International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka 1222, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh.
Health Res Policy Syst. 2012 Jun 13;10:19. doi: 10.1186/1478-4505-10-19.
In almost every major urban city, thousands of people live in overcrowded slums, streets, or other public places without any health services. Bangladesh has experienced one of the highest rates of urban population growth in the last three decades compared to the national population growth rate. The numbers of the urban poor and street-dwellers are likely to increase at least in proportion to the overall population growth of the country. The street-dwellers in Bangladesh are extremely vulnerable in terms of their health needs and healthcare-seeking behaviours. In Bangladesh, there is no health service-delivery mechanism targeting this marginalized group of people. This study, therefore, assessed the effectiveness of two models to provide primary healthcare (PHC) services to street-dwellers.
This study of experimental pre-post design tested two models, such as static clinic and satellite clinics, for providing PHC services to street-dwellers in the evening through paramedics in Dhaka city during May 2009-April 2010. Both quantitative and qualitative techniques were used for collecting data. Data were analyzed comparing before and after the implementation of the clinics for the assessment of selected health and family-planning indicators using the statistical t-test. Services received from the model l and model 2 clinics were also compared by calculating the absolute difference to determine the relative effectiveness of one model over another.
The use of healthcare services by the street-dwellers increased at endline compared to baseline in both the model clinic areas, and the difference was highly significant (p < 0.001). Institutional delivery among the female street-dwellers increased at endline compared to baseline in both the clinic areas. The use of family-planning methods among females also significantly (p < 0.001) increased at endline compared to baseline in both the areas.
As the findings of the study showed the promise of this approach, the strategies could be implemented in all other cities of Bangladesh and in other countries which encounter similar problems.
在几乎每个主要城市，都有成千上万的人生活在拥挤的贫民窟、街道或其他公共场所，没有任何卫生服务。与全国人口增长率相比，孟加拉国在过去三十年中经历了城市人口增长最快的时期之一。城市贫困人口和街头居民的数量很可能至少与全国人口增长成正比增加。孟加拉国的街头居民在健康需求和寻求医疗保健方面极其脆弱。在孟加拉国，没有针对这一边缘化群体提供卫生服务的机制。因此，本研究评估了两种模式为街头居民提供初级保健 (PHC) 服务的效果。
本实验性前后设计研究测试了两种模式，例如在晚上通过医务人员在达卡市为街头居民提供 PHC 服务的静态诊所和卫星诊所。在 2009 年 5 月至 2010 年 4 月期间，使用定量和定性技术收集数据。通过使用统计 t 检验比较诊所实施前后的选定健康和计划生育指标，对数据进行分析，以评估诊所的效果。通过计算绝对差值比较模型 1 和模型 2 诊所提供的服务，以确定一种模式相对于另一种模式的相对有效性。
与基线相比，街头居民在两个模型诊所地区的终线时都增加了对医疗保健服务的使用，差异具有高度显著性 (p < 0.001)。在两个诊所地区，女性街头居民的机构分娩率在终线时都高于基线。在两个地区，女性使用计划生育方法的比例也显著增加 (p < 0.001)。
正如研究结果所示，这种方法有很大的希望，因此可以在孟加拉国的所有其他城市以及遇到类似问题的其他国家实施这些策略。
