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Contracting out of primary health care services in urban Bangladesh: examining the quality of service

Ferdous Arfina Osman

Despite the fact that Bangladesh has witnessed substantial success with respect to health but the health of the poor people living in urban areas is still under numerous challenges.  While public sector has a strong Primary Health Care (PHC) infrastructure in rural areas, provision of PHC services in urban areas is pluralistic, fragmented and predominantly delivered by NGOs and the private sector.  Since last two decades, government has been providing the PHC services to the urban poor through contracting out to the NGOs. Urban Primary Health Care Service Development Program (UPHCSDP) is such an initiative. This is one of the first large-scale attempts in Asia to contract out primary care services to NGOs.  Various studies have reported the efficacy of the contracting out initiative in terms of service coverage and various pro-poor strategies but no in- depth study on the “quality” of these services has yet been available.  Addressing this gap, the current study has investigated the quality of service provided under the UPHCSDP.  Drawing on Carlson and Schwarz (1995), the study assessed the quality of services across four dimensions: access, equity, responsiveness and opportunity of citizens to influence the service. The study was carried out in eight slums of Dhaka city.  It relied on qualitative data collected through 40 key in-depth interviews of both service providers (8) and service recipients (32).  Findings demonstrate that the services are accessible to the urban poor both in financial and physical terms but in terms of other indicators services are yet to reach the expected level.