The emergence of a research culture in Bangladesh promoting rigorous research, developing interventions, and translating evidence into policies made a substantial contribution to the improvement of health outcomes in Bangladesh. Notably, the reduction of mortality from diarrhoea and vaccine preventable diseases and control of fertility have made the most significant contributions to recent health gains.
Entries in Abbas Bhuiya (15)
Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households.
Exploring the Ethics of Long-Term Research Engagement With Communities in Low- and Middle-Income Countries
Over the past few decades, there has been increasing attention focused on the ethics of health research, particularly in low- and middle-income countries. Despite the increasing focus on the literature addressing human protection, community engagement, appropriate consent procedures and ways to mitigate concerns around exploitation, there has been little discussion about how the duration of the research engagement may affect the ethical design and implementation of studies. In other words, what are the unique ethical challenges when researchers engage with host communities for longer periods (10 years or more), and what special considerations does this time commitment generate when applying ethical principles to these kinds of studies? This article begins to outline key areas of ethical concern that arise during long-term, sustained research activities with communities in low-resource settings. Through a review of the literature and consultations with experts in health systems, we identified the following key themes: fair benefits and long-term beneficence; community autonomy, consultation and consent; impacts on local health systems; economic impacts of research participation; ethical review processes; and institutional processes and oversight within research organizations. We hope that this preliminary exploration will stimulate further dialogue and help inform ethical guidance around long-term research engagements in the developing world.
Previous work from ICDDR,B established village doctors as an important player Bangladesh’s healthcare system, as they are often the first port of call for the rural poor. Considering this importance and the huge shortfall of formally trained health workforce in the country, there is a clear need to improve the quality of the services offered by these semi-trained village doctors. In response, a team of ICDDR,B researchers tested a package of interventions, which included training of the village doctors, establishing a community watch for improved accountability and establishing branded franchise of better trained village doctors.
There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria.