Rapid Assessment of Young People's Perspectives on Government, NGO and Private Health Services

The issue. Although the current prevalence of HIV in Bangladesh is low amongst the general population, it is higher amongst certain groups, such as injecting drug users. Bangladesh is on the brink of a generalized epidemic and young people (aged 15-24) are the most vulnerable group in terms of high-risk behaviour and lack of information. Health care facilities can play an important role for young people in promoting sexual health and shaping positive sexual health behaviours. Currently in Bangladesh, there is little health care provision tailored towards the needs of young people, however there is growing recognition that services should be more ‘youth-friendly’.

The research. This formative research assessed young people’s perspectives on existing health care provision and consulted them about key characteristics for youth-friendly health service in Bangladesh. This information will help programme planners to design programmes and evaluation tools that are responsive to the health and psychosocial needs of young people in Bangladesh.

The rapid assessment employed focus group discussions and semi-structured interviews with young people in 16 sites, rural and urban, across Bangladesh. Twenty-four discussions were held with a total of 159 participants, divided into 4 groups: married women, married men, unmarried men and unmarried women. Interviews were completed with 204 participants, with approximately equal numbers of young men and young women.

Key knowledge.

Health Problems

Information was collected on young people’s psychosocial, general and sexual health problems. The results indicate that although young people in Bangladesh are aware of and concerned about HIV/AIDS and other sexually transmitted infections (STIs), these are not their primary concern. The number and variety of problems identified by young people was significant, considering this study did not target a particularly vulnerable population. Reproductive and sexual health (RSH) problems were most frequently mentioned by young men, of which sexually transmitted infections (STI) were the most common. Young women indicated slightly more RSH problems, of which nearly half were STIs. Young women in particular expressed concerns about numerous other psychosocial issues, many of which also have significant implications for general and reproductive health and HIV transmission, such as early marriage/motherhood, violence and harassment.

Use of services

The majority of young people in this study who reported having a general health problem sought help from a qualified practitioner. Help seeking was lower (around 50%) for reproductive and sexual health problems, with shyness and shame the most commonly mentioned barriers to seeking health care. Of those youth who had used health care services, 86% reported being satisfied.

Desired characteristics of health services

Important features of a youth-friendly service were identified. Young people want health services which:

Ÿ are affordable (particularly important for women)

Ÿ have short waiting times

Ÿ offer a private and confidential service

Ÿ have knowledgeable and competent health care providers

Ÿ offer a wide range of services, and

Ÿ are equitable.

Young women, in particular, also valued a good clinic environment, which should be clean, with a toilet and a waiting room. The majority of young people (61%) said that they could pay between 1 and 20 taka for health services, but women offered an amount lower than men. A waiting time of thirty minutes was acceptable to most young people.

Satisfaction with different types of service providers

Service users and non-service users were asked to evaluate different types of health service providers in Bangladesh. A significant difference was found in satisfaction depending on the type of provider seen. The youth rated government services significantly lower on overall satisfaction and on the majority of quality indicators - confidentiality, technical competence, waiting times, equity, clinic environment - compared to NGO and private health services, but rated them significantly better than other service providers on affordability. Pharmacies were rated on par with government providers. The study also found that younger users were less satisfied with health services than older youth.

The young people identified equity in service provision as a particularly important feature in seeking health care. Current inequalities in service provision were perceived by young people based on socio-economic status and nepotism, particularly within government services, rather than by age, gender, religion or ethnic group.

Key messages.

Health services for young people in Bangladesh should address social problems such as early marriage and motherhood, dowry and violence and harassment, as these issues are particularly pertinent to young women and have significant consequences for physical and mental health.
Services need to be provided equitably, without favouritism, with clearly established and communicated standards.
Government and/or pharmacy services should be the priority for improvement either directly or making use of the expertise in the NGO sector through improvement of referral practices.

Further information

GFATM Bangladesh

National AIDS/STD Programme (Bangladesh)

This was a collaborative study between ICDDR,B, Associates for Community and Population Research, and Population Council.

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