Quantitative Service Delivery Survey in Health 2002
Bangladesh, 2002
Identification
BGD_2002_QSDS_v01_M
Quantitative Service Delivery Survey in Health 2002
| Name | Country code |
|---|---|
| Bangladesh | BGD |
Quantitative Service Delivery Survey (QSDS)
Quantitative Service Delivery Surveys (QSDS) are multi-purpose surveys that assess quality and performance in resource usage at the frontline facility level, such as schools, health clinics and hospitals. QSDS collect information on characteristics and activities of service providers and on various agents in the system, on a sample basis, in order to examine the quality, efficiency and equity of service delivery on the frontline.
QSDS are often combined with Public Expenditure Tracking Surveys (PETS) in order to obtain a more complete picture of the efficiency and equity of a public allocation system, activities at the provider level, as well as various agents involved in the process of service delivery.
While most of PETS and QSDS have been conducted in the health and education sectors, a few have also covered other sectors, such as justice, Early Childhood Programs, water, agriculture, and rural roads.
In the past decade, about 40 PETS and QSDS have been implemented in about 30 countries. While a large majority of these surveys have been conducted in Africa, which currently accounts for 66 percent of the total number of studies, PETS/QSDS have been implemented in all six regions of the World Bank (East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and North Africa, South Asia and Sub-Saharan Africa).
The goal of this study is to quantify on a nationally representative scale the extent of medical staff absenteeism in Bangladesh. Unannounced visits were made to health clinics with the intention of discovering what fraction of medical professionals were present at their assigned posts. The survey covered 180 health facilities.
Each sampled clinic was visited by a team of trained investigators. The official opening time and closing time of these facilities was 9:00 am and 3:30 pm, respectively. The availability of doctors and paramedics at the facility was recorded once at approximately 9:30 am, and again at approximately 2:30 pm. In between that time, the team collected facility-specific and provider-specific information. The visits to all the facilities were completed within one month (between mid-March and mid-April 2002).
Sample survey data [ssd]
Scope
| Topic | Vocabulary |
|---|---|
| Health | World Bank |
Coverage
National
Producers and sponsors
| Name |
|---|
| World Bank |
Sampling
For administrative purposes, Bangladesh is divided into six divisions, 64 districts (Zilas), and 507 sub-districts (Thanas or Upazilas). In rural areas, the Government of Bangladesh, provides health services through a three tier system. First, there are 376 Upazila Health Complexes (UHCs) that deliver inpatient services and are managed by doctors (medical school graduate ). The other medical staff in the UHCs are: nurses (4 year training); Medical Officers - paramedics (minimum 3 years training ); Family Welfare Visitors (FWVs) and Senior FWVs (minimum 18 month training); pharmacists; and lab technicians. Next, there are approximately 1000 upgraded Union Health and Family Welfare Centers (upgraded-UHFWCs)/Rural Health Dispensaries (RHDs) staffed by one doctor, paramedics and family welfare visitors. The present government is planning to increase number of upgraded-UPFWCs by posting doctors and improving facilities. Finally, there are approximately 3000 Union Health and Family Welfare Centers (UHFWCs) managed by paramedics and family welfare visitors. Both types of UHFWCs provide outpatient care. In some areas where government facilities are not functioning, services are provided by NGOs operating one or more static clinics. The government and NGOs also run satellite clinics that are regularly organized by field workers in communities to increase accessibility to health services.
The survey covered 180 health facilities: 60 Upazila Health Complexes, 30 Upgraded-UHFWCs, 60 UHFWCs and 30 static clinics run by NGO.
Researchers first stratified Upazilas into two categories: Upazilas which are exclusively covered under the Government health system and Upazilas in which a portion of the areas are served by some type of NGO provider. Thirty Upazilas from each of the two strata were selected at random. From each selected Upazila, researchers randomly selected one UHFWC. Since not every Upazila has an upgraded-UHFWC, 15 upgraded-UHFWC were chosen from each of the two strata, one with and one without NGO coverage. While Bangladesh has experienced a mushrooming of NGOs (ranging from provision of medical services to micro-credit to primary schooling), currently very few NGOs provide health services in rural areas with most of the health NGOs being concentrated in urban areas. Since there is no readily available list of NGO health providers operating in rural Bangladesh and there was no way of knowing a priori whether the NGO static clinic was staffed by a doctor, investigators simply visited the nearest NGO clinic to the Upazila headquarters.
Survey instrument
Besides noting the presence of service providers, some key characteristics of the doctors, paramedics, family welfare visitors, lab technicians and pharmacists were recorded. From service providers researchers collected information on age, sex, education, professional training, location of residence, length of service, and duration of posting. For doctors who were absent both in the morning and in the afternoon, investigators had to rely upon information provided by a variety of sources including statistical officers, UHC administrators, and other medical staff. Statistical officers in UHCs usually maintain an updated profile of all medical staff (e.g., information on age, gender, years in service, duration of posting, and place of residence). A statistical officer was present during visits to all 60 UHCs. In upgraded-UHFWCs, when the only doctor was absent, researchers had to rely upon information provided by the paramedic. Various facility-specific information (e.g., distance to Upazila headquarters) was also collected. Besides provider and facility level information, investigators collected secondary data on Upazila characteristics (e.g., percent of households in Upazila with electricity).
Data collection
| Start | End |
|---|---|
| 2002-03 | 2002-04 |
For the purposes of this study, "absenteeism" has a very specific definition. Facilities are visited at 9:30AM and 2:30 PM. Of the people with sanctioned and filled posts, a staff member is "absent all day" when s/he is at the facility at neither time, "absent half day" when at the facility at either one or the other time and "present" when there both times. When an average "absentee rate" is calculated for any group of people, it reflects the average of the value of 1, 1/2 and 0 respectively, for each of the providers in the group. So, an absentee rate of 50% could mean that all providers are absent for a half day or that half the providers are absent all day.
Data Access
Public use file
Use of the survey data must be acknowledged using a citation which would include:
- the identification of the Primary Investigator (including country name)
- the full title of the survey and its acronym (when available), and the year(s) of implementation
- the survey reference number.
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Contacts
| Name | Affiliation | |
|---|---|---|
| Hooman Dabidian | World Bank | hdabidian@worldbank.org |
| Cindy Audiguier | World Bank | caudiguier@worldbank.org |
Metadata production
DDI_BGD_2002_QSDS_v01_M
| Name | Affiliation | Role |
|---|---|---|
| Antonina Redko | DECDG, World Bank | DDI documentation |
2011-09-16
Metadata version
v01 (September 2011)