FINAL STUDY REPORT 2020 Analysis of Health Needs and Health System Response in the Coastal Districts of Bangladesh Fauzia Akhter Huda Hassan Rushekh Mahmood Maternal and Child Health Division Aniqa Tasnim Hossain Jasmin Khan Omar Faruk Zahed Shafiqur Razzak Kazi Tamara Binta Kamal Shams El Arifeen 6/30/2020 ACKNOWLEDGEMENT This research project was supported by South Asia Research Hub, Department for International Development, Government of UK. icddr,b acknowledges with gratitude the commitment of DFID to its research efforts. icddr,b is also grateful to the Governments of Bangladesh, Canada, Sweden and the UK for providing unrestricted support. DISCLAIMER: Views expressed in this report do not necessarily represent official views and policies of the Government of UK. 1 | P a g e LIST OF CONTENTS LIST OF ABBREVIATIONS ..................................................................................................................................... 8 EXECUTIVE SUMMARY ...................................................................................................................................... 13 INTRODUCTION................................................................................................................................................... 13 OBJECTIVES ........................................................................................................................................................ 22 METHODOLOGY .................................................................................................................................................. 24 STUDY DESIGN: .............................................................................................................................................. 24 STUDY AREAS: ............................................................................................................................................... 25 STUDY DURATION: ......................................................................................................................................... 26 DATA COLLECTION METHODS AND TOOLS ................................................................................................ 27 A. Household Survey ...................................................................................................................................... 27 B. Health Facility Survey ................................................................................................................................. 30 C. Qualitative Study ........................................................................................................................................ 31 DATA MANAGEMENT AND ANALYSIS ............................................................................................................... 32 ETHICAL CONSIDERATIONS .............................................................................................................................. 33 HOUSEHOLD SURVEY ................................................................................................................................... 35 In-depth Interviews (IDIs) ............................................................................................................. 40 Focus Group Discussions (FGDs) ............................................................................................... 40 Key Informant Interviews (KIIs) .................................................................................................... 40 Socio-demographic characteristics of the respondents participated in the household survey ..... 42 Socio-demographic characteristics of the respondents participated in the qualitative study ........ 44 Focused group discussions (FGDs) ............................................................................................. 45 Community Members ................................................................................................................... 45 Frontline Healthcare Providers (FHPs) ........................................................................................ 45 Key informant interviews (KIIs) .................................................................................................... 46 Prevalence of disability and use of assisted device ..................................................................... 46 Healthcare seeking behavior in last 30 days ................................................................................ 53 Disease-specific care-seeking ..................................................................................................... 57 Findings from the qualitative study ............................................................................................... 57 Health seeking behaviour of general people ................................................................................ 57 Health seeking behaviours of PWDs ............................................................................................ 60 Disability allowance and benefits received by PWDs ................................................................... 66 2 | P a g e Family planning (FP), antenatal care (ANC) and delivery care seeking among married women of reproductive age (MWRA) group (with/without any disability) .................................... 68 Cost for care seeking due to any illness in last 30 days ............................................................... 69 Hindering or facilitating factors for person with disability .............................................................. 71 Findings from the qualitative study ................................................................................................................. 115 Capacity of the existing health institutions ...................................................................................................... 115 Health institutions for general people ......................................................................................... 115 Health institutions for PWDs ...................................................................................................... 117 Healthcare providers’ interview .................................................................................................. 119 Training of health professionals on disability.............................................................................. 129 Knowledge on ‘Disability Protection Act-2013’ ........................................................................... 129 Challenges faced in accessing healthcare by general people ................................................... 130 Challenges faced in accessing healthcare by the PWDs ........................................................... 133 CONCLUSIONS & RECOMMENDATIONS ........................................................................................................ 138 CHALLENGES FACED DURING STUDY IMPLEMENTATION PERIOD ........................................................... 141 CYCLONEBULBUL ........................................................................................................................................ 141 POOR ROAD COMMUNICATION .................................................................................................................. 141 3 | P a g e LIST OF TABLES Table 1: Sites for qualitative study in Barishal and Khulna divisions, 2019-2020 .................................................. 31 Table 2: Listing Information from the Household Survey in Barishal and Khulna divisions, 2019-2020 ................ 36 Table 3: Samples selected for the qualitative study in Barishal and Khulna divisions, 2019-2020 ....................... 41 Table 4: Socio-demographic characteristics of the respondents in Barishal and Khulna divisions, 2019-2020 .... 42 Table 5: Socio-demographic information of IDI participants’ (male and female PWDs) ........................................ 44 Table 6: Socio-demographic information of FGD participants’ (male and female community members) .............. 45 Table 7: Prevalence of disability and use of assisted device in Barishal and Khulna divisions, 2019-2020 .......... 47 Table 8: Disability types, education, and occupation of the IDI participants’ ......................................................... 49 Table 9: Healthcare seeking behavior in last 30 days (Person without disability) in Barishal and Khulna divisions, 2019-2020 ............................................................................................................................................... 53 Table 10: Healthcare seeking behavior in last 30 days (Person with disability) in Barishal and Khulna divisions, 2019-2020 ............................................................................................................................................... 55 Table 11: Family planning, antenatal care, and delivery care seeking among married women of reproductive age (with/without any disability) ..................................................................................................................... 68 Table 12: Cost for care seeking due to any illness in last 30 days ........................................................................ 69 Table 13: Difficulties/easiness due to different environmental factors experienced by person with disability in Barishal and Khulna divisions, 2019-2020 .............................................................................................