Browsing by Author "Reichenbach, Laura"

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A qualitative study to explore the attitudes of women and obstetricians towards caesarean delivery in rural Bangladesh
(BMC, 9/12/2018) Begum, Tahmina; Ellis, Cathryn; Sarker, Malabika; Rostoker, Jean-Francois; Rahman, Aminur; Anwar, Iqbal; Reichenbach, Laura
Background: Caesarean section is a lifesaving surgical intervention for women and their newborns, though overutilization is a public health concern. The caesarean rate in Bangladesh is approximately 23% overall, and in private facilities it is over 70%. It is essential to know both the supply side (obstetricians) and demand side (parturient women) views on caesarean birth in order to formulate specific interventions to address the escalating rate of caesareans. Methods: This qualitative study took place in Matlab, a rural sub-district in Bangladesh. We interviewed women attending their 3rd antenatal visit, those with recent caesareans, and obstetricians from both public and private health facilities. In total there were twenty in-depth interviews and four focus group discussions. Study participants were asked about their preferences on birthing mode and knowledge of the caesarean section process. Thematic data analysis was done following a deductive approach. Results: Women from this rural community had a strong preference for normal vaginal birth. However, they were willing to accept the attending health care provider’s decision for caesarean birth. Antenatal care sessions did not provide information on the medical indications for caesarean section. Furthermore, some women had the misconception that episiotomy itself is a ‘small caesarean.’ Primary health care providers and clinic agents (brokers) had a strong influence on women’s decision to choose a health facility for giving birth. However, obstetricians, having a preference for caesarean section, were receiving more patients from these brokers which may be an important reason for the high rate of clinically non-indicated caesareans at private hospitals in Bangladesh. Improper labour monitoring and inadequate staffing at health facilities were additional influences on the preference for caesarean section. However, critical knowledge gaps were also observed among study obstetricians, particularly with regards to the indications for and timing of elective caesarean sections. Conclusion: There is a need to educate women about the advantages and disadvantages of different birthing modes to ensure their active participation in the decision making process. Strong policy regulations are needed to ensure legitimate decision making by obstetricians regarding mode of birthing.
MANOSHI Working Paper Series No 17
(icddr,b, 2012-01) Sarker, Bidhan Krishna; Mridha, Malay Kanti; Dasgupta, Sushil Kanti; Islam, Noushin; Reichenbach, Laura
MANOSHI Working Paper Series No 18
(icddr,b, 2012-01) Sarker, Bidhan Krishna; Higgins, Jonathan; Mridha, Malay Kanti; Ferdous, Jannatul; Dasgupta, Sushil Kanti Dasgupta; Ahmed, Sayem; Khan, Jahangir A.M.; Reichenbach, Laura
Sustaining health: the role of BRAC's community health volunteers in Bangladesh, Afghanistan and Uganda
(BRAC, 2011-09) Reichenbach, Laura; Shimul, Shafiun Nahin
This study fills an important gap in current understanding about a critical aspect of BRAG's health programmes - the financial sustainability of the community health volunteers (commonly referred to as Shasthya Shebikas in Bangladesh) that are the cornerstone of BRAG's health programmes. Shasthya Shebikas (SS) are a cadre of female volunteers that are recruited and trained by BRAG to provide a range of essential healthcare services to their communities. What is unique about BRAG's approach is that, while these women can be considered volunteers they do not receive a salary or monthly stipend, they are provided with financial incentives on the sale of basic medicines and selected health commodities to their community. This sets BRAG apart from other health programmes that rely on either entirely salaried or volunteer cadres of community health workers (GHW) and raises important questions about the financial and programmatic sustainability and replicability of BRAG's approach. GHWs like the SSs play a crucial role in terms of human resources for health in Bangladesh and other countries. The 2007 Bangladesh Health Watch reports a shortage of 800,000 health workers in Bangladesh. Relying on formal institutions to train health workers requires significant time and financial investment, therefore, the SSs can be a critical and cost-effective input into the provision of essential health services in Bangladesh. BRAG was among the first organization to set up a community health volunteer (GHV) programme in Bangladesh in the 1970s. Its original GHV programme recruited and trained male paramedics to treat minor illness for which they received a small fee for referrals. Lessons from BRAG's early GHV experience included issues related to remuneration, supervision and accountability. BRAG addressed these issues by recruiting and training cadres of female health volunteers. Since then, BRAG has adapted and revised the programme in response to programmatic and community needs and has effectively scaled up the programme from 1,080 SSs in 1990 to 80,000 SSs operating in 64 districts in Bangladesh today. The SSs are an impressive force in terms of their numbers, geographic coverage, and quick mobilization. The 80,000 SSs provide home visits to 18 million households every month (BRAG 2009). The BRAG Health Programme operating model clearly relies on the successful recruitment. training, and retention of female GHVs. The rationale for BRAG's approach is that community-based financial incentives of a volunteer community health workforce can achieve wide programme coverage and respond to community essential healthcare needs while providing income opportunities to its female volunteers.