Analysis of Primary Healthcare Providers for the Urban Poor in Bangladesh: Demand and Supply Side Perspectives

The urban primary healthcare (PHC) system in Bangladesh faces significant challenges in meeting the increased healthcare needs of the rapidly growing urban population. This thesis investigates how urban PHC in Bangladesh can be made more effective and responsive to the needs of the urban population, considering both demand and supply-side perspectives. From the demand side, population preferences were examined through a mixed-methods systematic review, a discrete choice experiment, and revealed preference analysis. From the supply side, key informant interviews with healthcare providers and policy-relevant personnel, and the technical efficiency of public and NGO PHC providers were conducted. The systematic review identified distance, costs, provider behaviour, and quality of care as the most frequently reported preference attributes. Six attributes of PHC providers were selected for conducting the DCE for both major and minor illnesses, including travel time, waiting time, recommendation, provider qualification, consultation fee, and medicine costs. DCE findings showed that for both minor and major illnesses, provider qualification was the highest priority. However, for minor illnesses, an MBBS provider was preferred over a senior doctor, and for major illnesses, it was the opposite. The revealed preference study indicated that facility proximity was the most preferred reason for selecting outpatient healthcare providers. Supply-side stakeholders highlighted challenges related to resource allocation, governance, and service delivery mechanisms, particularly the insufficient government-contracted facilities and the limited scope of services offered by existing facilities. Technical efficiency analysis of 423 subdistrict-level hospitals and 96 NGO PHC providers revealed significant potential for improving service output by 42% and 57%, respectively, through the effective use of existing resources. The thesis concludes that examining both demand and supply sides by studying technical efficiency and preferences will help policymakers identify the factors responsible for production inefficiency and make the care provision responsive to the preferences of the urban population.