Understanding demand and provision of eye care services among slum-dwellers in Dhaka, Bangladesh

Understanding demand and provision of eye care services among slum-dwellers in Dhaka, Bangladesh (James P Grant School of Public Health/Sightsavers)

Sightsavers utilised funding from Seeing is Believing to undertake some research as a part of its Phase IV Dhaka Urban Comprehensive Eye Care Project. This was conducted in collaboration with the J. P. Grant School of Public Health at BRAC University. The overall aim of this research is to better understand the demand and provision of eye care services in Dhaka with a specific focus on urban slum-dwelling communities.

We used a mixed method approach with three main components: i) mapping and assessing eye care facilities in Dhaka City Corporation; ii) exploring health-seeking behaviours, determinants and barriers to the uptake of eye care services among slum-dwellers; and iii) assessing their willingness to pay (WTP) for eye care services and the potential for cost recovery, taking refractive error correction and spectacles as a case study.

Our findings show a high prevalence of ocular morbidity in Dhaka’s slum population, and many slum-dwellers would benefit from accessible eye care services with nearly half of respondents (49%) self-reporting an eye problem at the time of the survey.

The demand for services however is low and constrained by both individual and community factors, including knowledge and education, direct and indirect costs of services and prioritization of treatment in the light of other competing needs.

We identified a total of 715 facilities providing eye care services in Dhaka City Corporation. The vast majority of these facilities were operating as private-for-profit (96%), with a small proportion of private non-for-profit (3%), and public facilities (1%). Although issues on the supply side in Dhaka may be less problematic than in rural areas of Bangladesh, the unequal distribution of services and the high number of private-for-profit providers may have an impact on access to eye care services for the poorest or most vulnerable populations by increasing the distance and costs to access these services.

It is also clear that the lack of awareness and low priority given to eye care are important factors influencing health seeking behaviour of slum-dwellers. More emphasis should be given to awareness or marketing campaigns and changing behaviour/attitudes in order to increase service uptake.

Our study on WTP shows a potential for cost recovery and/or using a market-based approach in providing spectacles to slum-dwellers. Respondents were willing to pay BDT 597 (USD 7.58) on average for spectacles, although this amount varies depending on respondent characteristics.

We find that slum-dwellers in Dhaka are not necessarily the poorest individuals when compared to the rest of the population of Bangladesh. However, our study also shows that slum-dwellers are not a homogeneous community and mechanisms for identifying the poorest individuals and enabling them to access eye care services remains crucial.

The WTP approach adopted in this study proved to be a useful tool to accurately estimate communities WTP for a health commodity; despite certain reservations in the literature about the use of such approach in lower socio-economic groups. We recommend replicating and enhancing this approach in other studies looking at health seeking behaviour and demand for eye care services. This research contributes to the evidence base needed to design future policy and programmes to increase the uptake of eye care services by urban slum-dwellers, particularly the poorest among them.

To read the full research article, please click here.

Thomas Engels

Health Economist, Sightsavers