FHF Bangladesh – Research & how it helped planning & delivery

Figure 1 – Overview of process for patient health seeking through pharmacies

Figure 1 – Overview of process for patient health seeking through pharmacies

At the halfway mark of implementation, the Seeing is Believing Project in Barisal has achieved several milestones and has successfully enlarged the access to eye healthcare for marginalized populations in Barisal division, particularly women. In the last six months, gender action has been a priority of the project, with several actions undertaken to make eye care more accessible for women.

According to our Knowledge, Attitude and Practices (KAP) study findings, the primary point of contact for health needs among women is not a certified doctor, but a local pharmacy or drug store, where the pharmacist or shopkeeper often suggest medicines directly without any diagnosis, rather than referring them to certified health providers. In order to tap into this health seeking behaviour and ensure appropriate referral, The Fred Hollows Foundation worked to provide primary eye care orientation to 450 pharmacists across Barisal division.

Through this orientation, we included the pharmacists as part of the referral system and trained and motivated them through the follow up program to encourage referral of patients to nearby hospitals, which have been equipped and renovated by The Foundation to provide quality eye care, including cataract surgeries. In a period of just four months, 1,646 patients have been referred by these pharmacies to authorized health providers.

Eye care in both public and private facilities has been made more accessible and convenient through gender friendly renovations and gender sensitization of hospital staff and data entry operators. Infant nursing corners have been established and renovated in partner hospitals, which are used by new mothers to nurse their children and also by elderly women to rest. Having such an area available assists in making eye health service visits more convenient and comfortable. Hospital staff have been provided gender sensitivity orientation so that they address the gender specific needs with more care. At the end of the year, data entry operators were provided with special training on gender sensitivity. As the data entry operators are generally the only staff present inside the OPD (other than doctors), their contribution to make the services more gender equitable will be important and we expect that this training will bring about a positive change in the OPD environment.

Through previous monitoring reports, a number of patients had post cataract surgery complications due to not following the post- operative instructions properly as a result of ignorance and religious practices. Many put water in their eyes, despite being prescribed to the contrary, due to religious pressure from family members, to perform ablution. To address this problem, The Fred Hollows Foundation has implemented a patient communication plan that aimed to ensure multiple opportunities for engagement with patients and their relatives as well as utilising visual aid items to ensure that the instructions were easy to understand and follow. The patient communication plan incorporated the following:

1. A video explaining the post-operative Do’s and Don’ts shown to the patient and relatives.
2. Message boards installed in post-operative rooms and waiting spaces for relatives.
3. Printed leaflets to be distributed among patients and their relatives.
4. Personal counselling by doctors and nurses to the patients and relatives

Positive results have already been seen as a result of this intervention, with patients now following the post-operative instructions more consistently and fewer cases of complications being seen.

Ridwan Mosharraf Hossain
Project Officer, The Fred Hollows Foundation Bangladesh
[email protected]