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Sarma H.,Health System and Economics Unit | Oliveras E.,Research and Metrics Unit
Sexually Transmitted Infections | Year: 2011

Objective: The authors conducted this study to assess the effectiveness of using a public health detailing approach by medical representatives of a private pharmaceutical company to disseminate sexually transmitted infection (STI) counselling information to non-formal providers (NFPs) to improve their STI counselling services. Methods: An intervention was developed that included developing STI counselling guidelines and training medical representatives to disseminate the counselling guidelines to NFPs. To assess the effectiveness of this intervention, the authors conducted 67 mystery client visits to compare the counselling provided by NFPs in intervention areas with counselling provided in areas where the intervention was not implemented. Results: A significantly higher proportion (p<0.05) of mystery clients in the intervention area received advice that was consistent with the national STI counselling guidelines compared with the mystery clients in the control area. No mystery clients in the control area were told to use condoms while the STI lasts compared with 44% (95% CI 28% to 62%) in the intervention area. Likewise, more than twice as many clients in the intervention area were advised not to visit sex workers (53% vs 23%; p=0.014). Conclusion: Public health detailing of medical representatives is a feasible mechanism to improve STI counselling services of NFPs in Bangladesh. Private sector companies provide a potential avenue for reaching the vast number of NFPs with basic information that they can share with their clients. The immediate improvements seen in this study suggest the strong potential of public health detailing as a training tool for NFPs. Source

Hoque M.E.,Health System and Economics Unit | Khan J.A.M.,Health System and Economics Unit | Hossain S.S.A.,Health System and Economics Unit | Gazi R.,Health System and Economics Unit | And 3 more authors.
Cost Effectiveness and Resource Allocation | Year: 2011

Background: Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh.Methods: Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates.Result: Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER). Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context.Conclusion: Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis of knowledge in the area. The most frequently applied economic evaluation is cost-effectiveness analysis. The majority of the studies did not follow the scientific method of economic evaluation process, which consequently resulted into lack of robustness of the analyses. Capacity building on economic evaluation of health and health-related programs should be enhanced. © 2011 Hoque et al; licensee BioMed Central Ltd. Source

Sarowar M.G.,Karolinska Institutet | Medin E.,Karolinska Institutet | Gazi R.,Health System and Economics Unit | Koehlmoos T.P.,Health System and Economics Unit | And 6 more authors.
Journal of Health, Population and Nutrition | Year: 2010

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services. © International Centre for Diarrhoeal Disease Research, Bangladesh. Source

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