Rashid Sabina Faiz, Akram Owasim, Standing Hilary
James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Reprod Health Matters. 2011 May;19(37):21-31. doi: 10.1016/S0968-8080(11)37551-9.
In Bangladesh, the formal public health system provides few services for common sexual and reproductive health problems such as white discharge, fistula, prolapse, menstrual problems, reproductive and urinary tract infections, and sexual problems. Recent research has found that poor women and men resort to informal providers for these problems instead. This paper draws on interviews with 303 providers and 312 women from two rural and one urban area of Bangladesh from July 2008 to January 2009. Both informal and formal markets played an important role in treating these problems, including for the poor, but the treatments were often unlikely to resolve the problems. Providers ranged from village doctors without formal training to qualified private practitioners. The health system is heavily marketised and boundaries between "public" and "private" are blurred. There exists a huge, neglected domain of sexual and reproductive health needs which are a source of silent suffering and for which there are no trained health staff providing treatment in government facilities. The complexity of this situation calls for engaged debate in Bangladesh on how to improve the quality of existing services, discourage or prevent obviously harmful practices, and develop financing mechanisms to enable women to access effective treatment, regardless of the source, for these neglected problems.
在孟加拉国,正规的公共卫生系统几乎不为白带异常、瘘管病、子宫脱垂、月经问题、生殖和尿路感染以及性问题等常见的性与生殖健康问题提供服务。最近的研究发现,贫困的女性和男性会转而求助于非正规医疗服务提供者来解决这些问题。本文基于2008年7月至2009年1月期间对孟加拉国两个农村地区和一个城市地区的303名医疗服务提供者以及312名女性进行的访谈。非正规和正规医疗市场在治疗这些问题方面都发挥了重要作用,包括对贫困人口,但这些治疗往往不太可能解决问题。医疗服务提供者的范围从未经正规培训的乡村医生到合格的私人执业医生。卫生系统高度市场化,“公立”和“私立”之间的界限模糊。存在一个庞大且被忽视的性与生殖健康需求领域,这些需求是无声痛苦的根源,而在政府医疗机构中没有受过培训的卫生人员提供治疗。这种情况的复杂性要求孟加拉国展开深入辩论,探讨如何提高现有服务的质量,劝阻或防止明显有害的做法,并建立融资机制,使女性能够获得有效的治疗,而不论来源如何,以解决这些被忽视的问题。
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