A TCV+ Study on

Centre for the Rehabilitation of the Paralyzed (CRP) Extension Services

Prepared By
Results Management Team
TABLE OF CONTENT

i. List of Figure ...................................................................................................................................... iii

ii. List of Table ........................................................................................................................................ iii
iii. ACRONYMS ...................................................................................................................................... iv
iv. EXECUTIVE SUMMARY .............................................................................................................. v
1 INTRODUCTION AND BACKGROUND ........................................................................................ vi
2 OBJECTIVES.................................................................................................................................... vii
3 METHODOLOGY ............................................................................................................................. vii
3.1 Study Approach and Design ................................................................................................... vii
3.2 The Study Area and Population ............................................................................................ viii
3.3 Data Collection ........................................................................................................................ viii
3.4 Limitations of Data Collection .................................................................................................. ix
3.5 Data Analysis ............................................................................................................................. ix
4 FINDINGS .......................................................................................................................................... ix
4.1 Extension Facilities and TCV.................................................................................................... x
4.2 Extension Facilities and TCV+ ...............................................................................................xiv
5 RECOMMENDATIONS ...................................................................................................................xvi
6 CONCLUSION ..................................................................................................................................xvi
i. List of Figure
Figure 1: Types of Services from CRP ................................................................................................... x

Figure 2:Types of Services from DPDC.................................................................................................. x

Figure 3: Time required in CRP and UDPDC. ...................................................................................... xi

Figure 4: Cost needed in CRP and UDPDC. ........................................................................................ xi

Figure 5: Visit required in CRP and UDPDC. ...................................................................................... xii

Figure 6: Average time, cost and visit ................................................................................................... xii

Figure 7: Quality of phone follow-up...................................................................................................... xv

Figure 8: Advantages of Receiving Telemedicine ............................................................................... xv

ii. List of Table

Table 1: Method of Data collection ....................................................................................................... viii

Table 2: Information of the informants ................................................................................................... ix

iii. ACRONYMS

a2i Access to Information

CRP Center of Rehabilitation for Paralyzed

CDISB Community Digital Information and Service Booth

DPO Disabled People’s Organization

SPSS Statistical Package for the Social Sciences

TCV Time, Cost and Visit

UDPDC Upazilla Disabled People Development Centre

UNDP United Nations Development Program

iv. EXECUTIVE SUMMARY
Patients and victim of spinal cord injuries visit CRP located at Savar for their primary
and core treatment. Patients from other districts and victims of spinal injuries also have
to visit CRP because these districts do not have any rehabilitation center for the
paralyzed. According to, treatment procedures, patients’ have to visit CRP for follow- up
as well. These visits require a certain amount of money and physical ability. This is a
burden for people and loses their interest for follow-up and further treatment. To make it
more convenient for citizens to avail services, CRP started their extension facilities.

Partially funded by the Prime Minister’s Office’s Access to Information (a2i) Program,
The CRP’s extension facilities of Telemedicine and Phone follow up brings essential
medical services to people’s doorsteps and reduces beneficiaries’ trouble and hassle by
reducing time, cost and visit factors.

With the aim to bring service at citizens’ doorsteps CRP has developed: (1) Digital
patient follow-up system in Community Digital Information and Service Booth (CDISB)
under Upazila Disabled People Development Council (UDPDC) in 8 upazilas, (2)
Income generating opportunities for persons with disabilities through CDISB (3)
Provision of specialized services including rehabilitation, referral, assistive devices,
vocational training, community reintegration of persons with disabilities and (4) Access
to justice and rights of persons with disabilities through advocacy, consultancy,
awareness and active communal participation.

The broad objective of this study was to find out the monetary and non-monetary
benefits of CRP’s extension facilities. The study aimed to find the TCV reduction on
citizens’ part from this extension facility and patients’ perception of this facility.
The overall findings cover the phone follow-up and telemedicine facilities of CRP
patients. The monetary benefits are discussed in terms of Time, Cost and Visit analysis
of CRP follow up patients. The non- monetary benefits cover the correlation between
patients’ satisfaction level and the extension service. This study reveals service oriented
satisfaction, and beneficiaries’ opinion regarding provided facilities. This study explores
the home visit facilities and its impact among patients.

According to the project officials, the extension facilities of this project meet the needs of
the patients’ as well have an impact on the social and economic context of Bangladesh.
However, in terms of better service qualities, these extension facilities need to be
strengthened further with basic facilities that main CRP centre provides. It must engage
more manpower and skilled physicians. Besides, scale-up of this program must change
the scenario for physically challenged people.
1 INTRODUCTION AND BACKGROUND
People, usually paralysed patients; get treatment from CRP main branch, situated in
Savar. Here, they get the basic treatment, after gaining strength and getting recovered
they leave the hospital with the prescription of regular follow-up. But visiting CRP costs
a major amount of money, time and visits as well. This entire procedure makes patients’
reluctant about taking follow-up visits to Savar. This results in adverse health effects
and sometimes even causes death of the patients. Considering this situation, CRP
authority came up with extension facility to provide basic treatments in UDPDC (Upazila
Disabled People Development Centre) in eight ‘Disabled Peoples’ Organization (DPO)’.
Thus, this research study explores the advantages of these extension facilities of CRP
and the monetary and non- monetary benefits of this programme to the patients.

CRP is known as Centre for the Rehabilitation of the Paralyzed. The basic goal of this
Centre is to provide treatment among those patients who suffer from spinal cord injuries
and other disabled persons. People doing manual labor, like carrying load on their
backs for extended hours, are the main victims of spinal cord injuries in Bangladesh.
CRP- Savar is the head office for the Centre for the Rehabilitation of the Paralyzed
(CRP). Recently they introduced eight more CRP centers for providing treatment
facilities. There are 72 UDPDC in whole Bangladesh, among these centers; seven
centers have been set up as a pilot booth for providing basic facilities to CRP Follow up
patients. CRP now facilitates DPO with their extension program. According to the CRP
authority, these people mainly belong to low income economic groups. The Savar
branch of CRP provides full facilities of treatment for the paralyzed as well. CRP
organized their facilities with Community Digital Information and Service Booth (CDISB)
and Upazilla Disabled People Development Council (UDPDC). They also developed
phone follow up and telemedicine services. According to the CRP perspective, these
facilities have reduced troubles of existing follow up patients.

According to the program vision of CRP - The initiative met the requirement of
specialized services of persons with disability and other vulnerable groups on equity,
justice and access to information by bringing the services at their doorstep.

In UDPDC, few volunteers are working with self-motivation with some other workers.
CRP provides them the list of their patients and these UDPDC team makes a database
of them and visit their home in an upazilla frequently. They provide the facilities to
patients and give them their required products like saline, catheter and other medical
necessities.

CRP along with CDISB also provided a booth for the follow up patients. CRP doesn’t
have its own centers in all upazillas. But each district has one “Disabled Peoples’
Organization”. CRP along with this forum came up with their extension facility services.
Among established UDPDC, there are 7 booths that provide follow up services to follow-
up patients.

From the provided service facilities of CRP, management team believes that it will help
people in terms of reduced time, cost and visit. We already mentioned that- most of the
people, victim of spinal cord injuries, belong to low income strata. So, high level
involvement in travel, visit and cost make them reluctant about taking services.

Knowing about the reduces Time, visit and Cost of patients, and other non- monetary
benefits- this study is conducted to reveal the impact of follow-up and telemedicine
facilities on TCV of CRP follow up patients.

2 OBJECTIVES
Broad objective of this study is to find out monetary and non-monetary benefits of
CRP’s extension facilities.
Specific objectives of this study are:
 To determine the amount of time saved on average, if any of those patients
receiving phone follow up and telemedicine services.
 To determine the amount of cost saved on average of those patients receiving
phone follow up and telemedicine services (in terms of travel cost,
accommodation, food and other costs) if any, by patients and his/her family.
 To determine the number of visits saved on average, if any, of those patients
receiving phone follow up and telemedicine services.
 To assess the general perception of CRP extension facilities through the phone
follow-up and telemedicine services.

3 METHODOLOGY
The study adopted several steps to collect quantitative and qualitative information in
order to fulfill its objectives. Data were collected through phone interviews, face-to-face
interviews, and in-depth interviews from different groups of respondents. Detail
indication of the methods and process that were followed conducting the study,
however, could be summarized as follows:

3.1 Study Approach and Design

This study was both qualitative and quantitative in nature. This research defines
quantitative research as a formal, objective, systematic process to describe and test
relationships and examine cause and effect interactions among variables. A descriptive
survey design was used. It provides an accurate portrayal or account of the
characteristics, for example, behavior, opinions, abilities, beliefs and knowledge of a
particular individual, situation or group, etc. The proposed study was based upon
Primary data. However, the secondary data was reviewed to - (1) conceptualize the
problem, understand the situation and define the problem statement for the project and
(2) Assess relevancy, efficiency and effectiveness of the intervention.

3.2 The Study Area and Population

This study has been conducted among those patients, who are victim of physical
disability and takes services from CRP. This study has been conducted among one
hundred and nine patients. Among them 21% informants were female and rest of the
informants was male.

Ensuring the inclusion of girls and boys, women and men with disabilities into
mainstream society with their treatment and therapy is the main vision of CRP. It works
to promote an environment where all girls and boys, women and men with disabilities
have equal access to health, rehabilitation, education, employment, the physical
environment and information CRP provides service from three major centers. These
are: CRP main center, UDPDC and DPO. The main center of CRP is located in Savar,
and UDPDCs are located at different eight areas of Bangladesh and DPOs are located
at upazilla level in different Districts. The Interviews were collected from different
districts where UDPDCs are located. These are at Comilla, Tangail, Mymenshing,
Gazipur, Khulna, Rajshahi, Manikganj, and Narayanganj. These centers are organized
with self-motivated volunteers.

3.3 Data Collection

Data were collected through interviews by structured questionnaires. In total 109
surveys was conducted. Out of 109, 47 surveys were conducted in person. Besides, to
know the perspective of CRP management team, three key informant interviews of
project officers were conducted.

Method used to collect data are presented in table

Method of data collection Units of data Percentage (%)

Phone Interview with structured questionnaire 62 55

Face to face with structured questionnaire 47 42

key informant interviews (KII) 3 3

Total 112 100

Table 1: Method of Data collection

3.4 Limitations of Data Collection
Although the research has reached its aims, there were some limitations. The
researchers faced several challenges while collecting data such as;
1. Getting contact numbers from service providers
2. Lack of wiliness to give survey over phone
3. Getting proper cooperation during in person interviews

3.5 Data Analysis

Data entry or importation was done concurrently with data collection. Data was
analyzed using SPSS software (IBM, v22). The researchers reviewed, edited and
cleaned the data by performing a series of frequency and data range checks. Any
inconsistencies were checked visually by comparing the electronic entry to the entry on
the original questionnaire.

4 FINDINGS
From the analyzed data it has been revealed that most of the people (92%) seek their
treatment from main CRP center. For the follow up they prefer DPO and UDPDC. Every
Informant went to the main CRP center and DPO or UDPDC for their follow up. They
have also received home visits. Almost 61% informant provided information that they
received home visit.

Among these informants 55% populations responded that they got regular home visit
from the service centers. Among this population who said they get home visit from
service providers 45% mentioned that they do not get regular home visits. Therefore,
percentages of service recipients represent the changing increasing scenario of home
visit. It also has increased peoples participation on follow up process and now they are
being influenced to get further treatment from nearest UDPDC or DPO. All the
information is showed in the bellow table:

PARTICULARS YES NO

Did the informants receive service from main center (Savar)? 92% 8%

Did the informants receive home Visit by Service Providers? 61% 39%

Regularity of Home Visit Service 55% 45%

Table 2: Information of the informants

 Physiotherapy 40.0% Telimedicine 38.2%

Medical Service 21.0% Physiotherapy 21.1%

Ocupational Therapy 19.0% Medical Service 19.7%

Speech and language
Vocational Therapy 9.0% 11.8%
therapy
Language therapy 4.0% Vocational therapy 2.6%

Others 7.0% Others 6.6%

Figure 1: Types of Services from CRP Figure 2:Types of Services from DPDC

It has been found from figure 1that in CRP main center people used to get
physiotherapy (40%), Medical service (21%) and occupational therapy (19%) for main
treatment purposes. On the other hand, people receive Telemedicine services (38.2%),
physiotherapy (21.1%) and other medical services including speech and language
therapy from UDPDC.

The service pattern of CRP and UDPDC are different from each other. In CRP people
get in depth medical facilities and treatment for their wellbeing on the other hand
UDPDC along with DPO provide follow up facilities and need based services for
patients.

4.1 Extension Facilities and TCV

Specific objective of this study was to determine the amount of time, cost and visit
saved on average of those patients receiving phone follow up and telemedicine
services. From the analysis of collected data we can measure the TCV outcome as
following-
Time required for treatment

75%

35%
26% 28%
23%
11%
2%

Less than 2 2.01-5 5.01-10 10.01 Above

CRP UDPDC

Figure 3: Time required in CRP and UDPDC.

Figure 3 shows a comparative picture of time cost consumption between CRP main
center and UDPDC. 75% of respondents said that UDPDC is providing services in less
than two hours. In contrast, about 28% of respondents who received health services
from CRP main center mentioned that it required more than 10 hours getting the facility
from Savar.

Cost required for treatment

86%

38% 35%

13% 13%
5% 9%

Less than 500 501-1000 1001-5000 5001 Above

CRP UDPDC
Figure 4: Cost needed in CRP and UDPDC.
Figure 4 shows a comparative analysis of the average cost incurred for the treatment in
CRP and UDPDC. About 86% informants opined that it took less than 500 taka to get
the treatment facility from UDPDC. In contrast, patients who receive treatment from
CRP, among them 38% informed that they have to spend around BDT 1,000-5,000to
receives similar facilities. At the same time 35% of them mentioned that they had to pay
more than BDT 5,000to take treatment from CRP.

Visit required for treatment

61%

31%
19%
17% 16% 18%
9% 10%
6% 7%
2% 3%

0 visit 1 visit 2 visits 3 visits 4 visits 5 visits

CRP UDPDC Above

Figure 5: Visit required in CRP and UDPDC.

Figure 5 shows the number of visits to get treatment from CRP and UDPDC. Study
reveals, 61% of patients who receives treatment from CRP mentioned that they needed
single visit. On the other hand patients are now frequently visiting UDPDC to receive
treatment. 19% respondents have mentioned that they have visited the nearest UDPDC
more than five times. As a result the analysis it can be concluded that the establishment
of UDPDC has increased the number of visit which shows a positive attitude towards
treatment facilities available and patients are more aware about follow- up facilities.

Comparative analysis of TCV (time, cost and visit)

3000tk

83% 99%

6hours

40tk 3visit 3visit

1hour

Average Time Average Cost Average Visit

CRP UDPDC
Figure 6: Average time, cost and visit
Figure 6 reflects that time and cost has been reduced at 83% and 99%. But, the
average visit has remained same. It should be noted here that though, the number of
visits has remained same, there is indication that awareness has risen among people
about their health and participation in follow-up services and number of visit indicates
peoples’ eagerness to avail better health services

The analysis revealed that function of UDPDC and DPO among different upazillas has
reduced the time of patients by up to 83%. Each time, if a patient moves to main CRP
center they have to pay an average of BDT 3,000 for each visit. If they come to CRP for
follow up they have to pay the same amount of money. But in the UDPDC and DPO
facilities they have to pay less amount of money to have treatment. These increase the
interest among patients to take follow up.

Patients have to spend more than 6 hours to take treatment in CRP on the other hand
patients spend only 1 hour to get the treatment from UDPDC and DPO volunteer. From
the analysis we see that the visit part in CRP and UDPDC remain same with three times
visit in an average.

Story of Jebunnahar

During the construction of her own house, Jebunnahar (pseudo name), a wall
collapsed upon her and she received spinal cord injury more than eight years
ago. She lives in Manikganj. After getting injured she got admitted into Savar
CRP which is located 4 KM far from her home and there she received
treatment. After primary left CRP centre. To get this treatment she had to pay
BDT 30,000approximately. As, she belonged to a low income generating social
group, this cost was not affordable by her family. So, she dropped- out from her
regular follow-up session because each additional visit incurred costs that was
challenging for her. On the other hand, the CRP extension facilities enabled her
to avail treatments from UDPDC and DPO. Here, she did not have to pay any
extra money for transport and getting treatment. She also received vocational
training and now she is getting regular follow- up from nearest UDPDC. In her
opinion, extension facilities provided by CRP made her health practice more
effective and improved her self-confidence and self-image. She added, it
reduced her hassle and regular problems to get treatment and it raised her
satisfaction level in terms of receiving health facilities.
4.2 Extension Facilities and TCV+
This study has been conducted among those persons having spinal injury or among
those who are physically paralyzed. Most of the patients have to visit CRP main center
for their main treatment. After receiving their treatment they leave CRP and start to live
in their homes. But, a mandatory follow-up is necessary for their recovery.

In previous time when there were no scope for phone follow up, and no system of
telemedicine facilities. As a result, these people had to visit CRP main center for further
treatment and follow up. But now, as CRP has extended their facilities among UDPDC
and DPO with advices and logistic supports, the follow up patients now can get their
primary follow up facilities from these centers. This e has reduced both their time and
cost of availing the services.

One of the project officers mentioned that-

“Most of the spinal cord injury patient belongs to low income status and do not have the
ability to continue follow up treatment. Because moving from one city to another city is
quite impossible for these patients. She added- irregular follow-up among patients may
even lead to death. But, now these patients have option to go to nearest UDPDC for
Skype conversation with doctors. Besides they are being provided with regular home
visit by UDPDC and DPO volunteer team. As a result, they are now aware of the
importance of regular follow up for better recovery. Now, from the comparison with
previous follow up the number of visits has been increased among patients. It is a
positive indicator for health workers. So, UDPDC and DPO team are continuously
motivating disabled people with best possible feedback to continue with their treatment.”

CRP is now providing phone follow up and telemedicine services and also providing
home visit facilities to the remote area for paralyzed patients. This service is being
called as extension services of CRP in this study. This study is concerned to find out the
monetary and non- monetary benefits of these facilities. Monetary benefits are
determined through TCV. But non- monetary benefits are most influential and important
part of this study. This study has covered the field of service regularity, peoples’
response about service facilities, and evaluation of services.
Quality of phone follow-up
56.1%

36.8%

5.3%
1.8%

Very good Good Moderate bad

Figure 7: Quality of phone follow-up

Figure 7 shows, about 98% of the informants agreed that the given service was
satisfactory. They express different levels of satisfaction in this regards. Among On the
other hand, less than 2% mentioned that it was not satisfactory.

Advantages of receiving telemedicine service

Reduce TCV 32.4%

Advantageous for patient 26.5%

Reduce labour 17.6%

Reduce sufferings 16.2%

Reduce tension 1.5%

No advantage 5.9%

Figure 8: Advantages of Receiving Telemedicine

Those who receive telemedicine service mentioned that about 33% respondents
mentioned this service reduced TCV for them. 26% informants stated it as a helping tool
for patients. This special extension service has reduced the hassle of patients around
17% informants mentioned that it reduced labor and 16% mentioned that these services
is reducing their sufferings as well. Regarding provided facilities main 73% informants
mentioned that they do not face any problem in phone follow up and telemedicine
services. But an important feedback of this provided service is- they face problems to
understand instructions (5.4%); at the same time they feel that there are lacks of
necessary equipment while dealing with telephone or video instructions.
5 RECOMMENDATIONS
Although this project proved as successful from TCV aspects, there still has scope of
improvement. The following recommendations may contribute in this regard-

 Respondents recommended there is need for increasing the number of

volunteers in UDPDC.
 They also recommended greater promotion of services of UDPDC.
 For better facilities, beneficiaries recommended to reduce the cost and fee of
rehabilitation centres
 Increase the number experts in home visit team.

6 CONCLUSION
CRP has been providing treatment among patients for their wellbeing for long time.
Recently the extension facilities have been introduced in several districts and upazilla.
This study reveals the extension facilities of CRP in brief and deals with detailed facility.
Besides it explores patients’ perspective and their understandings about provided
facilities. Though, the main vision of this study was to find the monetary benefits in
terms of Time, Cost and Visit (TCV), it also discovered other non- monetary benefits in
terms of beneficiaries satisfaction, service deliver timing and service providers behavior
towards service providers.