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Does Entitlement Card ensure Utilization of Urban Primary Healthcare Clinic in Bangladesh?

Sharmin Mizan, Md Mizanur Rahman, Razitasham binti Safii, Sk Akhtar Ahmad

Abstract

Background: Although Bangladesh substantial­ly reduced 40% maternal death in the last deca­des, it is still challenging, especially among the ur­ban poor. The achievements are not equitable bet­ween different economic quintiles and bet­ween the rich and the urban poor. This study aims to examine the extent to which the entitle­ment card affects the utilization of maternal and child health care and identifies other factors that influence MCH services.

Subjects and Method: This cross-sectional study was carried out in the working areas of the Ur­ban Primary Healthcare Project (UPHCP) in Bang­ladesh. A two-stage cluster sampling tech­ni­que was used to select the participants. A total of 3,949 women aged 15-49 years, having at least one child aged two years or less were selected for this study. The data were collected through face-to-face inter­views. The data were analyzed using multinomial logistic regression.

Results: The proportion of utilization of UPH­CC was 49.9%. One-fourth (26.6%) of them fully utilized it and another 23.3% utilized it partially. Stepwise multinomial logistic regression analysis revealed that those who had an Entitlement Card from the UPHC project were 11.75 times (95% CI= 9.481, 14.549; p= 0.001) more likely to fully Utilized and 3.64 times (95% CI= 3.643, 2.911; p= 0.001) likely be utilized partially compared to non-utilizer. Respondents having no formal edu­cation utilized UPHCC fully (AOR=2.32; 95% CI= 1.46, 3.68; p= 0.001) and partially (AOR= 1.76; 95% CI= 1.12, 2.77; p= 0.014) used UPHCC. It was 3.08 (95% CI= 2.03, 4.67; p= 0.001) times for fully and 2.71 (95% CI= 1.82, 4.04; p= 0.001) times for partially utilized UPHCC compared to non-users among the primary level of education. Small family size (≤4) and monthly family in­come in the range of BDT 10,000 above were likely to utilise UPHCC. However, non-Muslims were less likely to Utilized UPHCC.

Conclusion: Apart from the entitlement card, other factors such as monthly income BDT> 10,000, small family size, no formal educated mo­ther appeared to be potential predictors for utilization of the Urban Primary Health care clinic.

Keywords: entitlement card, maternal care, Utilization, urban primary healthcare

Correspondence: Md Mizanur Rahman. Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sa­rawak. Email: rmmizanur@unimas.my, rmizanur1958@gmail.com.

Journal of Maternal and Child Health (2020), 5(2): 213-225
https://doi.org/10.26911/thejmch.2020.05.02.12

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References

Addai I (2000). Determinants of use of maternal-child health services in rural Ghana. J. Biosoc. Sci. 32: 1–15. doi: 10.1017/s0021932000000018 [Crossref] [PubMed] [Google Scholar]


Ahmed S, Khan MM (2011). A maternal health voucher scheme: what have we learned from the demand-side finan-cing scheme in Bangladesh? Health Policy Plan. 26: 25–32. doi: 10.1093/heapol/czq015 [Crossref] [PubMed] [Google Scholar]


Ahmed SM, Alam BB, Anwar I, Begum T, Rumana H, Khan JA, Nababan H, Os-man FA (2015). Bangladesh health sys-tem review. Geneva: World Health Organization. [Google Scholar]


Ahmed SM, Petzold M, Kabir ZN, Tomson G (2006). Targeted intervention for the ultra-poor in rural Bangladesh: Does it make any difference in their health-seeking behavior? Soc. Sci. Med. 63: 2899–2911. doi: 10.1016/j.socscimed.2006.07.024 [Crossref] [PubMed] [Google Scholar]


Amano A, Gebeyehu A, Birhanu Z (2012). Institutional delivery service utilization in Munisa Woreda, South East Ethio-pia: a community-based cross-sectional study. BMC Pregnancy Childbirth 12: 105. doi: 10.1186/1471-2393-12-105 [Crossref] [PubMed] [Google Scholar]


Banke-Thomas OE, Banke-Thomas AO, Ameh CA (2017). Factors influencing utilization of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review. BMC Pregnancy Childbirth 17: 65. doi: 10.1186/s12884-017-1246-3 [Crossref] [PubMed] [Google Scholar]


Bernard HR, Wutich A, Ryan GW (2017). Analyzing Qualitative Data: Systematic Approaches, Second edition. ed. USA: SAGE Publications Pvt. Ltd. [Google Scholar]


Birmeta K, Dibaba Y, Woldeyohannes D (2013). Determinants of maternal health care utilization in Holeta town, central Ethiopia. BMC Health Serv. Res. 13: 256. doi: 10.1186/1472-6963-13-256 [Crossref] [PubMed] [Google Scholar]


Eisenhut A (2018). Cultural Connection: The Impact of Religion Can Play in Health care.


Farzana S (2014). Demand Side Financing (DSF) - Maternal Health Voucher Scheme in Bangladesh. doi: no_doi [Crossref] [PubMed] [Google Scholar]

https://doi.o-rg/10.1186/s12884-017-1445-y


Gyimah SO, Takyi BK, Addai I (2006). Chal-lenges to the reproductive-health needs of African women: on religion and maternal health utilization in Ghana. Soc. Sci. Med. 1982 62, 2930–2944. doi: 10.1016/j.socscimed.2005.11.034 [Crossref] [PubMed] [Google Scholar]


Halim MA (2014). An Analysis of Facility-based Exit Interview with the Maternal Voucher Recipients under Demand Side Financing Initiative in Bangladesh. Dhaka. Dhaka, Bangladesh. [Website]


Hatt L, Nguyen H, Sloan N, Miner S, Mag-vanjav O, Sharma A, Chowdhury J, et al. (2010). Economic Evaluation of De-mand-Side Financing (DSF) for Mater-nal Health in Bangladesh. [Website]


HB Consultants and Natural Resources Plan-ners (2012). Assessing the impact of user fees on UPHC–Reviewing health voucher and user fees exemptions. Second Urban Primary Health Care Project. [Website]


IBM SPSS (2013). IBM SPSS Statistics for Windows. New York, USA: IBM SPSS, Armonk.


Ivančič A, Mirčeva J, Vrečer N (2008). Lite-rature Review Report: Impact of edu-cation on health (youth, women, people with disabilities). [Website]


Khanal V, Adhikari M, Karkee R, Gavidia T (2014). Factors associated with the utilization of postnatal care services among the mothers of Nepal: analysis of Nepal demographic and health sur-vey 2011. BMC Women's Health 14: 19. doi: 10.1186/1472-6874-14-19 [Crossref] [PubMed] [Google Scholar]


Kifle D, Azale T, Gelaw YA, Melsew YA (2017). Maternal health care service seeking behaviours and associated factors among women in rural Hara-maya District, Eastern Ethiopia: a triangulated community-based cross-sectional study. Reprod. Health 14. doi: 10.1186/s12978-016-0270-5 [Crossref] [PubMed] [Google Scholar]


Kim J (2016). Female education and its im-pact on fertility. IZA World Labor 1–10. doi: 10.15185/izawol.228 [Crossref] [Google Scholar]


Local Government Division, Bangladesh (2012). Design Project Proforma (DPP): Urban Primary Health Care Services Delivery Project, Bangladesh, 2012. Ministry of Local Government, Rural Development and Co-operatives, Dha-ka, Bangladesh. [Website]


Ministry of Health and Family Welfare (2017). 4th Health, Population and Nu-trition Sector Programme (4th HPNSP), January 2017- June 2022. Programme Implementation Plan (PIP). [Website]


Ministry of Health and Family Welfare, Bangladesh (1998). Project Implemen-tation Plan, 1998.


National Institute of Population Research and Training, Bangladesh (2012). Bangladesh Maternal Mortality and Health Care Survey 2010 (Publication). National Institute of Population Re-search and Training (NIPORT), MEA-SURE Evaluation, and ICDDR, B, Dhaka, Bangladesh. [Website]


National Institute of Population Research and Training, Bangladesh (2013). End-line Household Survey under Second Urban Primary Health Care Project, 2012, Dhaka City Corporation. National Institute of Population Research and Training (NIPORT), Dhaka. [Website]


National Institute of Population Research and Training, Bangladesh (2016). Bangladesh Demographic and Health Survey 2014. [Website]


Noor FR, Talukder NM, Rob U (2013). Effect of a maternal health voucher scheme on out-of-pocket expenditure and use of delivery care services in rural Bangladesh: A prospective controlled study. The Lancet 382: 20. doi: 10.1016/s0140-6736(13)62181-9 [Crossref] [Google Scholar]


Ononokpono DN, Odimegwu CO (2014). Determinants of Maternal Health Care utilization in Nigeria: a multilevel ap-proach. Pan Afr. Med. J. 17 Suppl 1:2. [PubMed] [Google Scholar]


Rahman MM (1997). Socio-Demographic Determinants of Infant Mortality and Morbidity and Its Correlation with Maternal Health in Slum Dwellers of Dhaka City (Thesis). Dhaka University, Dhaka, Bangladesh.


Research Evaluation Associates for Develop-ment (2012). Enhancing Cost Effective-ness and Improving Quality of UPHC. Second Urban Primary Health Care Project (UPHCP-II). Local Government Division, Ministry of Local Government, Rural Development & Cooperatives, Bangladesh, Dhaka, Bangladesh.


Rutaremwa G, Wandera SO, Jhamba T, Aki-ror E, Kiconco A (2015). Determinants of maternal health services utilization in Uganda. BMC Health Serv. Res. 15: 271. doi: 10.1186/s12913-015-0943-8 [Crossref] [PubMed] [Google Scholar]


Srivastava A, Mahmood S, Mishra P, Shro-triya V (2014). Correlates of Maternal Health Care utilization in Rohilkhand Region, India. Ann. Med. Health Sci. Res. 4, 417–425. doi: 10.4103/2141-9248.133471 [Crossref] [PubMed] [Google Scholar]


Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, et al. (2009). Multiple imputations for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338, b2393. doi: 10.1136/bmj.b2393 [Crossref] [PubMed] [Google Scholar]


Teferra AS, Alemu FM, Woldeyohannes SM (2012). Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community - based cross-sectional study. BMC Pregnancy Childbirth 12(74). doi: 10.1186/1471-2393-12-74 [Crossref] [PubMed] [Google Scholar]


Weldemariam S, Kiros A, Welday M (2018). utilization of institutional delivery service and associated factors among mothers in North West Ethiopian. BMC Res. Notes 11, 194. doi: 10.1186/s13104-018-3295-8 [Crossref] [PubMed] [Google Scholar]


Wolelie A, Aychiluhm M, Awoke W (2014). Institutional delivery service utilization and associated factors in Banja District, Awie Zone, Amhara Regional State, Ethiopia. Open J. Epidemiol. 04: 30–35. [Google Scholar]


World Health Organization (2010). Glimpses of innovations in primary health care in South-East Asia. World Health Orga-nization, Regional Office for South-East Asia, New Delhi. [Website]


Zelalem-Ayele D, Belayihun B, Teji K, Admassu-Ayana D (2014). Factors Af-fecting utilization of Maternal Health Care Services in Kombolcha District, Eastern Hararghe Zone, Oromia Regional State, Eastern Ethiopia. Int. Sch. Res. Not doi: 10.1155/2014/917058 [Crossref] [PubMed] [Google Scholar]


Zhang L, Xue C, Wang Y, Zhang L, Liang Y (2016). Family characteristics and the use of maternal health services: a population-based survey in Eastern China. Asia Pac. Fam. Med. 15. doi: 10.1186/s12930-016-0030-2 [Crossref] [PubMed] [Google Scholar]

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