Quantitative Service Delivery Survey in Health 2002
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).
Kind of Data
Sample survey data [ssd]
Producers and sponsors
Authoring entity/Primary investigators
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.
Dates of Data Collection (YYYY/MM/DD)
Mode of data collection
Type of Research 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).
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.