Rahman M Hafizur, Agarwal Smisha, Tuddenham Susan, Peto Heather, Iqbal Mohammad, Bhuiya Abbas, Peters David H
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
Int Health. 2015 Jul;7(4):266-71. doi: 10.1093/inthealth/ihu077. Epub 2014 Nov 17.
Informally trained village doctors supply the majority of healthcare services to the rural poor in many developing countries. This study describes the demographic and socio-economic differences between medical representatives (MRs) and village doctors in rural Bangladesh, and explores the nature of their interactions.
This study was conducted in Chakaria, a rural sub-district of Bangladesh. Focus group discussions and in-depth interviews were conducted, along with a quantitative survey to understand practice perceptions. Data analysis was performed using grounded theory and bivariate statistical tests.
We surveyed 43 MRs and 83 village doctors through 22 focus group discussions and 33 in-depth interviews. MRs have a higher average per capita monthly expenditure compared to village doctors. MRs are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less (p<0.001). MRs are the principal information source about new medications for the village doctors. Furthermore, incentives offered by MRs and credit availability influence the prescription practices of village doctors.
MRs being the key player in providing information about drugs to village doctors might influence their prescription practices. Improvements in the quality of healthcare delivered to the rural poor in informal provider-based health markets require stricter regulations and educational initiatives for providers and MRs.
在许多发展中国家，未经正规培训的乡村医生为农村贫困人口提供了大部分医疗服务。本研究描述了孟加拉国农村地区医药代表（MRs）和乡村医生之间的人口统计学和社会经济差异，并探讨了他们互动的性质。
本研究在孟加拉国一个农村分区查卡里亚进行。进行了焦点小组讨论和深入访谈，并开展了一项定量调查以了解实践认知。使用扎根理论和双变量统计检验进行数据分析。
我们通过22次焦点小组讨论和33次深入访谈，对43名医药代表和83名乡村医生进行了调查。与乡村医生相比，医药代表的人均月支出更高。医药代表受教育程度更高，98%拥有学士学位，而84%的乡村医生接受过十二年级及以下教育（p<0.001）。医药代表是乡村医生获取新药信息的主要来源。此外，医药代表提供的激励措施和信贷可得性会影响乡村医生的处方行为。
医药代表作为向乡村医生提供药品信息的关键角色，可能会影响他们的处方行为。在基于非正规医疗服务提供者的卫生市场中，要改善为农村贫困人口提供的医疗服务质量，就需要对医疗服务提供者和医药代表制定更严格的监管措施和教育举措。
