health markets require stricter regulations and educational initiatives for providers and MRs.
Authors: Ahmed Ehsanur Rahman; Aniqa Tasnim Hossain; Abu Bakkar Siddique; Sabrina Jabeen; Mohammod Jobayer Chisti; David H Dockrell; Harish Nair; Kanta Jamil; Harry Campbell; Shams El Arifeen Journal: J Glob Health Date: 2021-09-11 Impact factor: 4.413
Authors: Ahmed Ehsanur Rahman; Samantha Herrera; Sayed Rubayet; Goutom Banik; Rezaul Hasan; Ziaul Ahsan; Wahida Siraj; Anisuddin Ahmed; Abu Bakkar Siddique; Qazi Sadeq-Ur Rahman; Lara M E Vaz; M Jahurul Islam; M Altaf Hossain; M Shahidullah; M Mohiuddin Osmani; Shams E L Arifeen; Stephen N Wall Journal: PLoS One Date: 2020-05-11 Impact factor: 3.240