Influence of a pilot urban primary healthcare model on the use of medically trained healthcare providers among the low-income slum populations in Bangladesh: findings from an implementation research study.

Abstract

Background: Delivering quality primary healthcare to the urban population has been challenging in many developing countries including Bangladesh. With a fragmented and pluralistic urban health system, the country experiences major hurdles in the provision of primary healthcare to its urban dwellers. Since 2021, an urban primary healthcare model called 'Aalo Clinic' is being piloted to serve the low-income urban population in Bangladesh. With an aim to ensure universal health coverage for the urban population, the model delivers an essential package of health services. We aimed to assess the implementation effect of this pilot model on the utilization of healthcare from medically trained providers (MTPs) for the management of acute illness.

Methods: Following a cross-sectional study design, an implementation research study was conducted between October 2021 and August 2023 in the Korail, Mirpur, Shyampur, Dhalpur, and Tongi-Ershadnagar slums. Cross-sectional household surveys were conducted at baseline and end-line, involving over 2000 households in each round. Descriptive analysis and Chi-squared test were performed to assess the changes in healthcare utilization from MTPs, and logistic regression models were applied to assess the effectiveness of the model on healthcare utilization from MTPs while controlling for other covariates.

Results: The utilization of healthcare from MTPs was significantly higher in the end-line (9.81% from Aalo Clinic and 18.6% from non-Aalo Clinic MTPs) compared to the baseline (0.64% from Aalo Clinic and 17.68% from non-Aalo Clinic MTPs). Healthcare utilization from local drug stores declined from 80.56% at baseline to 67.19% at end-line. Multivariate logistic regression showed respondents were 12.43 times more likely (95% CI: 7.49-20.63) to use Aalo Clinic services at end-line, indicating increased uptake of medically trained providers following the model's implementation.

Conclusions: The Aalo Clinic Model was effective in influencing healthcare-seeking pattern of the slum populations and enhancing the utilization of qualified care from MTPs. The study supports replicating the model within existing healthcare structures and scaling it nationwide to advance universal health coverage in urban Bangladesh, contingent on sustained government funding for its operations.