BRAC Research and Evaluation Division, BRAC Centre, 75 Mohakhali, Dhaka-1212, Bangladesh.
Health Policy Plan. 2009 Nov;24(6):467-78. doi: 10.1093/heapol/czp037. Epub 2009 Aug 31.
In Bangladesh, there is a lack of knowledge about the large body of informal sector practitioners, who are the major providers of health care to the poor, especially in rural areas, knowledge which is essential for designing a need-based, pro-poor health system. This paper addresses this gap by presenting descriptive data on their professional background including knowledge and practices on common illnesses and conditions from a nationwide, population-based health-care provider survey undertaken in 2007. The traditional healers (43%), traditional birth attendants (TBAs, 22%), and unqualified allopathic providers (village doctors and drug sellers, 16%) emerged as major providers in the health care scenario of Bangladesh. Community health workers (CHWs) comprised about 7% of the providers. The TBAs/traditional healers had <5 years of schooling on average compared with 10 years for the others. The TBAs/traditional healers were professionally more experienced (average 18 years) than the unqualified allopaths (average 12 years) and CHWs (average 8 years). Their main routes of entry into the profession were apprenticeship and inheritance (traditional healers, TBAs, drug sellers), and short training (village doctors) of few weeks to a few months from semi-formal, unregulated private institutions. Their professional knowledge base was not at a level necessary for providing basic curative services with minimum acceptable quality of care. The CHWs trained by the NGOs (46%) were relatively better in the rational use of drugs (e.g. use of antibiotics) than the unqualified allopathic providers. It is essential that the public sector, instead of ignoring, recognize the importance of the informal providers for the health care of the poor. Consequently, their capacity should be developed through training, supportive supervision and regulatory measures so as to accommodate them in the mainstream health system until constraints on the supply of qualified and motivated health care providers into the system can be alleviated.
在孟加拉国,人们对庞大的非正规部门从业者缺乏了解,这些从业者是为穷人提供医疗保健服务的主要力量,尤其是在农村地区。为了设计一个基于需求、有利于穷人的卫生系统,了解这方面的知识至关重要。本文通过介绍 2007 年进行的一项全国性的基于人口的卫生保健提供者调查,提供了关于他们专业背景的描述性数据,包括他们对常见疾病和情况的知识和实践。传统的治疗师(43%)、传统的接生员(22%)和无资质的西医提供者(乡村医生和药品销售商,16%)成为孟加拉国医疗保健领域的主要提供者。社区卫生工作者(CHWs)约占提供者的 7%。与其他提供者相比,TBAs/传统治疗师的平均受教育年限为<5 年。TBAs/传统治疗师的专业经验更丰富(平均 18 年),而无资质的西医(平均 12 年)和 CHWs(平均 8 年)的经验更丰富。他们进入这个行业的主要途径是学徒制和继承(传统治疗师、TBAs、药品销售商)以及来自半正规、不受监管的私立机构的为期数周到数月的短期培训(乡村医生)。他们的专业知识基础还没有达到提供基本治疗服务并保证最低可接受的护理质量所需的水平。由非政府组织(NGO)培训的 CHWs(46%)在合理使用药物(如使用抗生素)方面比无资质的西医提供者要好一些。公共部门不仅要忽视,而且要认识到非正规部门提供者对穷人医疗保健的重要性。因此,应该通过培训、支持性监督和监管措施来发展他们的能力,将他们纳入主流卫生系统,直到能够缓解合格和有积极性的卫生保健提供者供应到系统中的限制。
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