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Date: ..
Questionnaire Survey
On
Healthcare Inequality among the Poor in Rural Bangladesh
By
Md Fazlul Haque
Name of Respondent: .
Mobile Number: ..
House Holding Number: ..
Village:
Union/Ward:
Upazila:
Sex: Male/Female
Name
Gen
der
(M/F
)
4
5
6
7
Age
(Year/m
onth)
Educational
level
(primary/seco
ndary/interme
diate/undergra
duate/masters/
Higher)
Occupation
(Farmer/Busine
ss/Service/Profe
ssional/Daily
laborer/Housew
ife/Student/Reti
red/Unemploye
d/Unable/Other)
Annual Income
(in Taka)
M=
Tot
al
Size of family=
(Households
income)=
F=
-
2. Agricultural: ...
3. Non-agricultural: ..
Television; nos (Color/Black & White)
Mobile Phone:..
Goat: ..
Cow:
Bicycle/Rickshaw/Van/Auto-bike:
Hen/Duck: .
:Number of living rooms.
Kitchen: Yes/No
Brick-built House:
Sanitary Latrin :Yes/No
Tube-well: Yes/No
Others:
Total:
Patients profile
Name
Chronic Diseases
(NCDs):
1.Heart Attacks
2.Stroke
3.Cancer
(Brain,Breast,Col
on,Blood)
4.Diabetes
5. Arthritis (joint
pain)
6.Respiratory
7. Others
Common
Diseases:
1. Fever
2. Allergy
3. Headache
4. Asthma
5. Autism
6. Back Pain
7. Diarrhea and
Dysentery
8.Tetanus
9.Pneumonia
Age(y
ear/m
onths)
Sex
(M/F)
Length of
prevalence
(year/month
s)
Cost of
Treatment
(in Taka)
Current
recovery
condition
(recovered/impro
ved/deteriorate/id
entical)
10. Malaria
11.Skin Diseases
12.Ear and Eye
infection
13. Others ..
2. Was anyone died in your family within three years suffering from any
diseases (only unnatural or due to ailment)? Yes/No
If yes, then answer the following questions in sub-section 2.1
2.1 Causes of death in your family and relevant information
No. of
Death
Causes of Death
(Type of Diseases)
Length of
prevalence of
Disease
before Death
(year/month)
Cost of
Treatment
(in Taka)
Sex
(Male/Female
)
Tk
Tk..
Part D: Affordability of Healthcare
Sufferings
1.
2.
3.
3.2 Do your family member think that women doctor is available whenever you
need to visit? Yes/No
3.3 Do doctor always shows good behavior with your family member when they
are visited? Yes/No
If No then
3.3.1 What type of problem your family members were facing at the time of
visiting doctor? Please mention the level of satisfaction/dissatisfaction
Degree of Satisfaction/Dissatisfaction
Issue
Strongly
Satisfied
Satisfied
Neutral
Dissatisfied
a) Government
b) Private
.....
c)Community Clinic
Strongly
Dissatisfied
2. How your family members feel about the recovery rate after visiting the
doctor?
Type of Hospital/Clinic
Partially
Recovered
Identical
Mostly
Deteriorate
Deteriorate
1. Government
2. Private
3. Community Clinic
2.1 Whenever you/your family member face health problem or diseases where
are you used to go for treatment?
a) Govt. Hospital
d) Ayurveda
2.2 Why your family members choose this type of treatment? Give reasons
Choice of Treatment
from
1. Govt.
Medical/Hospital
2.PrivateMedical/Hos
pital/Clinic
3. Homeopathic
4. Ayurveda
5. Indigenous
(Kobiraj)
Reasons to choose
Cheap
est
Recover
y Rate is
High
Recovere
d Quickly
Easily
Accessibl
e/
Available
Faith
on
Motivat
ed by
others
Near
to
Hous
e
Oth
ers
.hour
Vaccinated person
Age
Sex
No.
of
Vac.
Where
Age being
Vaccinated
Why vaccinated
(govt.hos/private/C
ommunity
Clinic/other
Cos
t/Fr
ee
of
cost
1. Cholera
2. Smallpox
3. B.C.G
4. Polio
5. T.A.B.C
6.Immunization
(Children)
7.other
3.4 Do your family member know why we do the following things?
Things your family member know
Yes/No
Level of knowledge
Satisfactory
Not
satisfactory
Prevention
Level of knowledge
Satisfactory
1. Dysentery
2. Diarrhoea
3. malaria
..
Thank you for your kind cooperation!!!!
Not
satisfactory
Date:
Key Informant Interview
On
Inequality in Healthcare to the Poor People in Bangladesh: A Case Study in Rajshahi
District
By
Md Fazlul Haque
1. Do you think the poor people are mostly vulnerable in taking health care facilities?
Why they are most vulnerable?
2. Is there any inequality in health care access between rural and urban people? Yes/No
Who are most vulnerable, rural poor or urban poor? Explain why?
.
3. Which factor is more responsible for health care inequality within households between
rural and urban people? Between poor and rich? Can you please explain in detail?
..
4. Why the poor people go for homoeopathic/indigenous treatment? Is it only the reasons of
less cost or any other reasons persist? What are those reasons?
5. Do you think the development of private sector (hospital and clinic) health care business is
one of the main reasons for prolong the health care inequality? How?
..
......................
6. Is there any special reasons for the people of rural area in Rajshahi district are most
vulnerable in access to health care services? What are these reasons?
7. Do you think the poor people in rural areas are not conscious about their diseases, how to
get treatment and how to conduct with health care providers?
.
8. Would you please give your suggestions to convey to the poor people of those areas for
their better access with their existing affordability (ability) in health care services intake and
quality health care service?
9. What role can play by the elected representatives/local leaders, civil society, existing
NGOs, and social activist etc.to reduce the health care inequality of those poor people
integrated?
Role of
1.Doctor/Nurse
2.Homieo/Ayurveda/Indigenous
Doctor
3.Medical Representative
5. Local Leader
Role/Responsibility
6. Journalist
10. In your opinion, what type of policy changes in health sector by the government of
Bangladesh will be helpful to reduce the healthcare inequality of poor people in Bangladesh?
Policy on
1. Govt. Health Care Expenditure/ Budgetary
Allocation
5. Others
Your Suggestions
Thank you so much for your valuable comments and kind cooperation!!!
Date:
Name of Union:
Upazila: .
Number of Participants..
Remark:
(All information from this questionnaire will be used for research only.
For any query please contact: Md Fazlul Haque. E-mail:
niloyhaq@yahoo.com. Mobile: 01712040001)
Regional and Rural Development Planning (RRDP)
School of Environment, Resource and Development (SERD)
Asian Institute of Technology (AIT)
Thailand
September 2016
Engagement Questions:
1. What type of illness you usually face?
2. Can you afford the cost of treatment for common diseases?
3. Which type of treatment (Modern, Homeopathic, Ayurvedic, and
Indigenous) you would like to get when you are sick? Why?
Exploration Questions:
4. In your locality, are the healthcare facilities available? Are the
Hospital, Doctor, Medicine, and Dispensary sufficient and easily
available in your village/union/upazila?
5. When you get sick, is your family member/family head responsible to
get treatment? What type of problem you were facing getting treatment
from your family side and from the healthcare provider side?
6. What type of financial/economic and social barrier do you face getting
treatment?
7. Ill-health condition is a barrier to earning and leading a happy life- do
you know about that? What do you know? Please explain.
Exit Questions:
8. In your opinion, how can you get better treatment? What type of
barrier you would like to overcome in this regard? How?
..
Thank you so much for your valuable comments and kind cooperation!!!
Union at a glance
Union:
Upazila:
District: Rajshahi, Bangladesh
1. Total Population:
2. Total Household:
3. Rate of Poor Family (%):
4. Rate of Extreme Poor Family (%):
5. Literacy Rate:
6. Village Doctor (Quack):
7. Indigenous Doctor:
8. Midwife:
9. Community Clinic:
10. Community Latrine:
11. Hospital: a) govt. :.. b) private:..
12. Dispensary:
13. VGD:
14. VGF:
15. Maternal Allowance:
16. Old-aged Allowance:
17. Others:
..
N.B: Please collect the Union Map