R4D Bangladesh

Report on 6th Lesson Learning Workshop, 22-24 April 2012

Fri, 25 May 2012 04:01 GMT

Document Type: Meeting Report

Production Year: 2012

Citation: Anon. Report on 6th Lesson Learning Workshop, 22-24 April 2012. (2012) 17 pp.

Summary: Caritas organised a lesson learning workshop titled “Consolidating and Sharing Lessons from Phase One” at Holiday Inn Resort in Bandarban from the 22nd-24th April 2012. A large number of the Caritas team were present at the event, and all nine shiree scale fund partners attended. As shiree is currently moving into phase 2, it was a chance for the new partner NGOs to introduce themselves whilst allowing the scale fund round one NGOs to impart knowledge and experiences they had gained working with the extreme poor over the previous years. A number of representatives from NGOs based in the Chittagong Hill Tracts were also able to give their perceptions of project implementation in the region. Members of the shiree team gave presentations on graduation and nutrition – both key issues as we move into phase two.

First report of a 16SrI, ‘Candidatus Phytoplasma asteris’ isolate affecting eggplant and Mikania sp. in Bangladesh

Fri, 25 May 2012 01:42 GMT

Document Type: Journal Article

Production Year: 2009

Citation: Kelly, P.L.; Arocha, Y.; Dider, S.Z. First report of a 16SrI, ‘Candidatus Phytoplasma asteris’ isolate affecting eggplant and Mikania sp. in Bangladesh. Plant Pathology (2009) 58 (4) 789-789. [DOI: 10.1111/j.1365-3059.2009.02070.x]

Summary: In April 2008, symptoms similar to those previously described for aubergine little leaf disease were observed in aubergine plants in Kaliganj, Bangladesh. Disease incidence was up to 45%, and yield per plant was reduced by 90%. A nearby weed (Mikania sp.) also showed early symptoms of phytoplasma infection, such as small yellow and distorted leaves. Leaf samples from symptomatic and symptomless aubergine and Mikania sp. were collected and analysed. Total DNA was extracted and assayed in a nested PCR with universal phytoplasma 16S rRNA primers P1/P7 and fU5/rU3. No PCR amplicons were produced by symptomless samples, but products of expected size (~880 bp) were obtained from four out of five aubergine plants, and one of the four Mikania samples. Amplicons were purified, cloned and sequenced. All 16S rRNA aubergine phytoplasma sequences were highly identical (100%), and a representative sequence was deposited in GenBank (Accession. No. EU921446). The Mikania sequence (EU921447) shared 99% identity with that from aubergine, and both showed 99% identity with members of group 16SrI, 'Candidatus Phytoplasma asteris' [Phytoplasma asteris]. This is thought to be the first record of a 'Ca. Phytoplasma asteris'-related strain associated with aubergine little leaf disease and Mikania in South East Asia, including Bangladesh.

Training traditional birth attendants in clean delivery does not prevent postpartum infection.

Wed, 16 May 2012 09:01 GMT

Document Type: Journal Article
Creator: Goodburn, E.A.; Chowdhury, M; Gazi, R.; Marshall, T.; Graham, W.

Production Year: 2000

Citation: Goodburn, E.A.; Chowdhury, M; Gazi, R.; Marshall, T.; Graham, W. Training traditional birth attendants in clean delivery does not prevent postpartum infection. Health Policy and Planning (2000) 15 (4) 394-399. [DOI: 10.1093/heapol/15.4.394]

Summary:

The objective of this study was to compare the maternal outcome, in terms of postpartum infection, of deliveries conducted by trained traditional birth attendants (TBAs) with those conducted by untrained birth attendants.

The study took place in a rural area of Bangladesh where a local NGO (BRAC) had previously undertaken TBA training. Demographic surveillance in the study site allowed the systematic identification of pregnant women. Pregnant women were recruited continuously over a period of 18 months. Data on the delivery circumstances were collected shortly after delivery while data on postpartum morbidity were collected prospectively at 2 and 6 weeks. All women with complete records who had delivered at home with a non-formal birth attendant (800) were included in the analysis. The intervention investigated was TBA training in hygienic delivery comprising the ‘three cleans’ (hand-washing with soap, clean cord care, clean surface). The key outcome measure was maternal postpartum genital tract infection diagnosed by a symptom complex of any two out of three symptoms: foul discharge, fever, lower abdominal pain.

Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh

Tue, 15 May 2012 07:29 GMT

Document Type: Journal Article
Creator: Hawkes, S.; Morison, L.; Foster, S.; Gausia, K.; Chakraborty, J.; Weeling, R.; Mabey, D.

Production Year: 1999

Citation: Hawkes, S.; Morison, L.; Foster, S.; Gausia, K.; Chakraborty, J.; Weeling, R.; Mabey, D. Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh. Lancet (1999) 354 (9192) 1776-1781. [DOI: 10.1016/S0140-6736(99)02463-0]

Summary: In the control of reproductive-tract infections, including sexually transmitted infections (STIs), in low-income and middle-income countries, WHO recommends syndromic management for individuals with symptoms. This intervention was initially developed in areas where prevalence of such infections is high. The authors investigate the clinical effectiveness and cost of this approach among a group of women with a low prevalence of infection.

Making health markets work better for poor people: the case of informal providers

Tue, 15 May 2012 03:46 GMT

Document Type: Journal Article
Creator: Bloom, G.; Standing, H.; Lucas, H.; Bhuiya, A.; Oladepo, O.; Peters, D.H.

Production Year: 2011

Citation: Bloom, G.; Standing, H.; Lucas, H.; Bhuiya, A.; Oladepo, O.; Peters, D.H. Making health markets work better for poor people: the case of informal providers. Health Policy and Planning (2011) 26 (Suppl. 1) i45-i52. [DOI: 10.1093/heapol/czr025]

Summary: There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.

Medical Representatives in rural Bangladesh: Who are They and What Is Their Role in the Drug Market?

Tue, 15 May 2012 02:52 GMT

Document Type: PowerPoint Presentation
Creator: Rahman, M.H.; Agarwal, S.; Tuddenham, S.; Peto, H.; Iqbal, M.; Bhuiya, A.; Peters, D.

Production Year: 2011

Citation: Rahman, M.H.; Agarwal, S.; Tuddenham, S.; Peto, H.; Iqbal, M.; Bhuiya, A.; Peters, D. Medical Representatives in rural Bangladesh: Who are They and What Is Their Role in the Drug Market? Presented at 8th World Congress on Health Economics (iHEA), Toronto, Canada, 11 July 2011. (2011) 24 pp.

Summary: Introduction Little is known about the role of medical representatives (MRs) in influencing the prescribing practices of informal and formal healthcare providers in developing countries. This study aims to describe the job characteristics of MRs, and the differences in promotional practices they apply to informal and formal healthcare providers.

Methods This study was conducted in 9 unions and 1 township of Chakaria, a rural sub-district of Bangladesh. Focus Group Discussions and In-depth Interviews were conducted among informal and formal healthcare providers and MRs, along with a quantitative survey including questions about demographics, education, and practice perceptions. Data analysis was performed using Grounded Theory for qualitative data and bivariate statistical tests for quantitative data.

Results Among medical representatives, 55.8% have a graduate degree and 41.9% have a post graduate degree. The duration of training varies by pharmaceutical company with an average duration of 41.5 days. Pharmaceutical companies offer MRs incentives such as bonuses, promotions, and travel opportunities based on their sales volume. MRs may offer purchasing discounts, free samples, extended credit lines, and gifts to doctors in order to increase sales. They share a more friendly relationship with informal providers and a more professional relationship with formal providers. The doctors who give out a greater number of prescriptions are favored for promotional activities. Some evidence suggests that medical representatives from more reputed (larger) companies may favor formal providers whereas informal health care providers may be more often targeted by smaller pharmaceuticals.

Conclusion The incentives offered by pharmaceutical companies to medical representatives encourage aggressive promotional practices that differ for informal versus formal providers. We suggest that MR may be an untapped ally in efforts to address undesirable prescribing practices in the informal sector of developing countries. Regulating incentives offered by pharmaceutical companies to MRs may encourage more ethical drug promotional practices in the informal sector.

FHS Inception Phase Report

Fri, 11 May 2012 08:31 GMT

Document Type: Report

Production Year: 2011

Citation: Anon. FHS Inception Phase Report. (2011) 16 pp.

Summary: The Inception Phase for the second phase of the Future Health Systems Research Program Consortium lasted from January-August 2011. This report summarizes the progress made during that time and lays out a plan of action for the next five years of work. In particular, the report summarizes progress made on research (including different analytical frameworks, themes and methodologies), management, capacity development, policy influence and research uptake and monitoring and evaluation of the program.

Making informal health providers work better for the poor: Lessons from Nigeria and Bangladesh

Fri, 11 May 2012 07:01 GMT

Document Type: Video
Creator: Bloom, G.

Production Year: 2011

Citation: Bloom, G. Making informal health providers work better for the poor: Lessons from Nigeria and Bangladesh. (2011) [16 min 46 sec]

Summary: Dr Gerry Bloom from the Institute of Development studies presents to the M4P (Markets for the Poor) Conference in Brighton, UK, on 8 November 2011. In this presentation, Dr Bloom shares research undertaken with partners (the University of Ibadan in Nigeria and ICDDR,B in Bangladesh) on the role of informal providers in health markets in Nigeria and Bangladesh. He argues that the health sector does function like a market (with 65% of users going to informal providers in Bangladesh, for example). In order to improve health services for the poor, we need to recognise and engage these markets.

An internal health systems research portfolio assessment of a low-income country research institution

Fri, 11 May 2012 05:24 GMT

Document Type: Journal Article
Creator: Koehlmoos, T.P.; Walker, D.G.; Gazi, R.

Production Year: 2010

Citation: Koehlmoos, T.P.; Walker, D.G.; Gazi, R. An internal health systems research portfolio assessment of a low-income country research institution. Health Research Policy and Systems (2010) 8 (1) 8. [DOI: 10.1186/1478-4505-8-8]

Summary: Background: In order to determine the type and amount of health systems research being conducted within ICDDR,B (also known as the Centre), a leading research institution in Bangladesh, an internal review of all on-going research protocols was conducted in September 2007. Methods: A review of all ongoing research protocols within the Centre was conducted. The names of the investigators and the institutional divisions of the protocols were removed in order to decrease the amount of reviewer bias. The building blocks of the World Health Organization's "Framework for Action" on health systems was used to categorize the protocols considered to be health systems research projects. Several additional items were collected, e.g. the highest level of education completed by the Principal Investigator. A total dollar value was placed on the health systems research portfolio of the institution based on the budgets of the selected protocols. Results: As of September 2007 16 out of 118 (13.5%) reviewed protocols were considered to be health systems research projects. Results of the six building blocks of the health system categorization demonstrated that a majority of these protocols involved elements of health services delivery. There was very little engagement in more downstream systems and policy research that involved leadership and governance of the health system. Eleven of the HSR studies were local in scope, while there was only one study that has a multinational focus. The Centre's total dollar value for the health systems research project portfolio added up to US$ 3,723,331. Conclusions: This internal review can serve as a snap shot of on-going activities, and as a baseline for future assessments against which to monitor progress in the area of health systems research. Further, it can serve as a model for other institutions striving to assess and develop health systems research programmes and capacity.

CDKN in conversation... with Saleemul Huq

Wed, 09 May 2012 03:47 GMT

Document Type: Video
Creator: Climate and Development Knowledge Network (CDKN)

Production Year: 2010

Citation: Climate and Development Knowledge Network (CDKN). CDKN in conversation... with Saleemul Huq. (2010) [Video: 6 min 35 sec]

Summary: Saleemul Huq, Senior Fellow at IIED looks at the future of climate change and development. Covering a range of issues he looks at technological innovation, the role of South-South collaboration, and he focuses on Bangladesh as an iconic country for climate change. Interviewed by Simon Maxwell, CDKN Chair, as part of the 'CDKN in Conversation' video series.