PhD Thesis

Role of NGOs in Access to Health Care for the Slum People in Dhaka

2025-07-07T09:09:35Z

Role of NGOs in Access to Health Care for the Slum People in Dhaka Bhuiyan, Mohammad Ismail Health care services under any country's health system are a vital and phenomenal aspect and segment. Health is a basic requirement for human beings, and usually, this requirement must be fulfilled by a large organization like the government of one’s country. So, the government becomes the central, authoritarian, and automatic entity responsible for providing health care services to its people. Apart from the government, other entities like private hospitals, institutions, and NGOs play a vital role in providing health care services to everyone irrespective of race, ethnicity, community, gender/sex, rich, poor, etc. This study primarily focuses on NGOs’ role in describing and exploring access to health care services for the underserved and unprivileged people of urban slums through conducting an integrative mixed methods design. Thus, it meant both quantitative and qualitative methods were applied together to address the research questions of the study, especially taking survey samples, conducting FGDs on the greater Mirpur of three Thanas, like Pallabi, Rupnagar, and Vashantek areas of seven slums. The aforementioned areas for this research were chosen because Greater Mirpur is primarily populated and crowded with many slums. The sampling frame was formed from the target population, where every household was included and given a number. The nature of the initial survey sample or selection of households was a simple random sample, and a simple random sample was conducted through random digit numbers (RDNs). Then, males and females were chosen from every randomly selected household systematically. Data was also collected through in-depth interviews (personal interviews) from the stakeholders, doctors, executives, nurses, paramedics, and concerned people from the responsible and related NGOs working with the people of selected slums or study areas. A total number of respondents for the survey was selected, 764, but 722 were found for interviews, where males were 329 and females were 393 respondents from the slums above. 4 FGDs were carried out on the respondents from the surveyed areas and each FGD was composed of 9, 10, 10, 11 respondents at best and 40 respondents were as participants altogether in the FGD. Twenty in-depth interviews were conducted with doctors, administrators, programme managers, nurses, paramedics, and community service providers working with NGOs for the slum people. ix This research followed some relevant models or theories. The study followed the Health Belief Model, Diffusion of Innovation Theory, Andersen’s Health Services Use/Utilization Model, Parasuraman’s SERVQUAL (Service Quality) Model, and Robert Putnam’s Social Capital Theory. These models and theories helped me understand the central concepts of the research question and elicit answers. Seven hundred twenty-two respondents (95%) were found in the survey out of 764 respondents from the three Thanas of seven slums, where 54.4% of respondents were female and 45.6% of respondents were male. Age ranges (25-44) covered most respondents (57.1%). Most of the participants (92.4%) were married, and the majority (39.1%) of the respondents were part of ‘no education’, which meant illiterate. A more significant portion of the respondents (34.6%) were homemakers involved in household chores, and a vital proportion of participants (39.2%) were dependent on the income of their husbands, sons, and wives of the households. When considering visiting health care centres and using health care services, 31.7% of respondents said they visited NGOs' clinics, 30.9% visited government hospitals, and 29.6% visited nearby pharmacies. The study revealed that slum people mostly visited NGOs’ health services centres for their healthcare services. In considering NGOs’ indoor health care services, both Caesarian and regular delivery care (97.3% and 95.1%) held the first and second positions, respectively. Study revealed that the antenatal or emergency maternity health facilities, with 91.9 % and 91.1% respectively, which were considered the third most health facilities confirmed in the indoor system, and emergency neonatal and child health care, and emergency malnourished child health care facilities had 85.2% and 79.0% respectively. The hygienic programme became the highest choice (98.9%) of outdoor health care services. Health and nutrition (97.0%) ranked second among outdoor services. Both EPI and FP programmes had almost equal and close percentages of outdoor services (92.6% and 92.8%), respectively. Postnatal, adolescent, and Reproductive health had available facilities with (83.7%, 75.5%), child health care (67.8%), Diarrhoea and cholera (65.0%) services were available at outdoor systems, and these services were very common among NGOs. A qualitative study showed similar findings with more x detailed information regarding the NGOs’ health care services provided in indoor and outdoor health systems for the slum people. The study displayed that NGOs provided health care services through different systems, and 93.1% of participants received indoor and outdoor services through static clinics. Surprisingly, 92.3% of health beneficiaries acknowledged that CHWs/CSPs provided their health services from NGOs. 92% of respondents found their outdoor and doorstep health services through satellite clinics. Meanwhile, 85.2% of respondents received health care services through telehealth and telemedicine. Telehealth and telemedicine systems are rising through M-technology systems during the COVID-19 pandemic. This research denoted that NGOs provided health care services for the slum people through availability and affordability. EPI, maternal care (antenatal care, delivery care, and postnatal care services), FP programme, child health care, and health and nutrition programme. About 100% of respondents mentioned that EPI and ANC services were available, and 99% confessed that delivery care services, newborn/postnatal care, family planning, child health care, and health and nutrition care services were available and provided by NGOS. Other available health care services provided by NGOs were sanitation and hygiene services, adolescent and reproductive health services, diarrhoea and TB services. Study further observed that the community service provider (40.5%) and nearby static clinic (38.3%) were the primary regular sources of availability of health care services. For the affordability of health care services, 94.7% of respondents said that the most affordable service of the NGO was EPI immunization services. 93.0% of participants considered essential medicines the most inexpensive health items. Blood test services (89.4%), FP services (76.0%), and pregnancy strips (69.9%) were the affordable and reasonably priced services for the underserved slum people. The study disclosed that NGOs’ initiatives and grassroots approach impacted the use and access to their health care services. Such impact showed through the 11 sub variables of initiatives and the grassroots approach. The study showed that the NGOs’ initiatives (seven initiatives) and grassroots approach (doorstep services) were significantly associated with access to health care services. The study found NGOs’ initiatives and grassroots approach’s strong and significant association with affordable services (P<0.01), special health services (P< 0.000), doorstep services (P<0.05), xi engage responsible community leaders ( P<0.01), distribution of medical and medicine items (P< 0.01), Update slum dwellers with updated information ( P< 0.05), e-health technology (P< 0.00), BCC strategy (P< 0.05) were significantly associated with dependent variable access to health care services. These relations indicated that NGOs’ initiatives and grassroots approach ensured better use and access to health care services for the slum people. Qualitative findings are integrated with quantitative results, providing more comprehensive information. Based on mixed methods integrative findings, the study suggests that the government, donors, and policymakers synchronize their initiatives and grassroots-level services with the NGOs so that such initiatives and approaches, along with their services, may easily trace, reach slum people, and help them use and access health services. Quantitative findings were further examined by examining the associations and differences between the health care services of the Government and NGOs through the chi-square test of independence. These associations or differences were attempted to be shown by socio-demographic variables when receiving health services from the government and NGOs. The test indicated a significant association between the socio demographic variables and visiting or receiving the Government and NGOs' health services facilities. Especially, socio-demographic variables, sex, age, employment status, and income, had a significant association with visiting and receiving Government and NGOs health services facilities at the α=.01 level. The study displayed some vital findings based on two latent concepts, ‘BCC strategies of NGOs’ and ‘community supportive services’, by respective slum leaders. These two concepts were not included in the main study but played vital roles in using and accessing NGOs’ health care services. NGOs introduce and launch BCC strategies to carry out and implement health services in rural and urban slum areas. BCC strategies are used to curb fertility rate to prevent unwanted pregnancy, to reduce maternal and child morbidity and mortality rates, and to utilize the EPI and FP programmes with utmost effort. NGOs conducted BCC strategies in rural and urban slums through BCC materials, traditional media, and social media like Facebook, WhatsApp, interpersonal channels, communication, and community mobilization. A study conducted a multiple logistic regression model to see the association and impact of predictors (BCC strategies) on outcome (seeking health care behaviour/services). The study presented xii some BCC strategies or approaches significantly associated with the outcome variable (visiting or seeking health behaviour or services). Out of six BCC strategies or techniques, the study finds that predictors BCC materials (leaflet, sticker, and poster (P<0.00), traditional media (P< 0.05), and impersonal communications (P<0.033) were significantly associated with the dependent variable seeking health care services. However, qualitative findings disclosed more detailed information and insights on the prevalence and influence of social media on the attitude and practice of slum people regarding the use and access of NGOs’ health care services. Using Facebook, WhatsApp, and Messenger, as well as forming different groups, helped slum people interact with one another and become aware of the NGOs’ various health care facilities. The NGOs engage community supportive services ensured by the slum leaders who were to provide early information relating to health care services and create a network among the community people to share messages and information on the pandemic, viral, and seasonal health care services. Here, the study launched a logistic regression to demonstrate the relationships of predictors (community supportive services) with outcomes (use, access, and seeking NGOs’ health care services). The study endeavored to show an association of some community supportive services with using, accessing, and seeking NGOs’ health care services. Out of four community supportive services like access to early information on health services (P<0.012), community network to get access to health services (P< .000) alert pandemic and other diseases (P< .020), and convey messages to slum people for health, nutrition and hygiene awareness (P< .381) three supportive services were significantly associated with outcome using, accessing and seeking NGOs’ health care services. So, the study attempted to reveal that NGOs incessantly inspired slum leaders to persuade their slum communities to seek NGOs’ health care services. Qualitative results on community supportive services lifted quantitative findings. The survey study uncovered findings on the respondents’ perception of the health care services of NGOs. Respondents’ perception was considered and judged through the rating scale/Likert scale technique. This perception was measured based on the Quality Service Model. Respondents perception regarding the health services delivery of NGOs was measured with some quality of services like services with promptness and less waiting (Strongly agree 31.6%), services with affordability (20.2%), services with xiii strong and constant intercommunication (31.4%), listening to the health problems (25.6%), organized and clean infrastructure (30.7%), experienced and cooperative medical personnel (18.1%) and, promised and committed services (Agree 24.9%), Services provided with Reliability and Responsibility (30.2%), services with available facilities and personnel (25.8%), services with integrity and fairness (29.8%), insisting on the care of patients (29.2%), satisfactory diagnostic and logistic supports (27.1%). Respondents of slums believed, perceived, and confirmed that NGOs ensured the above-mentioned quality of services while delivering health care services to the slums. Slum people’s perception of NGOs’ health care services escalated the use and access to health care services. Most of the slum people who received NGOs’ health services were perceived and cajoled with NGOs' above-mentioned manners and attitude. The percentage believed and practiced that NGOs’ employees are different from other service providers, which propelled them to use and access NGOs’ health care services. Qualitative findings exclusively showed from the research question “what are the new areas of health care services or facilities undertaken by the NGOs for the slum people of this study. Findings revealed that the different NGOs have taken different initiatives to improve their health services and facilities. A study found that a few NGOs will partner with the government in preventive, promotional, and surveillance steps for COVID-19 vaccination. Others have already taken and will continue to take ‘Telehealth and telemedicine initiatives’ conducted for the maternal services (Antenatal, delivery, and postnatal services) during the COVID-19 and post-COVID-19. Few NGOs, especially BRAC, are intending to launch the “Vision Bangladesh Project” for the eye defective people at the district level with the government. The rest of the responsible NGOs will employ and engage CHWs/CSPs with special maternal health services training in rural and urban slums. The study demonstrated that the NGOs will provide the CHWs or CSPs with mobile phones and install various apps to form groups to update slum dwellers with health care messages and information. Some NGOs pledged to provide maternity health services with ultramodern technology and introduce multiple new diagnostic systems. This research demonstrated NGOs’ diverse roles and functions, by which they provided health care services to the underserved and unprivileged urban slum people. NGOs performed their health care services through these various roles and initiatives, and xiv healthcare services were provided to the slum people through multiple systems. The findings of this study revealed that NGOs carried out their services based on either partnership services with the government or project-based services through donors or stakeholders, and services provided to poor people through the collaboration of domestic or local stakeholders or sponsors. The study suggested and recommended more diverse and innovative roles and functions launched by the NGOs, the government, and donors to ensure more updated and modern health care service facilities for the slum people. The government should also increase and arrange more public and private partnership (PPP) projects with NGOs, or the government should engage NGOs with more projects like the UHCSDP to provide health care services to the urban slum poor. This thesis is submitted for the degree of Doctor of Philosophy.

Role of Women Empowerment in Determining Fertility in Bangladesh

2025-07-07T09:05:43Z

Role of Women Empowerment in Determining Fertility in Bangladesh Chowdhury, Shanjida Women‟s empowerment (WE) is crucial in shaping any country‟s social, economic, and demographic dynamics, particularly in developing countries such as Bangladesh. Researchers define and measure this multidimensional concept in various ways, making it challenging to evaluate using a single metric. Women‟s empowerment is a key factor influencing fertility rates, especially in countries such as Bangladesh, where gender norms often limit women‟s agency in reproductive decision-making. In Bangladesh, where traditional gender roles prevail, understanding how WE affect fertility is essential for promoting gender equality and managing population growth. This study aims to assess WE levels in various spheres, determine how these dimensions (household, economic, sociocultural, and psychological) affect fertility decisions, and investigate the influence of socio-demographic factors on fertility outcomes. A mixed-method approach was adopted to explore research questions. Quantitative data were collected using a structured questionnaire from 625 women of reproductive age groups from eight different areas of Dhaka city. Qualitative data were gathered through twenty-nine in-depth interviews (IDIs) and seven focus group discussions (FGDs) with 93 married women from urban areas. The quantitative data provided a broad understanding of WE and fertility patterns in the study area. In contrast, the qualitative data offered more profound insights into the participants‟ experiences and perceptions of the women involved. This study examines the extent of women‟s involvement in household decisions, their control over economic resources, freedom of movement, access to media and technology, views regarding gender-based violence, and psychological well-being, linking these factors to fertility preferences and behavior. Fertility outcomes were analyzed using the number of children born to the women in the study. The results show that 36.2% of ever-married women were under 30. Early marriage for women is a serious concern in Bangladesh. Still, 39.0% of respondents were married under 18 years of age. Approximately 25.0% of women give their first child under 20. v Almost 32.0% of women have completed secondary education. A countable percentage of the total respondents (15.7%) were illiterate. More than 32.0% of ever-married women have three or more children. However, 28.6% of women desired to have three or more children. Using exploratory and confirmatory factor analyses, this study created a valid and reliable four-dimensional framework for determining how empowered women are in Bangladesh. Initially, this study started with 46 indicators, and through the model fitting process, we narrowed it down to 32 indicators, which were grouped into eight factors, explaining 76.27% of the total variance. The CFA results show that our model fits well, and all factors are reliable and valid. The economic dimension has the highest value, indicating that economic empowerment is the most influential dimension in shaping the overall empowerment score. However, most participants (55.5%) in economic decision making showed moderate involvement, while 27.2% demonstrated low involvement. Another domain of economic empowerment, economic independence, is predominantly low, with 61.4% of participants indicating low autonomy. Socio-cultural empowerment can be classified into various domains, including access to media and technology, freedom of movement, and justification of violence. Access to media and technology and freedom of movement fell predominantly within the moderate category, with percentages of 52.2% and 67.0%, respectively. A higher percentage (81.4%) supported the notion of no violence. Self-esteem and self-efficacy under psychological empowerment fell under a moderate level. However, psychological empowerment exhibits the second most influential dimension in shaping the overall empowerment score. Qualitative findings of this study identified that economic empowerment enhances women's bargaining power and decision-making capabilities. Findings also unveiled that empowered women exhibit greater self-confidence and independence in expressing opinions and making decisions in both household and societal settings. Results of the bivariate analysis revealed a significant association between the number of children ever born (CEB) and WE and different explanatory variables such as the age of respondents, age at first birth, women‟s educational attainment, women‟s employment status, wealth index, the experience of domestic violence, husband‟s fertility preference, vi and contraceptive use. To investigate the role of WE on the total number of CEB, binary logistic regression models were fitted, and the odds of two or less vs. more than two were estimated. The current study employs four models to assess these relationships more rigorously. Model I showed that women with high empowerment in economic, household, socio-cultural, and psychological domains had significantly lower odds of having more than two children. When considering overall empowerment in Model II, women with high overall empowerment had 97.8% lower odds (OR = 0.022, CI: 0.010 0.045) of having more than two children. When socio-demographic variables are added to Model III, the odds ratios for economic empowerment (aOR=0.199, CI: 0.070–0.566) and household empowerment (aOR=0.092, CI: 0.017–0.474) become lower than Model I. In Model IV, overall empowerment levels often weaken after adding socio-demographic variables. This suggests that socio-demographic variables, such as age, education, and wealth, have an explanatory role in the relationship between empowerment and CEB. Some domain-specific aORs drop significantly, indicating that socio-demographics explain part of the variation seen in CEB. However, the binary logistic regression model results revealed that women with higher empowerment were more likely to have two or fewer children. As WE increase, the odds of having more than two children decrease. In addition to WE, socio-economic and demographic factors are crucial in shaping fertility outcomes. Age and education significantly influence fertility outcomes. Wealth index, type of family, sex preference, and contraceptive use also affect fertility. The qualitative findings identified significant sociocultural barriers, including family pressure, sex preference, and misconceptions about contraceptives that hinder women's empowerment toward fertility decisions. The prevalent preference for sons still impacts the number of CEB. The study found that an increase in WE was linked to a reduction in CEB. Other predictors of CEB were the respondent‟s age, age at birth, women's educational attainment, wealth index, and contraceptive use, which were all identified as factors associated with a lower number of children. Conversely, women who experienced domestic violence, whose husbands desired more children, and who had sex preferences were more likely to have more children. This study contributes to the growing literature vii on WE in developing countries. Policymakers should focus on the dimension-specific and overall WE level in reducing CEB. Furthermore, this study recommends enhancing WE and its role in the number of CEBs. The findings indicate that fostering empowerment within households is crucial for addressing challenges related to population growth and improving gender equality. This thesis is submitted for the degree of Doctor of Philosophy.

Women’s rights in Hindu law: Reality and challenges in the context of Bangladesh

2019-12-04T08:14:16Z

Women’s rights in Hindu law: Reality and challenges in the context of Bangladesh Akter, Salena This thesis submitted to the department of political science, University of Dhaka in fulfillment of the requirements for the degree of Doctor of Philosophy.

Bangladeshi origin people living in the United kingdom: perceptions towards Bangladesh in terms of visits, remittances and investment

2019-12-04T08:13:01Z

Bangladeshi origin people living in the United kingdom: perceptions towards Bangladesh in terms of visits, remittances and investment Islam, Md. Aminul The purpose of this study is to know the perceptions of Bangladeshi origin people living in the United Kingdom permanently towards Bangladesh in terms of visits, remittances and investment along with their future plan for keeping connection with Bangladesh. The economy of Bangladesh mainly depends on agriculture, remittances of worker working abroad and exportations of various goods like tea, jute and jute made handicrafts, sea food, ready-made garments etc. The reserve of foreign currency in the country is highly dependent on remittances of Bangladeshi emigrants working in different countries which also alleviate poverty in the country as well. The foreign currency reserve is crucially important for balance of payments for international trade in the country. The export sector alone is not sufficient for the expected reserve of foreign currency of the country but in fact, the major part of foreign currency is presently coming from the export sector only. The poverty in the country is growing very fast resulting in high growth rate in unemployment. At the household level, remittance eliminates poverty through reducing high growth rate of unemployment. The remittance is highly needed for a sustainable economy in Bangladesh for alleviation of poverty and to increase the volume of foreign currency reserve. The amount of remittances from different countries to Bangladesh more or less is appreciable but the remittance from the UK is much less than the expectation. Because the Bangladeshi origin people living in the UK are loosing interest to Bangladesh generation by generation which is natural phenomena, many of them are shifting to other different countries for economic recession in the UK. Given the prevailing conditions, there is an urgent need to increase the volume of remittances coming from the UK for economic emancipation of the country. With a view to increasing the volume of remittances from Bangladeshi emigrants working in different countries the government of Bangladesh has formulated and undertaken some favorable policies and programs for emigrants especially for the business and banking sectors. But the expected target of receiving remittances from Bangladeshi emigrants in the UK is yet to be achieved. The study discusses the background of the Bangladeshi origin people living in the UK permanently. Following that, the study elaborately presents the causes of low frequency of visits, low volume of remittances and low trend in investment in Bangladesh along with the present and future plan for relationship between Bangladeshi origin people living in the UK and Bangladesh. The core issues that have been covered are: (i) historical perspectives of reasons and process of migration of Bangladeshi people to the UK along with their facts & figures (ii) the obstacles that hinder frequent visits to Bangladesh (iii) the underlying causes of receiving low remittances and low trend in investment and (iv) their plan for future connection with Bangladesh. From the study it was found that the overall perceptions of the Bangladeshi people living in the UK especially towards people’s behavior, hospitality etc in Bangladesh deserve to be appreciated. However, the interaction between Bangladeshi origin people in the UK and Bangladesh are deteriorating generation to generation which primarily originates from demographic background, staying in different society for long period and very minimum level of social connection with Bangladesh. Furthermore, the study has found that there have been sufficient positive views among the Bangladeshi origin people in the UK towards Bangladesh. It has been clear that to receive the expected amount of remittances from the Bangladeshi origin people in the UK to Bangladesh needs close interaction with them. Frequent interaction can be established through ensured safe and secured visiting environment in Bangladesh for them that will certainly up-grade volume of investment by them simultaneously. The study found that Bangladeshi origin people in the UK are willing to keeping good connection with Bangladesh in future. It is recommended that the government of Bangladesh should understand the concerns of Bangladeshi people living in the UK towards Bangladesh. The concerns of the people could be intervened through taking initiatives by the second generation living in the UK and by the NGOs, government and semi-government organizations in Bangladesh. The findings of our study suggest that the mutual beneficial relationships can be established for long through undertaking persistent policies to be implemented by the government of Bangladesh.