This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Bhuiya's presentation focussed on ICDDR,B's work with informal providers of health care and village doctors in Bangladesh.

1. Experience in Engaging with Informal Health Care Providers in Rural Bangladesh AbbasBhuiya On behalf of BangladeshTeam Beyond Scaling Up ConferenceBrighton24-25 May 2010

2. Background Informal healthcare providers are most common – 95% of the health work force They make their living by selling drugs They make inappropriate use of drugs

4. Reducing inappropriate and harmful use of drugs

5. Improving quality of services

7. Interventions - 1 Training on Dos and Dont’s Diarrhea Hepatitis Malaria, Tuberculosis Viral Fever Obstructed labor Ante-partum hemorrhage Post-partum hemorrhage, and for under-five children pneumonia, severe pneumonia, very severe disease

8. Information for referral Facilities with name, location, mode and cost of transport Estimated cost of treatment, estimated duration, Telephone directory of contacts Refresher trainings every two to three months Consultation service over mobile phone with a qualified doctor Interventions - 2

9. Interventions - 3 Oversight committee at Union level with 33 members UP Chairman-1, UP Members- 9 male and 3 female – total 12 Village Doctors -04 VHP committees -02 Local elites -03 Imam -01 School teachers -1 male and 1 female -02 Beneficiaries ( poor, women) -03 NGO group leaders -03 Students/Youths -02

11. Quality of physical facility

12. cleanliness, privacy, water availability, sanitation, waiting area

13. Assessment of the knowledge on dos and don’ts about 11 common diseases

14. Award

15. Crest in large community meeting

17. Table 1 - Mean no. of drugs prescribed by Village Doctors for pneumonia (< 5 yr), cold and fever during pre and post intervention, Chakaria 2009-10 Data source: Exit interview

18. Table 2 – Harmful and inappropriate prescription of drugs by Village Doctors during pre and post intervention for pneumonia, diarrhoea and cold and fever, Chakaria, 2009-10t Data source: Exit interview

19. Conclusions It was possible to get engaged with the informal healthcare providers Only training, recognition and local watch is not enough to reduce inappropriate and harmful practices substantially Alternative source to protect their income is needed

20. Communication Print Research briefs Monograph Journal article Mass media Oral Seminar, workshop, conference Strategy and other meeting, discussion

21. Outputs So far Research Briefs, monograph, journal articles based on baseline data Future Research briefs, monograph, journal articles