January 9, 2013
Bangladesh! I finally arrived in Dhaka after two flights totaling 20+ hours. It’s my first time to be in Bangladesh and South Asia, and I am really excited about the upcoming 3 weeks!
The Population Council has been very helpful in setting up the accommodation, so where I live is only 10-15 minutes away from their office. On my first day, I met my supervisor, Md. Noorunnabi Talukder, who gave me a brief overview of the health system in Bangladesh and introduced me to everyone in the Council. Every staff was very friendly, and a few of them came to check on me multiple times to make sure I was taken good care of. My main tasks involve the construction of a composite quality index for the maternal health services in Bangladesh and the analysis of in-depth interview findings regarding the demand-side financing programs (voucher program to eligible women). The demand-side financing program has been successful in enabling more rural, pregnant women to use the public maternal health services. My goal is to help evaluate whether quality of service has improved and whether there are major implementation challenges to be solved. I am starting off with a quick literature review on similar studies that also evaluate maternal health services, and hopefully that will provide some useful reference points.
One prominent feature of Dhaka City is the constant crowd everywhere (both cars and people), which is not surprising given the large population. Unfortunately, the infrastructure has not caught up accordingly. Even in this central business district, the roads are often poorly maintained, with holes and piles of concrete everywhere. Traffic is often chaotic with no functioning system or pedestrian crossings. Because of that, rickshaw is actually the best transportation option within a short distance. From a public health perspective, it certainly raises concerns over potential road accidents, difficulties for people with physical disabilities, and barriers to effective emergency response system.
On a side note, it appears that I have brought some of the cold weather from Boston to Bangladesh, as we just experienced the coldest day in over 40 years! People here are not used to this level of coldness, especially without any heating system, so it has been quite challenging. Just earlier today I saw people making fire on the streets. Hopefully it will get warm soon!
January 16, 2013
During the past weekend, I managed to visit the Old Dhaka, Sonargaon, and Patnam City with some other students from the Harvard School of Public Health. Despite the “crazy” traffic (it took us almost 4 hours to travel 27km on the way back), I was really glad to see other sides of Dhaka and the beautiful remains of Patnam City. Besides the gorgeous scenes, I was deeply impressed by the friendliness and hospitality of the local population. First of all, there was one tour guide from the Pink Palace, Wazed, who volunteered to walk us around the neighborhood, visit the Armenian Church, and take a boat ride up the river. Then we met another young gentleman, Naz, who invited us to his home for some tea and snacks in a village near Sonargaon. As we walked around the villages, we all felt the strong community spirit among the members.
After these wonderful weekend trips, I am now continuing to work on the composite quality index methodologies. I just narrowed down to two main methods, and will start to test them on the datasets from client exit interviews and observation of client-provider interactions. The idea is to compare different methodologies and data sources in the evaluation of maternal health services, so that program managers may adopt one that aligns with their goals, timeline and resource considerations.
January 24, 2013
Time flies and this is the last day of my winter session. Fortunately, this past week has been busy but highly productive.
First of all, I joined three staff from the Council on a field visit to one Upazila (sub-district) Health Complex, a nearby Union Health Center and Community Health Center. It was eye opening to see these facilities and meet with frontline health workers in person. These happened to be some of the oldest health facilities in Bangladesh, and they were facing challenges in terms of both human resource shortages and lack of maintenance support.
Besides the visit, I was busy writing up the report on the composite quality index methodologies, which I managed to finish this morning! I am looking forward to the end-line survey data collection to be completed, so that my work could be put to use. Yesterday, I also conducted a brief training session for the junior staff. Many of them are very focused on day-to-day fieldwork, so hopefully the session helped provide some perspectives on how the data they collected are translated into eventual findings about quality and implementation issues.
Reflecting on the past three weeks, I am really thankful for this working experience with the Council. Everyone, from the support staff to the senior officers, was highly supportive and provided a lot of guidance on my work. Hopefully I will be visiting Bangladesh again in the near future!