Village doctors are the dominant healthcare providers in rural Bangladesh, making up 96% of informal providers. While village doctors are popular due to their availability and low costs, the quality of their services is questionable. The government is working with village doctors through training programs and accountability groups to improve quality and link the informal system to the formal healthcare sector, in order to address the shortage of trained physicians and ensure care for rural communities.

1. n n o v a t i o n in Informal Health Market in Bangladesh Innovations in informal health market in Bangladesh

4. Health Care Providers in Chakaria, Bangladesh, 2006 TBA Spiritual Healer Village Doctor Homeopath Formal sector Kabiraj Population (560,000) Per 10,000 Formal (4%) 2.00 Qualified Physician (Regular) 39 .70 Qualified Physician (Guest) 20 .36 Sub-Assistant Community Medical Officer (SACMO-Paramedics) 7 .13 Family Welfare Visitor 13 .23 Midwife (ICDDR,B Trained) 12 .21 Family Welfare Assistant (Trained on midwifery by government) 13 .23 Nurse 8 .14 Informal (96%) 43.64 Village doctor (Allopathic) 328 5.86 Village doctor (Homeopathy) 174 3.11 Kabiraj (Traditional) 289 5.16 Religious/spiritual healer 694 12.39 Traditional birth attendant 959 17.13

6. Sources of First Line of Care, Chakaria, 2007 * SACMO=Sub assistant community medical officer Source of healthcare % Village doctors/Pharmacy 50.3 Home remedy 23.3 MBBS 10.6 Homeopath 8.1 SACMO* 4.7 Spiritual healers 1.1 Others 1.9

7. Use of Physicians and Village Doctors by Poor and Better Off, Chakaria, 2007

9. Reasons for Choosing Village Doctors, Chakaria, 2007 Multiple responses recorded Reasons for choosing the health care provider (n=340) % Quality of treatment is good 69.5 Nearest health care provider 42.5 Low treatment cost 17.3 Well behaved health care provider 17.3 Treatment cost on credit 14.6 No other health care facility available nearby 5.8 Health care provider is a family member or a relative or a known person 5.6 Advised by the neighbors or others 0.4

11. Use of Drug for Treating Diarrhoea, Fever, and ARI by the Village Doctors, Chakaria, 2006 Inappropriate 75% Appropriate 18% Harmful 7%

12. Shortage of physician, nurse and technologist, Bangladesh, 2007 Gap between the need as per WHO recommendation and existing numbers Source: Bangladesh Health Watch 2008

15. Working with the Village Doctors to Make Health Systems Work for the Poor in Bangladesh

18. In Search of a Model - Interventions Component Activity Quality of service Training Accountability Watch Reward, consolidation, promotion Branding/Franchising

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