Sajib Md Refat Uz Zaman, Hasan Kamrul, Hayder Tanvir, Hasan A M Rumayan, Rahman Md Musfikur, Ether Saraban, Rahman Atia, Tanwi Tania Sultana, Rahman Fariya, Sayeed Abu, Bari Sanwarul, Rahman Syed Moshfiqur, Arifeen Shams El, Ahmed Anisuddin
Department of Health and Kinesiology, University of Illinois Urbana- Champaign, Urbana, IL, USA.
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Arch Public Health. 2025 Apr 14;83(1):103. doi: 10.1186/s13690-025-01592-6.
Hard-to-reach riverine communities of northern Bangladesh face unique challenges in healthcare services. Friendship, an international social purpose organization, implemented a 3-tier healthcare model addressing these unique challenges over the past 20 years. This study evaluated Friendship's 3-tier healthcare model in the northern riverine area, assessing service-seeking practices, experiences, stakeholders' perceptions, and cost benefits for beneficiaries.
A concurrent mixed-method approach was employed, including desk reviews, a cross-sectional quantitative survey, facility mapping, and qualitative interviews with service recipients, community representatives, healthcare providers, and health managers. Data were collected from five hard-to-reach riverine sub-districts across the Kurigram, Gaibandha, Bogura, Sirajganj, and Jamalpur districts of Bangladesh between April 2022 and July 2023. Data analysis followed major thematic domains for a comprehensive and complementary understanding.
A significant proportion (43.0%) of survey participants had no formal education, were aged 18-35 (57.5%), and earned less than 1,620 USD yearly (66.6%). Friendship's healthcare services at the doorstep through satellite clinics and Female Community Medic Aides were widely accepted and preferred within the community for convenience, affordability (0.05-0.09 USD service charges), and superior quality, particularly the specialized treatments available on the hospital ships.
Friendship's 3-tier healthcare model made the accessibility and affordability of primary healthcare. Upon implementing a robust referral mechanism, continuing collaboration with the Government of Bangladesh, and expanding community awareness sessions to include topics such as mental health and disaster response, this model has the potential to be effective in similar settings in Bangladesh and other developing countries, as well as during emergency responses.
孟加拉国北部难以抵达的河滨社区在医疗服务方面面临独特挑战。国际社会公益组织“友谊”在过去20年里实施了一种三层医疗模式来应对这些独特挑战。本研究评估了“友谊”在北部河滨地区的三层医疗模式，评估了寻求服务的行为、经历、利益相关者的看法以及对受益者的成本效益。
采用了一种同步混合方法，包括案头审查、横断面定量调查、设施测绘以及对服务接受者、社区代表、医疗服务提供者和卫生管理人员的定性访谈。2022年4月至2023年7月期间，从孟加拉国库尔igram、盖班达、博古拉、锡拉杰甘杰和贾马尔布尔地区五个难以抵达的河滨分区收集了数据。数据分析遵循主要主题领域，以实现全面和互补的理解。
很大一部分（43.0%）调查参与者没有接受过正规教育，年龄在18 - 35岁之间（57.5%），年收入低于1620美元（66.6%）。“友谊”通过卫星诊所和女性社区医疗助手提供的家门口医疗服务，因其便利性、可承受性（服务收费0.05 - 0.09美元）和卓越质量，特别是医院船上提供的专科治疗，在社区中被广泛接受和青睐。
“友谊”的三层医疗模式使初级医疗服务变得可及且可承受。在实施强大的转诊机制、继续与孟加拉国政府合作以及扩大社区宣传活动以纳入心理健康和灾害应对等主题后，该模式有可能在孟加拉国和其他发展中国家的类似环境中以及应急响应期间发挥有效作用。
