Analysis of PHC performance: Perspectives from Bangladesh

1. Primary Health Care Improvement Global Stakeholder Meeting Analysis of PHC performance:Perspectives from Bangladesh Dr. Sultan Shamiul Bashar Management Information System MOHFW, Bangladesh

2. Bangladesh recognized importance of PHC even before Alma Ata Declaration in 1978 • Just after liberation in 1971, a PHC network in the country was established • After Alma Ata Declaration of 1978, Health & Family Welfare Centers were built in union (lowest administrative unit) levels

3. Health Care Network of Bangladesh Type of Facility Level Super-specialty hospital National Medical college/tertiary hospital Division (8) District (64) 50-250 bed hospital Sub-district (489) 31-50 bed hospital Union (4,553) Outpatient static facility Ward (40,977) Community Clinic / Domiciliary Workers Internet Connectivity Villages (87,310)

4. Community clinics:Revitalization of PHC • Over 13,000 • The number to be increased to ~ 18,000 • Roughly 1 for every 6,000 people • The core value is people’s active participation

5. Laptops in Community Clinics Multiple use • Telemedicine • Updating health data • Educating people • Training of health staffs • Communication • Internet browsing Visiting ITU Secretary General Dr Hamadoun I Toure is witnessing telemedicine service in Savar Upazila Hospital (March 2, 2010)

6. CommunityPopulation dataHealth service information Population data Health service information Upazila Health worker District Community Clinic National HMIS data flow

7. Use of data for decision making • Policy makers will view the dash board for evidence • Public will see selected data portion • Necessary communication and advocacy are being conducted Dash board

8. Data visualization for decision making GIS map

9. Data improvement and utilization: A cultural transition Co- ordination & betterment • Weekly meeting at CC • Monthly meetings at:- • Sub-district • District • Division • Now at the national level Online Local Health Bulletin

10. Thus, we are all set to jump into the next level … In other words … It’s the time for us to grab that “tremendous opportunity” of having a major positive impact on health through targeted measurement and better utilization of the data management backbone which we have already established

11. PHC performance • Improved as evidenced by typical and traditional measurements … • ↓ MMR 170 per 100,000 livebirths which was 574 per 100,000 livebirths in 1990 • under-5 mortality rate has been dropped to stunning 41 per 1,000 livebirths by 2012 from 144 per 1,000 livebirths in 1990 .This is a 71% reduction against the target of 66% reduction by 2015 •  Obviously due to improved performance of the PHC components (“…health systems based on high-performing PHC are able to achieve better health outcomes, more equitably and at lower relative cost…”)

12. Measurements • Access : Increased number of OPD visits, pt visits at CC • Comprehensiveness : Area for improvement … • Continuity : Addressed to some extent …. registering pregnant • women to ensure follow ups

13. Measurements • Coordination : CC meeting with different agency personnel • People-centeredness : Community participation @ CC. Ethnographic research needed … • Quality : Not measured directly, need to develop tools

14. Data usability • Data not being utilized at the national policy level • May be due to lack of knowledge about the demand side (policy makers) • Data presentation may not match the needs of top level planners • Supply side (enablers) should conduct research

15. Looking forward for more ……

16. Thank you very muchFor your patience