Impact of Community Clinics on Health outcome: Evidence from a Natural Experiment in Bangladesh

1. Impact of Community Clinics on Health outcome: Evidence from a Natural Experiment in Bangladesh Md Amzad Hossain, University of Virginia MoogdhoMazhab, Univeristy of Virginia

2. Study Overview • Infectious diseases are a pervasive menace worldwide, developing countries in particular • account for about one fifth of total neo-natal deaths in Bangladesh • To improve health outcomes, Bangladesh created one community clinic for every 6k people that were also within 1/2 hour of walking distance. • Did this improve health care? • Were the costs worth the investment? • Is this a good model that should be continued and expanded upon? • Results: Based on preliminary results, immunizations were significantly higher in those populations served by these community clinics.

3. Research Question • Does access to community clinics improve Health outcome? • Neonatal and under 5 Child Morality Late • Maternal Mortality Rate • Immunization against infectious diseases • Nutritional Outcome • Other health outcomes e.g., reproductive health • Cost-Benefit Analysis (if data permits)

4. Contributions of this Study • Providing evidence based recommendations on the impacts (health outcomes/cost effectiveness) Strengths of the Study • Very large-level community-based interventions • Natural experiment where we exploit a exogenous policy change

5. What was the Policy Change?

6. Community Clinics Formation • Two rooms with drinking water and lavatory facilities, and a covered waiting area. • Based on Private-Public Partnership. • Funds for building the clinics were provided centrally, but communities had to donate land. • The staff and medicine supplies were provided by the government. • Each clinic should have at least two staffs: one health assistant and one family welfare assistant.

7. Community Clinics Available services: • Maternal & neonatal health care services (ANC/PNC); • Integrated Management of Childhood Illness (IMCI); • Reproductive Health and FP services; • Expanded Program on Immunization (EPI); • Nutritional education and micro-nutrient supplements; • Health education & counseling; • Screening of Chronic Non Communicable Diseases • Treatment of minor ailments, common diseases & first aid • Establishing referral linkage with higher facilities

8. Community Clinics: Service Outreach

9. Data • Different rounds of Bangladesh Demographic and Health Survey • Administrative data • Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh  • Revitalization of Community Health Care Initiatives in Bangladesh (RCHCIB)

10. Results: Impact on Immunization

11. Work in Progress • Impact on • Neonatal and under 5 Child Morality Late • Maternal Mortality Rate • Prevalence of Infectious Diseases • Other health outcomes e.g., reproductive health • Cost-Benefit Analysis • Cost of the intervention per infant life saved or maternal lives saved • How does it compare in terms of cost effectiveness compared to other interventions ?

12. Acknowledgements • Global Infectious Disease Institute (GIDI) • Sheetal Sekhri, Department of Economics, UVA • David Garcia, UVA Global Infectious Diseases Institute