Background:
In almost every major urban city, thousands of people live in overcrowded slums, streets, orother public places without any health services. Bangladesh has experienced one of thehighest rates of urban population growth in the last three decades compared to the nationalpopulation growth rate. The numbers of the urban poor and street-dwellers are likely toincrease at least in proportion to the overall population growth of the country. The streetdwellersin Bangladesh are extremely vulnerable in terms of their health needs andhealthcare-seeking behaviours. In Bangladesh, there is no health service-delivery mechanismtargeting this marginalized group of people. This study, therefore, assessed the effectivenessof two models to provide primary healthcare (PHC) services to street-dwellers.
Methods:
This study of experimental pre-post design tested two models, such n as static clinic andsatellite clinics, for providing PHC services to street-dwellers in the evening throughparamedics in Dhaka city during May 2009-April 2010. Both quantitative and qualitativetechniques were used for collecting data. Data were analyzed comparing before and after theimplementation of the clinics for the assessment of selected health and family-planningindicators using the statistical t-test. Services received from the model l and model 2 clinicswere also compared by calculating the absolute difference to determine the relativeeffectiveness of one model over another.
Results:
The use of healthcare services by the street-dwellers increased at endline compared tobaseline in both the model clinic areas, and the difference was highly significant (p < 0.001).Institutional delivery among the female street-dwellers increased at endline compared tobaseline in both the clinic areas. The use of family-planning methods among females alsosignificantly (p < 0.001) increased at endline compared to baseline in both the areas.
Conclusions:
As the findings of the study showed the promise of this approach, the strategies could beimplemented in all other cities of Bangladesh and in other countries which encounter similarproblems.