Bangladesh

Initial costs
Health care is not free in Bangladesh. The initial consultation with a doctor ranges from 500 to 1000 Takas, then there is the further cost of medication. Since the average monthly income is about 3000 Takas, many cannot afford to consult a doctor. There is the added problem that there are not enough doctors for the population size. Approximately 80 million people have no access to modern health services other than immunisation and family planning. One impact of this is that Bangladesh has some of the highest rates of malnutrition and deaths of women from childbirth in the world.

Introducing BTS
One approach to address this problem is to offer rural doctors online medical centres to help them provide better healthcare for their patients. A private company called Bangladesh Telemedicine Services (BTS) has set up telemedicine centres to help doctors identify diseases early on. They have computers and a library of CD-Roms relating to medicine. The centres are also linked to a network of 200 specialists in Dhaka, who will be able to offer advice. It is hoped that the project will be self-funding in that diseases will be caught and treated much sooner, thereby saving money in expensive treatment later on.

Limited interest?
Whilst doctors say that in theory they are interested in the project, local doctors have so far proved reluctant to use the first telecentre in the village of Sonagazi. Health experts suggest this may be because rural doctors are reluctant to publicly show their lack of knowledge. Others feel that there is a tendency to use their own computer rather than visiting the centre. But perhaps the biggest stumbling block to the success of the project is the fact that at present the courses and CD-Rom study is not recognised by an official certificate from the Bangladesh Medical Council.

Decreasing abortion rates
Another factor contributing to the high number of maternal deaths has been that in the past many women resorted to unsafe illegal abortions as a means of controlling their family size. However, as recent research has show, by ensuring women have access to high-quality family planning services, this can be prevented. Reliable abortion statistics are hard to verify, but in one area where the Maternal Child Health and Family Planning Project (MCH-FP) has been set up to provide health checks and education about contraception, abortions have dropped to about a third of those in other areas.