A SSESSMENT ON E SSENTIAL S ERVICE D ELIVERY (ESD) P ROGRAM IN NGO C LINIC AND UPHCP Md. Shahadat Kamal EC Bangladesh 1

W HAT IS ESD P ROGRAM ? ESD is Essential Service Delivery Program provided by some Govt. and Non Govt. Clinics. There are 5 Components: Reproductive Health Care Child Health Care Communicable Disease Control Limited Curative Care Behavior Change Communication 2

O BJECTIVES OF THE S TUDY General Objective: T o assess the capacity and utilization of the NGO Clinic and UPHCP for implementation of Essential Service Delivery (ESD) Specific Objectives To investigate - type of providers involved in the service - experience and training of service providers to provide ESD - capacity to provide services - facilities - exit clients opinions about the service - the opinions of community level influentials about the capacity of the service providers 3

M ETHODOLOGY Sample Selection (Number of sample 285) Data Collection Questionnaire Interview Focus Group Discussion (12 FGD) Key Informer Interview (48 KII) Data Compilation Data Analysis Reporting 4

K EY F INDINGS o There are 46 types of services in ESD o Out of 46 services some are common, such as Family Planning, ANC/PNC, Vaccination, MRI are most common and Popular o 4 types of services provided by the CRHCC and PHCC under UPHCP varied but most of the NGO clinics have same 46 of services. S ERVICE EXISTED IN THE ESD PROGRAM 5

K EY F INDINGS TYPE OF PROVIDERS IN ESD o There are 12 types of service providers o They are Clinic Manager, Doctor, Field Supervisor, Nurse, Counselor, Health Worker, Accountant, Office Assistant, Lab Technician, Pharmacist, MLSS, Night Guard and Aya o Highest tier is Clinic manager and the lowest is Aya o Doctor is holding two positions at the same time, Clinic Manager cum Physician 6

K EY F INDINGS o Mid level Staff received ESD related training (72%) o Top level Service providers received ESD training (100%) o Field level staff received (72%) o Newly appointees are in process to receive training o Refresher training on ESD is irregular E XPERIENCE AND T RAINING T O PROVIDE ESD 7

o Facilities: o Lab facility o Client privacy o Waiting room Toilet facility o Free and low cost service o Free Medicine o Satellite clinic o Inadequate medicine and Lab facility o Lack of Generator for smooth electric supply o Poor client provider ratio o Inadequacy of Satellite clinic o Non-availability of Ambulance service F ACILITIES OF THE C LINICS K EY F INDINGS 8

o Clients who come in the clinic (according to monthly income level: o 7.5% (bellow 5000) o 42% ( ,000) o 20% ( ) o 25% ( ) o 5% (more than 2500) o Clients come to the clinics because they get – Free and low cost treatment, Free medicine, Nearby. C LIENTS AND THEIR OPINION K EY F INDINGS 9

Clients demand for service: Free medicine (70%) Quick Ambulance service (70%) Trained and skilled doctor & paramedics (75%) o Cause of clients unhappiness: Irregular and shortage of medicine supply o Service quality is satisfactory (70%) o Service quality is dissatisfactory (30%) C LIENTS AND THEIR OPINION K EY F INDINGS 10

Lack of modern health facilities (lab, AC) Shortage of manpower Low incentives for service providers Regular supply of medicine Staff training O PINION OF C OMMUNITY INFLUENTIAL ' S ABOUT SERVICE / PROVIDERS CAPACITY K EY F INDINGS 11

Satellite clinics should be increased according to the density and demand of population Staffs incentives (salary, bonus, increment, PF, Gratuity, TA/DA and other allowance) should be revised in order to increase commitment and ensure quality of work Staffs capacity is very much essential for ensuring quality of service. So refresher training should be organized regularly in order to develop staffs capacity. This types of refresher training can be organized quarterly or half-yearly. Supervision, monitoring and follow up activities should be increased in order to ensure quality of service. S UGGESTIONS 12

Newly appointed staffs and mid level service providers should get timely basic and refresher training respectively In order to increase client flow and ensure satisfaction regular and adequate supply of medicine should be ensured. Some important training have been required such as Clinic Management and Administration for clinic manager, Application of Modern Medical Tools & Techniques for doctor, Social Motivation & Motivation, Planning & Implementation, Effective Communication, Quality Service Promotion for Mid Level staff S UGGESTIONS 13

Modern Diagnostic services and facilities in both CRHCC & PHCC and other clinics should be introduced Community involvement should be increased. Yearly or half yearly opinion meeting, Case study dissemination meeting and Area visit can be organized. Continuous electricity supply should be ensured and for this community influential's donation/contribution can be collected for purchase of generator. Separate Clinic Manager (non-doctor) and doctor should be employed in order to ensure service of quality Thanks S UGGESTIONS 14

T HANKS 15