Study Area

3.2.1 Limited Resource Area

‘Limited Resource’ refers to the inadequate resources or resource scarcity or resource constraint means that the quantities of productive resources available to the economy are finite. For example, developing countries reportedly lacks of resources, which has led to failure in the access to public services including education and healthcare services (Fuglsang, 2010). Resources are the tangible and intangible assets that firms use to develop and implement their strategies which is particularly important for new services development (Ray et al., 2004; Witell et al., 2017).

Providing better healthcare services are depending on the availability of resources such as physicians, nurses and hospital bed. Physicians are the heart of the health service delivery system in any country. Nonetheless, the severe shortage of physicians in developing countries have been neglected over the decade. The density of physicians and hospital bed per population are much lower in developing countries than the developed countries. For example, the number of physician per 1000 population in African region is 0.21 where Americas 1.94, Eastern Mediterranean 0.74, Europe 3.2, Southeast Asia 0.52 and in the Western Pacific 1.1. The global average is 1.23 per 1000 population. The number of physicians per 1000 population in Bangladesh is 0.389, three times lower than the global average which is indicating the ‘limited human resource’ in the health sector in Bangladesh. Therefore, the development of human resource for health need to be upgraded in the health sector in Bangladesh.

At the national level, developing countries are account for 90% of the global burden of disease where they can spend only 12% global spending on health. The average health expenditure per capita in developing countries is about $30. On the other hand, developed countries spend about 100 times more than on health per capita than developing countries. The average health expenditure per capita in developed countries is about $3039. Health expenditure per capita in Bangladesh was $30.83, hundred times

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lower than the global average which is indicating the ‘limited financial resource’ in the health sector in Bangladesh. Therefore, the development of human resource for health need to be upgraded in the health sector in Bangladesh.

‘Limited Resource’ areas are often indicating the areas or countries where peoples are living under poverty, are called Base of the Pyramid (BoP) market. Recently, there has been growing research interest on BoP market. The concept of BoP refers to the large group of populations who live on less than $2.50 a day, unserved or underserved, and often ignored and lack access to many goods and services (Linna, 2013; London, 2008; Prahalad, 2006). Healthcare services are one of them that they are often failing to access healthcare services due to lack of resources including shortage of human resource for health, lack of healthcare knowledge among healthcare service providers and recipients, and lack of healthcare infrastructures in rural and slum areas.

The cases where we focused on ‘limited resources’ are fitted the definition above mentioned. Service research from limited resource perspective is very close to my research. The present research is a case study conducted in a limited resource area.

3.2.2 Selection Criteria of Study Area

Mymensingh, Fulbaria and Bhaluka sub-districts of Mymensingh district in Bangladesh are selected as the study area. The study area selection is based on several criteria including the number of households, number of populations and the number of human resource for health. The number of household and the number of populations is taken from the demographic survey conducted by Bangladesh Bureau of Statistics (BBS) in 2011, and the number of human resource for health is taken from the live data of the directorate general of health services (DGHS), Bangladesh. According to ‘District statistics 2011 Mymensingh’ conducted by BBS, the top three sub-districts in terms of households and populations are Mymensingh, Bhaluka and Fulbaria as shown in the table 3-1. The number of household and the number of population of Phulpur and Tarakanda sub-district projected together since it was a single administrative area. Recently it has divided into two separate administrative areas, but the data is not separated yet. Therefore,

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in terms of the number of household, Mymensingh, Bhaluka and Fulbaria are the top ranked sub-district in the Mymensingh district.

Table 3-1 Demographic and healthcare workforce statistics in grater Mymensingh District.

After the independence of Bangladesh in 1971, many of jobless peoples from across the country came to big cities for seeking jobs. According to slum census 2014 conducted by Bangladesh Bureau of Statistics, (2015, p. 3), “Many of these people were jobless, capital-less, homeless and had no other alternative other than to live in the slum areas”. These big cities where slum people increases day by day are including, Dhaka, Chittagong, Rajshahi, Khulna, Rangpur and Sylhet. According to slum census 2014, in terms of households and populations, Dhaka city is the top ranked slum area in Bangladesh shown in the table 3-2.

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Table 3-2 Demographic statistics of major slum areas in Bangladesh.

Source: Census of slum areas and floating population 2014, Bangladesh Bureau of Statistics, 2015.

Another criterion is the key components of a well-functioning health system such as human resource for health (the number of physicians, number of community healthcare providers, and the number of midwives) and service delivery networks (the number of health facilities) (2010). With many other key components, human resource for health are the central key component to achieve and improve the health status of individual, families and communities. To achieve these goals, well managed healthcare service facilities are needed. Therefore, human resource for health and service delivery facilities are important for the development of well-functioning healthcare system.

Inadequate human resource for health and service facilities are common problems in developing countries. Bangladesh has no exceptions in this regard. Human resource for health and healthcare service facilities in selected study areas are not indicating the least number compared to other sub-districts of Mymensingh. But the number of human resource for health in rural areas are lower than the urban areas, and in slum areas are lower than the urban areas is well researched. Therefore, three sub-districts and urban slum areas are selected based on the number of households, populations and the number of populations getting healthcare services by per physician. After ranking and comparing, Mymensingh, Fulbaria and Bhaluka are the top ranked sub-districts in rural

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areas and Dhaka is the top ranked area for slum residence that has potential to represent the current healthcare situation in rural and urban slum areas of Bangladesh.

3.2.3 Reason to Focus on ‘Knowledge’

Knowledge has been recognized as a unique source and key elements of sustainable economic development and improvement of human well-being (Nonaka and Takeuchi, 1995; World Bank, 1998) over the last decade. However, in most of developing countries, the unequal distribution of healthcare knowledge, which leads to unequal economic growth and health well-being (World Health Organization, 2004). To improve the situation of poor healthcare knowledge distribution, its services system should be considered to understand significantly what knowledge, how and who are providing to customers in a pluralistic environment.

3.2.4 Knowledge vs Education

Education is one of the best way to transfer knowledge from one entity to another.

Government and non-government organizations (NGOs) have taken several initiatives to transfer healthcare knowledge in Bangladesh. The transfer of healthcare knowledge through mass media, health campaigns, the use of community health educator, and routine counselling services at the healthcare service facilities. Many of such transfer process were improperly designed to reach the unserved and underserved peoples living in rural areas of Bangladesh. While the traditional way of healthcare knowledge transfer process was unable to aware rural residence, the SSs model for healthcare knowledge transfer succeeded. SSs are responsible for visiting households, holding group meeting with community peoples, provide skill training, basic literacy and basic healthcare services. In addition, SSs are holding meeting with community peoples targeting an issue relevant to community people’s problem and issues, such as; violence against women, human rights,

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family planning, water and sanitation, immunization, training on nutrition and basic curative services (Hadi, 2001). All of these support services can be seen as education on healthcare issues which aimed to raise awareness about health and healthcare among community peoples through knowledge transfer.