Exploring the Roles, Practices and Service Delivery Mechanism of Health Service Providers Regarding TB in Two Urban Slums of Dhaka

Enamul Hasib, Tariq-Ul-Hassan Khan, Malabika Sarker, Shayla Islam, Akramul Islam, Ashaque Husain, Sabina Faiz Rashid

Health Nutrition and Population Programme, BRAC, Dhaka, Bangladesh.
James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
National Tuberculosis Control Program, Dhaka, Bangladesh.
Water Aid Bangladesh, Dhaka, Bangladesh.

DOI: 10.4236/cus.2013.14015                

Abstract

Tuberculosis (TB) is a major health care burden in developing countries. With a high number of population living in an environment with high congestion, controlling TB in Bangladesh especially in urban areas has been a big challenge. The current study aims to identify the perception and treatment practice of formal and informal health service providers regarding TB in terms of treatment, referral system and to find out the partnership mechanism and also community perception and their health seeking behavior in two urban slums of Dhaka city. This is a cross-sectional study utilizing mixed methods approach and was conducted in two urban slums, namely, Slum A and Slum B of Dhaka city. Health service providers both formal and informal, community people and TB patients were selected as study population. In the quantitative part a survey was carried out where all the existing health service providers were interviewed. These health service providers were identified through 12 PRA (Participatory Rapid Appraisal) Social Mapping. Seven Focus Group Discussions (FGD) were conducted with this community. Popular Health service providers were identified through PRA matrix ranking during the FGDs and were selected for in-depth interview. TB patients were identified during FGD for in-depth interview. Community in urban slums is well aware of the infectious, contagious characteristics of TB. However, the long duration of DOTS program has been a major cause of high rate of drop-out. Generally drug sellers, traditional healers, homeopath and allopath (MBBS) practitioners are the primary point of contact of TB patients. They know where to refer to diagnosis and treatment. The referral system based on informal relationship sometimes leads to referring patients to wrong service providers. The mechanisms of TB programs in urban areas of Bangladesh should seriously consider arranging regular training and monitoring of health workforce, setting up formal partnership between formal and informal health service providers and generate information that policy-makers could use to scale up TB control program.

Keywords

Tuberculosis; Health Service Provider; Partnership

Conflicts of Interest

The authors declare no conflicts of interest.

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