Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine Bangladesh
Abstract Background Hard-to-reach riverine communities of northern Bangladesh face unique challenges in healthcare services. Friendship, an international social purpose organization, implemented a 3-tier healthcare model addressing these unique challenges over the past 20 years. This study evaluated...
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| Format: | Article |
| Language: | English |
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BMC
2025-04-01
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| Series: | Archives of Public Health |
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| Online Access: | https://doi.org/10.1186/s13690-025-01592-6 |
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| author | Md Refat Uz Zaman Sajib Kamrul Hasan Tanvir Hayder A M Rumayan Hasan Md. Musfikur Rahman Saraban Ether Atia Rahman Tania Sultana Tanwi Fariya Rahman Abu Sayeed Sanwarul Bari Syed Moshfiqur Rahman Shams El Arifeen Anisuddin Ahmed |
| author_facet | Md Refat Uz Zaman Sajib Kamrul Hasan Tanvir Hayder A M Rumayan Hasan Md. Musfikur Rahman Saraban Ether Atia Rahman Tania Sultana Tanwi Fariya Rahman Abu Sayeed Sanwarul Bari Syed Moshfiqur Rahman Shams El Arifeen Anisuddin Ahmed |
| author_sort | Md Refat Uz Zaman Sajib |
| collection | DOAJ |
| description | Abstract Background Hard-to-reach riverine communities of northern Bangladesh face unique challenges in healthcare services. Friendship, an international social purpose organization, implemented a 3-tier healthcare model addressing these unique challenges over the past 20 years. This study evaluated Friendship’s 3-tier healthcare model in the northern riverine area, assessing service-seeking practices, experiences, stakeholders’ perceptions, and cost benefits for beneficiaries. Methods A concurrent mixed-method approach was employed, including desk reviews, a cross-sectional quantitative survey, facility mapping, and qualitative interviews with service recipients, community representatives, healthcare providers, and health managers. Data were collected from five hard-to-reach riverine sub-districts across the Kurigram, Gaibandha, Bogura, Sirajganj, and Jamalpur districts of Bangladesh between April 2022 and July 2023. Data analysis followed major thematic domains for a comprehensive and complementary understanding. Results A significant proportion (43.0%) of survey participants had no formal education, were aged 18–35 (57.5%), and earned less than 1,620 USD yearly (66.6%). Friendship’s healthcare services at the doorstep through satellite clinics and Female Community Medic Aides were widely accepted and preferred within the community for convenience, affordability (0.05–0.09 USD service charges), and superior quality, particularly the specialized treatments available on the hospital ships. Conclusion Friendship’s 3-tier healthcare model made the accessibility and affordability of primary healthcare. Upon implementing a robust referral mechanism, continuing collaboration with the Government of Bangladesh, and expanding community awareness sessions to include topics such as mental health and disaster response, this model has the potential to be effective in similar settings in Bangladesh and other developing countries, as well as during emergency responses. |
| format | Article |
| id | doaj-art-ea8ea57bb15c4674801e7d41b4dae0ad |
| institution | OA Journals |
| issn | 2049-3258 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Archives of Public Health |
| spelling | doaj-art-ea8ea57bb15c4674801e7d41b4dae0ad2025-08-20T02:17:46ZengBMCArchives of Public Health2049-32582025-04-0183111310.1186/s13690-025-01592-6Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine BangladeshMd Refat Uz Zaman Sajib0Kamrul Hasan1Tanvir Hayder2A M Rumayan Hasan3Md. Musfikur Rahman4Saraban Ether5Atia Rahman6Tania Sultana Tanwi7Fariya Rahman8Abu Sayeed9Sanwarul Bari10Syed Moshfiqur Rahman11Shams El Arifeen12Anisuddin Ahmed13Department of Health and Kinesiology, University of Illinois Urbana- ChampaignMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchStrathclyde Law School, University of StrathclydeDalhousie UniversityMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchGlobal Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala UniversityMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchMaternal and Child Health Division, International Centre for Diarrhoeal Disease ResearchAbstract Background Hard-to-reach riverine communities of northern Bangladesh face unique challenges in healthcare services. Friendship, an international social purpose organization, implemented a 3-tier healthcare model addressing these unique challenges over the past 20 years. This study evaluated Friendship’s 3-tier healthcare model in the northern riverine area, assessing service-seeking practices, experiences, stakeholders’ perceptions, and cost benefits for beneficiaries. Methods A concurrent mixed-method approach was employed, including desk reviews, a cross-sectional quantitative survey, facility mapping, and qualitative interviews with service recipients, community representatives, healthcare providers, and health managers. Data were collected from five hard-to-reach riverine sub-districts across the Kurigram, Gaibandha, Bogura, Sirajganj, and Jamalpur districts of Bangladesh between April 2022 and July 2023. Data analysis followed major thematic domains for a comprehensive and complementary understanding. Results A significant proportion (43.0%) of survey participants had no formal education, were aged 18–35 (57.5%), and earned less than 1,620 USD yearly (66.6%). Friendship’s healthcare services at the doorstep through satellite clinics and Female Community Medic Aides were widely accepted and preferred within the community for convenience, affordability (0.05–0.09 USD service charges), and superior quality, particularly the specialized treatments available on the hospital ships. Conclusion Friendship’s 3-tier healthcare model made the accessibility and affordability of primary healthcare. Upon implementing a robust referral mechanism, continuing collaboration with the Government of Bangladesh, and expanding community awareness sessions to include topics such as mental health and disaster response, this model has the potential to be effective in similar settings in Bangladesh and other developing countries, as well as during emergency responses.https://doi.org/10.1186/s13690-025-01592-63-tier healthcare modelComprehensive healthcare modelHard-to-reachRiverine low-resource settingBangladesh |
| spellingShingle | Md Refat Uz Zaman Sajib Kamrul Hasan Tanvir Hayder A M Rumayan Hasan Md. Musfikur Rahman Saraban Ether Atia Rahman Tania Sultana Tanwi Fariya Rahman Abu Sayeed Sanwarul Bari Syed Moshfiqur Rahman Shams El Arifeen Anisuddin Ahmed Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine Bangladesh Archives of Public Health 3-tier healthcare model Comprehensive healthcare model Hard-to-reach Riverine low-resource setting Bangladesh |
| title | Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine Bangladesh |
| title_full | Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine Bangladesh |
| title_fullStr | Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine Bangladesh |
| title_full_unstemmed | Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine Bangladesh |
| title_short | Reaching the unreachable: a mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern riverine Bangladesh |
| title_sort | reaching the unreachable a mixed method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard to reach northern riverine bangladesh |
| topic | 3-tier healthcare model Comprehensive healthcare model Hard-to-reach Riverine low-resource setting Bangladesh |
| url | https://doi.org/10.1186/s13690-025-01592-6 |
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