A TCV+ Study on Simplifying Government Hospital Health Service
Prepared By Results Management Team
CONTENT
i. List of Figure ...... iii ii. List of Table ...... iii iii. ACRONYMS ...... iv iv. ACKNOWLEDGEMENT ...... v v. EXECUTIVE SUMMARY ...... vi 1. INTRODUCTION AND BACKGROUND ...... i 2 OBJECTIVES ...... ii 3 METHODOLOGY ...... iii 3.1 Study Approach and Design ...... iii 3.2 The Study Population ...... iii 3.3 Study area ...... iii 3.4 Data Collection ...... v 3.5 Limitations of data collection ...... v 3.6 Data Analysis ...... v 4 FINDINGS ...... vi 4.1 Demographic characteristics of beneficiary ...... vi 4.2 TCV Analysis ...... vii 4.3 TCV+ Analysis ...... ix 5 RECOMMENDATIONS ...... xiii 6 CONCLUSION ...... xiv
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i. List of Figure Figure 1: Gender of the service receiver ...... vi
Figure 2: Way of receiving the service ...... vi
Figure 3: Required time to get service using both processes ...... vii
Figure 4: Cost required getting service from process ...... vii
Figure 5: Required visit to get service using ticket and health card ...... viii
Figure 6: Average Time, cost and visit...... ix
Figure 7: Advantages for receiving service using health card...... x
Figure 8: Disadvantages for receiving service using health card ...... x
Figure 9: Disadvantages of ticket counter ...... xi
Figure 10: Satisfaction level by getting the health card service ...... xii
Figure 11: Reasons of satisfaction level for getting health card service ...... xii
ii. List of Table Table 1: Mode of data collection ...... v
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iii. ACRONYMS
a2i Access to Information
BBS Bangladesh Bureau of Statistics
SIF Service Innovation Fund
SPSS Statistical Package for the Social Sciences
TCV Time, cost and visit
UNDP United Nations Development Programs
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iv. ACKNOWLEDGEMENT
The a2i team would like to express sincere gratitude to all the stakeholders of this survey. a2i is thankful to the people of Wazirpur upazilla who provided their valuable time during interview. a2i is also indebted to Wazirpur health complex authority for their cooperation and information regarding health card service. The team also acknowledges the contribution of Fahmida Sarwar, Saifunnahar Shanty, Sharika Naureen and Sarmin Akter Simul for collecting, editing, and analyzing data.
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v. EXECUTIVE SUMMARY
The simplification of government health services is one of the prominent sub-sectors. Sometimes it is difficult to get treatment from the government hospitals as there are many steps to get the treatment. It takes time, consumes more cost and often requires more number of visits for a single service. Through the introduction of the health card system, it helps the poor people to get the health services with less time, cost and visit. To evaluate government hospital health card services at Barisal, a study was conducted using single random sampling method for data collection and interviewed 161 beneficiaries for this purpose. Main purpose of this study was to analysis TCV of service recipients who used health card service.
The overall findings reveal that, through the implementation of extension facility of health cards turns the required expenditure of time, cost and visit of beneficiaries into the least. Findings showed the replacing system has reduced the average time and cost of beneficiary at 66% and 47% to receive a medical treatment service.
Regarding the non- monetary benefits; correlation between people’s satisfaction level and provided health card service, study found that health card service is more appropriate. About 33% and 31% of informants opined they are satisfied because of ‘examine with importance’ and ‘less cost consumption respectively. They also see the health card system as a less consuming way of getting a medical service.
According to the service providing authority, the extension facilities of this project meet the needs of the people as well as put an impact in the social and economic context. However, in terms of better service qualities, this extension facility needs to be strengthened further with more equipment and medicine. There must be adequate involvement of skilled doctors.
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1. INTRODUCTION AND BACKGROUND
One of the fundaments of any govt. is to ensure better health facilities for its citizen. In spite of significant improvement in health sector, there are scopes for providing quality health services especially in Bangladesh. Therefore, Information and communication technology has been introducing in various sectors. . In this aspect, the government of Bangladesh introduced the health card services at Wazirpur upazilla in Barisal as a pilot project. In the previous process, patients had to go to the Barisal Zilla hospital, about 25 km far from Wazirpur. Previous services required a ticket from the hospital counter by paying 5 taka. Also they had to wait a long time for receiving health services. Again they need to wait in front of the doctors’ rooms. Thus, patients had to spend their time, money and at the same time they needed to visit more times. With the purpose of providing quality and better health service, Wazirpur Upazilla health complex in Barisal introduced health card for its service recipients. To assess TCV of health card services, a study was conducted entitled, Simplifying Government Hospital Health Service.
Better health rate is the key indicator of a successive nation. As defined by the World Health Organization (WHO), it is a "State of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity." Health is considered as one of the basic human rights. A high proportion of the population of developing countries is not getting the quality health services. However, in a developing country like Bangladesh, people especially poor are deprived of this basic need.
In the new process, patients need not to take ticket from the hospital counter. Now the card holders can go to the doctors’ room directly. There, separate doctors’ chambers are assigned to the patients with cards. A sample of health cards is shown below:
The extension facility here introduces the health card system. In this process, first, the authority select people eligible for health card and then health cards were distributed for health services. However, this initiative aimed to provide health services with minimum time, cost, and visit.
2 OBJECTIVES
The broad objective of this study was to analyze health service through the health card and ticket counter systems. It investigated to find out the monetary and non-monetary benefits of the health service extension facility.
The specific objectives of this study were: • To determine the amount of time and cost saved due to health service extension facility. • To evaluate the number of visits for getting health services after introducing service extension facility. • To explore service oriented satisfaction, and perception of service recipients.
3 METHODOLOGY
The study adopted several steps to collect quantitative and qualitative information in order to fulfill the objectives of the study. Data were collected through phone interviews, face-to-face interviews, and in-depth interviews from different groups of respondents. Detail indication of the methods and process that were followed conducting the study, however, could be summarized as follows:
3.1 Study Approach and Design This study was both qualitative and quantitative in nature. This research defines quantitative research as a formal, objective, systematic process to describe and test relationships and examine cause and effect interactions among variables. A descriptive survey design was used. It provides an accurate portrayal or account of the characteristics, for example, behavior, opinions, abilities, beliefs and knowledge of a particular individual, situation or group, etc. The proposed study was based upon Primary data. However, the secondary data was reviewed to - (1) conceptualize the problem, understand the situation and define the problem statement for the project and (2) Assess relevancy, efficiency and effectiveness of the intervention.
3.2 The Study Population The study was about the extended health facility of government health service at Wazirpur upazilla in Barisal. Therefore, the citizens from Wazirpur area were considered as a study population. This study has been conducted among those who received the medical service from Wazirpur upazilla health complex using health card under this pilot project. A total of 161 beneficiaries were interviewed to this purpose.
3.3 Study area Wazirpur upazila is among the 11 upazillas of the Barisal district. This upazilla is 248.36 square kilometers in area and its total population is 241374 (Bangladesh Population Census, 2001). Administratively, it consists of 9 unions, where there are 123 Villages. In medical facilities, there are one upazilla health complex, nine family planning centers and four satellite clinics in Wazirpur upazilla. The map of the study area is given below-
3.4 Data Collection Data were collected through interviews by structured questionnaires. In total 161 interviews have been done for this study. Out of 161, 75 were conducted through telephone and 86 of them were done by face to face interviews. Mode used to collect data:
Method of data collection Units of data Percentage
Phone Interview 75 47
Face to face 86 53
Total 161 100
Table 1: Mode of data collection
3.5 Limitations of data collection Although the research has reached its aims, there were some limitations. The researchers faced several challenges while collecting data such as; 1. Getting contact numbers from service providers 2. Getting wiliness responses to take a survey over phone 3. Getting proper cooperation during face to face interviews
3.6 Data Analysis Data entry or importation was done concurrently with data collection. Data was analyzed using SPSS software (IBM, v22). The researchers reviewed, edited and cleaned the data by performing a series of frequency and data range checks. Any inconsistencies were checked visually by comparing the electronic entry to the entry on the original questionnaire.
4 FINDINGS
4.1 Demographic characteristics of beneficiary The health card service of a2i program proved helpful to the service seekers as it was very much successful from the TCV aspect. The study was concerned to find the benefits of people explained through TCV and other benefits of this facility.
male 38%
female 62%
Figure 1: Gender of the service receiver According to Figure 1, among the interviewees, most of them (62%) were females, whereas the males are comparatively less (38%) in number.
ticket counter 51%
health card 46%
mobile 2%
others 1%
Figure 2: Way of receiving the service Figure 2 describes that in regards of service receiving, most of the health card holders receive health service through ticket counters (51%) and health cards (46%).Very few of them receive service by mobile phones (2%) and others(1%). It is a clear indication that a huge number of patients receive medical treatment through health cards which reflects that the deserving people were given the health cards.
4.2 TCV Analysis The study was conducted with a view to assess the amount of time, cost and visit saved on average for a single service taken by the respondents who use the health card service. From the analysis of the collected data, we can measure the TCV (time, cost and visit) as following-
Time required getting service
94% 88% Ticket
Health card
9% 3% 3% 2%
within 5 5.01 to 10 More than 10
Figure 3: Required time to get service using both processes The figure 3 shows that 94% of the service receivers needed to spend about 5 minutes to get service using health card, whereas only 2% of them needed to spend more than 10 minutes. On the contrary, 88% of the ticket service receivers spent 5 minutes or less on average and 3% of them spent more than 10 minutes to get the health services.
Required cost to get service
100% Ticket Counter
67% Health Card
27% 0% 3% 0% 2% 0% 2% 0%
within 100 101 to 200 201 to 300 501 to 750 More than 1500 Cost (Taka) Figure 4: Cost required getting service from process Figure 4 shows a comparative analysis on the cost needed for receiving a single medical treatment through the ticket counter and the health card Service. All the
respondents who had used the health card service spent BDT 100 or less on average for taking medial service. On the contrary, people who received services through the ticket counter, among them 67% service receivers had to spend more than BDT 100. This chart also gives the notion that, 27% of the interviewees had to pay 200 taka at the same time and others (7%) had to pay more than 200 taka to take a single medical facility from the ticket counter service while none of the recipients using the health card service needed to pay more than 100 taka.
Visits required getting service
93% 88% Ticket counter
Health card
10% 7% 2% 0%
1 2 3 frequency of visits Figure 5: Required visit to get service using ticket and health card In the figure 5, 93% of the respondents stated that it took a single visit and 7% of the respondents mentioned that it took 2 visits to get a single health service using the health cards. On the other hand, 88% of the respondents claimed that they had needed one visit and 10% had needed 2 visits to take a single medical service through the ticket counter. This graph clearly shows that the introduction of the health card service is very helpful for the service seekers because it takes less time, cost and distance to travel.
Comparative analysis of TCV (time, cost and visit)
118 tk
47%
3 hours 63 tk 66% 0%
1 hour 1 visit 1 visit
Average Time Average Cost Average Visit Ticket Counter Health Card
Figure 6: Average Time, cost and visit The given figure (6) shows the comparative analysis of TCV (time, cost and visit) required getting a single medical treatment. It revealed that, the health card service is very much successful to lessen the average time and cost. It shows, new system of health cards has reduced average time at 66%. That means ticket counter service took more than double time than that of the health card service system. It also shows that average cost has been reduced at 47% by replacing system. Thus, the average cost reduced almost half than that of the earlier time although when it comes to the issue of required average visit, it remains the same.
4.3 TCV+ Analysis As this study provides a TCV+ study on the services, it also focused on other non- monetary benefits like service providers’ behavior, beneficiaries’ satisfaction level and other aspects regarding the health card system. Regarding this issue, study revealed that health card service is more appropriate compare to the ticket counter service getting a medical treatment. For better understanding of non-monetary benefits the study scrutinized the advantages and disadvantages of health card service system. Then the study went through the disadvantages of ticket counter system. Thereafter, the study evaluated the satisfaction of beneficiary and the reasons of their satisfaction.
Advantages of health card service system
reduce time 28% get proper treatment 19% reduce cost 18% reduce labor 14% reduce harrasement 10% reduce transport 5% reduce tension 4% no facilities 3% others 1%
Figure 7: Advantages for receiving service using health card In this regard, as shown in figure 7, respondents receiving service from the health cards mentioned the reasons as following: According to them, the health card facility is taking less time, less cost and providing effective solutions. The health card service is not only lessening time (28%), cost (19%) and visit (18%), but also lessening labor (14%), harassment (10%), transport (5%) and tension (4%) in a visible number.
Disadvantages of health card system
no problem 80% lack of proper treatment 6% others 3% more labor 2% more transport 2% more harrasement 1% more tension 1% more corruption 1%
Figure 8: Disadvantages for receiving service using health card Figure 8 shows, 80% respondents opined that they did not face any problem while getting service through health card. It is a clear indication that the health card service is
providing good service. On the contrary, 6% of the respondents mentioned lack of proper treatment is the key hindrance of health card service.
Disadvantages of ticket counter system
more time 26% waiting more in the queue 18% more labor 15% more harrasement 11% more transport 5% more tension 4% no problem 4% ticket: others 1%
0% 10% 20% 30% Figure 9: Disadvantages of ticket counter The given Figure 9 shows the statistical data of the percentage of respondents’ reasons of their dissatisfaction on ticket counter system. a number of respondents felt more time (26%), more waiting in the queues (18%), more labor (15%), more harassment (11%) and more transport (5%) are required to get service using the ticket counter. The ticket counter service really requires more time, cost and visits.
Level of satisfaction
6% 14% 2%
13%
64%
very dissatisfied dissatisfied moderatly satisfied satisfied very satisfied
Figure 10: Satisfaction level by getting the health card service The study revealed, as shown in figure 10, people who received health service through health cards are mostly satisfied (64%) with the health service providers. It also revealed that, 14% and 13% of informants were very much satisfied and moderately satisfied respectively with the health card service. In contrast, only 6% and 2% of beneficiaries expressed dissatisfaction with the new service of health card.
Reasons behind the satisfaction level
33% 31%
19% 15%
2%
less time less cost provide free examine with irresponsibility of medicine importance doctors
Figure 11: Reasons of satisfaction level for getting health card service Figure 11 shows that, the most important reason behind the satisfaction level are ‘examine with importance’ and ‘less cost’ and the percentages of people satisfied for
those reasons were 33% and 31% respectively. In case of satisfaction, less cost consumption and free medicine facility were the others main satisfactory factors in health card service.
5 RECOMMENDATIONS
The study recommended that there still need to improve the health card service. It suggests the Hindrance related to the health card service should be reduced. The following recommendations may contribute in this regard:
Recommendations Responsible authority
Adequate number of doctor to be vested with the health Wazirpur health card services. complex
The program can cover more areas as well as Wazirpur health beneficiaries under health card service. complex
An appropriate publicity campaign should be launched to Wazirpur health popularize this new system. complex
Develop more beneficiary friendly health card service Wazirpur health system. complex
The Health Complex should be provided with sufficient Ministry of health and equipment and medicines. family welfare.
6 CONCLUSION
The government health service through ticket counter has been providing treatment among people for the wellbeing of their health. Recently, the health card service has been introduced in Wazirpur upazilla at Barisal for the people. This study revealed the health card service deals with the detailed medical facility. Besides, it explored beneficiary’s perspectives and their understandings about the provided services.
The health card service reduced TCV (time, cost, and visit) and excessive work. It requires less time, cost and visits and also provides better service. The study also concluded that the new service has been reducing hassles of people. Moreover, People having heath cards were given service with importance which was the most prominent element of their satisfaction.