7 April 2016 Château de Penthes, Geneva, Switzerland Analysis of PHC performance: Perspectives from Bangladesh Dr. Sultan Shamiul Bashar Management Information System MOHFW, Bangladesh P RIMARY H EALTH C ARE I MPROVEMENT G LOBAL S TAKEHOLDER M EETING

Bangladesh recognized importance of PHC even before Alma Ata Declaration in 1978 Just after liberation in 1971, a PHC network in the country was established After Alma Ata Declaration of 1978, Health & Family Welfare Centers were built in union (lowest administrative unit) levels

Community Clinic / Domiciliary Workers Outpatient static facility bed hospital bed hospital Medical college/tertiary hospital Division (8) District (64) Sub-district (489) Union (4,553) Ward (40,977) Villages (87,310) National Super-specialty hospital Level Type of Facility Health Care Network of Bangladesh Internet Connectivity

Community clinics: Revitalization of PHC  Over 13,000  The number to be increased to ~ 18,000  Roughly 1 for every 6,000 people  The core value is people’s active participation

Telemedicine Updating health data Educating people Training of health staffs Communication Internet browsing Laptops in Community Clinics Visiting ITU Secretary General Dr Hamadoun I Toure is witnessing telemedicine service in Savar Upazila Hospital (March 2, 2010)

Community Population data Health service information National Upazila District Health worker Community Clinic Health service information Population data HMIS data flow

Dash board Use of data for decision making Policy makers will view the dash board for evidence Public will see selected data portion Necessary communication and advocacy are being conducted

GIS map Data visualization for decision making

Weekly meeting at CC Monthly meetings at:-  Sub-district  District  Division  Now at the national level Data improvement and utilization: A cultural transition Data improvement and utilization: A cultural transition

Thus, we are all set to jump into the next level … In other words … It’s the time for us to grab that “tremendous opportunity” of having a major positive impact on health through targeted measurement and better utilization of the data management backbone which we have already established

Improved as evidenced by typical and traditional measurements …  ↓ MMR 170 per 100,000 livebirths which was 574 per 100,000 livebirths in 1990  under-5 mortality rate has been dropped to stunning 41 per 1,000 livebirths by 2012 from 144 per 1,000 livebirths in 1990.This is a 71% reduction against the target of 66% reduction by 2015  Obviously due to improved performance of the PHC components (“…health systems based on high-performing PHC are able to achieve better health outcomes, more equitably and at lower relative cost…”) PHC performance

 Access: Increased number of OPD visits, pt visits at CC  Comprehensiveness: Area for improvement …  Continuity: Addressed to some extent …. registering pregnant women to ensure follow ups Measurements

 Coordination: CC meeting with different agency personnel  People-centeredness: Community CC. Ethnographic research needed …  Quality: Not measured directly, need to develop tools Measurements

 Data not being utilized at the national policy level  May be due to lack of knowledge about the demand side (policy makers)  Data presentation may not match the needs of top level planners  Supply side (enablers) should conduct research Data usability

Looking forward for more ……

Thank you very much For your patience