CQUniversity, Brisbane, Australia.
University of Edinburgh, Edinburgh, UK.
BMC Health Serv Res. 2023 Sep 7;23(1):964. doi: 10.1186/s12913-023-09972-w.
Bangladesh outperforms its Least Developed Country (LDC) status on a range of health measures including life expectancy. Its frontline medical practitioners, however, are not formally trained medical professionals, but instead lightly-trained 'village doctors' able to prescribe modern pharmaceuticals. This current study represents the most complete national survey of these practitioners and their informal 'clinics'.
The study is based on a national Computer Assisted Telephone Interviewing (CATI) of 1,000 informal practitioners. Participants were sampled from all eight divisions and all 64 districts of Bangladesh, including 682 participants chosen from the purposively recruited Refresher Training program conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), supplemented with 318 additional participants recruited through snowball sampling.
In addition to demographics, village doctors were asked about the characteristics of their 'clinics' including their equipment, their training, income and referral practices.
Three quarters of the wholly male sample had not completed an undergraduate program, and none of the sample had received any bachelor-level university training in medicine. Medical training was confined to a range of short-course offerings. Village doctor 'clinics' are highly dependent on the sale of pharmaceuticals, with few charging a consultation fee. Income was not related to degree of short-course uptake but was related positively to degree of formal education. Finally, practitioners showed a strong tendency to refer patients to the professional medical care system.
Bangladesh's village doctor sector provides an important pathway to professional, trained medical care, and provides some level of care to those who cannot afford or otherwise access the nation's established healthcare system. However, the degree to which relatively untrained paramedical practitioners are prescribing conventional medicines has concerning health implications.
孟加拉国在一系列健康指标上表现优于最不发达国家（LDC）地位，包括预期寿命。然而，其一线医务人员并非经过正规培训的医疗专业人员，而是经过轻度培训的“乡村医生”，能够开出现代药物。本研究代表了对这些从业者及其非正式“诊所”的最完整的全国调查。
该研究基于对 1000 名非正式从业者的全国计算机辅助电话访谈（CATI）。参与者从孟加拉国所有八个地区和 64 个区中抽取，包括从国际腹泻病研究中心（ICDDR，B）专门招募的进修培训计划中选择的 682 名参与者，以及通过滚雪球抽样招募的 318 名额外参与者。
除了人口统计学数据外，乡村医生还被问及他们的“诊所”的特征，包括他们的设备、培训、收入和转诊情况。
样本中四分之三的男性完全没有完成本科课程，而且样本中没有人接受过任何医学本科大学培训。医学培训仅限于一系列短期课程。乡村医生“诊所”高度依赖药品销售，很少收取咨询费。收入与短期课程的接受程度无关，但与正规教育的程度成正比。最后，从业者表现出强烈的将患者转诊到专业医疗保健系统的倾向。
孟加拉国的乡村医生部门为专业、受过培训的医疗保健提供了重要途径，并为那些无法负担或无法获得国家既定医疗保健系统的人提供了一定程度的护理。然而，相对未经训练的辅助医疗从业者开出现代药物的程度对健康有令人担忧的影响。
