TY - JOUR
T1 - Who are more responsive? Mixed-methods comparison of public and private sector physicians in rural Bangladesh
AU - Joarder, Taufique
AU - George, Asha
AU - Sarker, Malabika
AU - Ahmed, Saifuddin
AU - Peters, David H.
N1 - Funding Information:
T.J. sincerely acknowledges the financial support provided by Fogarty International Training Center (D43TW007587) for his doctoral education. He also received Health Systems Programme Award for Doctoral Student Research, which came as a relief for conducting his fieldwork in Bangladesh. He would like to thank the Health Systems Programme under Department of International Health, JHSPH for the award.
Funding Information:
This article is based on the first author’s (T.J.) doctoral dissertation at Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHSPH). He acknowledges all the persons and institutions that contributed in carrying out this study and finishing it in time. Director General of Directorate General of Health Services, Government of Bangladesh Dr Abul Kalam Azad was crucial in facilitating data collection from public sector, and President of Bangladesh Private Medical Practitioners Association, Dr Maniruzzaman Bhuiyan for private sector. He is enormously thankful to Dr Sabina Faiz Rashid, Dean of James P. Grant School of Public Health, for allowing him to use the office space in Dhaka, and arranging a handsome amount of funding to conduct the fieldwork. The second author (A.G.) is supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant No 82769). Any opinion, finding and conclusion or recommendation expressed in this material is that of the author and the National Research Foundation of South Africa does not accept any liability in this regard.
Publisher Copyright:
© 2017 The Author.
PY - 2017
Y1 - 2017
N2 - Responsiveness of physicians (ROPs) reflects the social actions by physicians to meet the legitimate expectations of health care users. Responsiveness is important since it improves understanding and care seeking by users, as well as fostering trust in health systems rather than replicating discrimination and entrenching inequality. Given widespread public and private sector health care provision in Bangladesh, we undertook a mixed-methods study comparing responsiveness of public and private physicians in rural Bangladesh. The study included in-depth interviews with physicians (n = 12, seven public, five private) and patients (n = 7, three male, four female); focus group discussions with users (four sessions, two male and two female); and observations in consultation rooms of public and private sector physicians (1 week in each setting). This was followed by structured observation of patient consultations with 195 public and 198 private physicians using the ROPs Scale, consisting of five domains (Friendliness; Respecting; Informing and guiding; Gaining trust; and Financial sensitivity). Qualitative data were analysed by framework analysis and quantitative data were analyzed using two-sample t-test, multiple linear regression, multivariate analysis of variance, and descriptive discriminant analyses. The mean responsiveness score of public sector physicians was statistically different from private sector physicians:-0.29 vs 0.29, i.e. a difference of-0.58 (P-value < 0.01; 95% CI-0.77,-0.39) on a normalized scale. Despite relatively higher level of responsiveness of private sector, according to qualitative findings, neither of the sectors performed optimally. Private physicians scored higher in Friendliness, Respecting and Informing and guiding; while public sector physicians scored higher in other domains. 'Respecting' domain was found as the most important. Unlike findings from other studies in Bangladesh, instead of seeing one sector as better than the other, this study identified areas of responsiveness where each sector needs improvements.
AB - Responsiveness of physicians (ROPs) reflects the social actions by physicians to meet the legitimate expectations of health care users. Responsiveness is important since it improves understanding and care seeking by users, as well as fostering trust in health systems rather than replicating discrimination and entrenching inequality. Given widespread public and private sector health care provision in Bangladesh, we undertook a mixed-methods study comparing responsiveness of public and private physicians in rural Bangladesh. The study included in-depth interviews with physicians (n = 12, seven public, five private) and patients (n = 7, three male, four female); focus group discussions with users (four sessions, two male and two female); and observations in consultation rooms of public and private sector physicians (1 week in each setting). This was followed by structured observation of patient consultations with 195 public and 198 private physicians using the ROPs Scale, consisting of five domains (Friendliness; Respecting; Informing and guiding; Gaining trust; and Financial sensitivity). Qualitative data were analysed by framework analysis and quantitative data were analyzed using two-sample t-test, multiple linear regression, multivariate analysis of variance, and descriptive discriminant analyses. The mean responsiveness score of public sector physicians was statistically different from private sector physicians:-0.29 vs 0.29, i.e. a difference of-0.58 (P-value < 0.01; 95% CI-0.77,-0.39) on a normalized scale. Despite relatively higher level of responsiveness of private sector, according to qualitative findings, neither of the sectors performed optimally. Private physicians scored higher in Friendliness, Respecting and Informing and guiding; while public sector physicians scored higher in other domains. 'Respecting' domain was found as the most important. Unlike findings from other studies in Bangladesh, instead of seeing one sector as better than the other, this study identified areas of responsiveness where each sector needs improvements.
KW - Bangladesh
KW - Responsiveness
KW - health systems
KW - human resources for health
KW - mixed methods
KW - private sector
KW - public sector
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U2 - 10.1093/heapol/czx111
DO - 10.1093/heapol/czx111
M3 - Article
C2 - 29149312
AN - SCOPUS:85040117681
SN - 0268-1080
VL - 32
SP - iii14-iii24
JO - Health policy and planning
JF - Health policy and planning
ER -