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Bangladesh – Urban primary healthcare

Better policy, better health

THE new health policy update (August 2008) has given rise to some heated debates as to the universal right to Primary Health Care (PHC) and the open market approach through “non-state institutions” like the NGOs and the private sector operators. Real case studies of the national health care models and simulated projections can help visualise a probable model.

The urban primary healthcare system in Bangladesh is a good proxy for this exercise because it is defined and information is available. We can easily study the two most significant entities — the government and the NGO.

The government system – In Bangladesh, the publicly financed primary health facility in urban areas is quite poor. There are just 9095 Mother and Child Welfare Centers (MCWC) and 3540 urban dispensaries focusing entirely on primary care. By contrast, rural areas have almost 6,000 primary health care service delivery points.

The NGO system – The urban vacuum in non-commercial primary health care is mostly filled by NGO clinics. Approximately 19% of the total population receives services through an NGO clinic. Currently, two major networks funded by ADB and USAID provide comprehensive PHC (Essential Service Package/ESP) in the urban areas.

The United States Agency for International Development (USAID) has supported NGO service delivery for the past 30 years. The USAID network has evolved from separate rural and urban mechanisms in the first phase (1997-2002) to a unified program in the second phase (2002-2008), and now the Smiling Sun Franchising Program (SSFP: 2008-2011) aims to establishing a franchising network of NGO clinics.

“Franchising itself is a new concept and approach in Bangladesh. It is a system where individuals or businesses (franchisees) invest their assets in a system to utilise the brand name, operating system and ongoing support. Everyone (franchisee) in the system is licensed to use the brand name and operating system. The business relationship is a joint commitment by all franchisees and the franchisor, to get and keep customers. Legally, franchisees are bound use the prescribed marketing and operating systems of the franchisor.”

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