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Technical Brief | Bangladesh

October 2010

e-Health in Bangladesh: Findings on Strengthening Remote Health Service Facilities


2008
Aims of the study
Information and communication technologies (ICT) can improve access to health care and quality of services while containing costs. In Bangladesh, where 75% of the population, but only 25% of physicians, live in rural areas, ICT can increase the both the reach and the quality of information and communication. The study, sponsored by the Grameen Communication Center (GCC) and implemented by University Research Corporation (URC), explored the potential for establishing a standard ICTbased health care service delivery system in Bangladesh. The objectives were: Identify areas that need to be addressed prior to developing and establishing an ICT-based health care service delivery system; and To assess the capacity of the health care service delivery personnel in ICT-based health care service delivery.

Method

The study used purposive sampling to identify doctors working in Dhaka but providing service to the rural health centers at regular intervals. Surveys were conducted with 266 providers during a one month period in 2008.

Key findings

Approximately half (47%) of the providers were government employees, and 40% were private providers. A third (37%) were general practitioners, but the providers also included other specialties. Most doctors (77%) visited remote areas weekly for a day or less. Most of the participants said that they need 3-6 hours for a round trip, reducing service delivery time at a specific health center. Over half (58%) provided their services at a health clinic, 18% were at a hospital, and 12% were in a personal chamber. Most of the service centers (91%) have a phone and 63% have a computer but a very few number have internet service (11%). Only 3% have health-related software.

Visiting providers generally manage patient records manually, although a third do not maintain any records of these visits.

Conclusions

Provider patient record management

An electronic scheduling and patient management system has the potential to benefit both the health center by reducing financial and time costs and the patient who will receive better quality care. This survey highlights that Bangladesh has the readiness for move forward with ICT in the health sector:

Do not manage 31%

Manually 64%

Increasing numbers of patients have access to mobile phones. Health providers are interested and feel computerized records would benefit both their work and their patients. The Government has initiated ICT based health care services at the national level, and installed computers in all Upazila Health Complexes. Challenges to increased use of ICT in provision of health care in remote areas are: Limited computer and internet infrastructure. Lack of computer-literate staff. Motivation to maintain patient records.

Electronically 5%

Most facilities continue to be visited by patients even in the absence of the provider. Many patients are forced to wait until the doctors next visit or to rely on assistance from health assistants, half of whom do not have any training. A significant portion of patients, however, seek follow-up through the phone, facilitated by the rapid increase of cell phones in Bangladesh. Almost half (46%) of the doctors receive more than 50 calls every week. Patients follow-up mechanisms

Recommendations
At the provider level
The technology must be kept simple, relevant, and local. Electronic patient records are a feasible first step.

Wait until the next visit 42%

Over the telephone 42%

Urban-based public sector doctors specialized in medicine are in a good position to incorporate ICT in their practice in rural areas.

Build capacity in ICT

Develop a pilot for ICT in health in remote areas, including both public and private sectors.
Suggestions from the health assistant 7% Visit the doctor in doctors locality 9%

Train health professionals in ICT, specifically electronic patient records. Establish monitoring and supervision systems to ensure data validity and ensure linkages to the national MIS.

Generally most physicians are computer-literate, with 86% using a computer at least several hours a week. Only 7% doctors, however, used health related software and 14% doctors did not use any ICT applications. Most have heard of e-health and think it is a good initiative, facilitating their jobs and also helpful for patients. Most are also familiar with electronic health/medical records (EHR/EMR). Almost all providers thought HER/EMR would increase efficiency of patient management and aid in quick service delivery for emergency patients. Challenges for EHR/ EMR include lack of logistic support i.e., insufficient computers, internet providers and electricity support, as well as limited training of health assistants.

Advocate for a supportive environment

Form a national ICT Forum to lead policy formulation, enactment, and monitoring. Work with community leaders to advocate for the use of telemedicine.

Principal Investigator: URC Bangladesh Funded by: Grameen Communication Center

Improving systems to empower communities


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