Implementation Effect of a Pilot Urban Primary Health Care Model on the Usage of Health Care From Medically Trained Providers for Chronic Diseases Among Slum Populations in Bangladesh: Findings From an Implementation Research Study.

backgroundEnsuring affordable and quality primary health care for urban populations remains a persistent challenge in resource-constrained countries such as Bangladesh. The country's fragmented and pluralistic urban health system exacerbates these challenges, making it particularly difficult to deliver primary health care to urban residents. In Bangladesh, the Aalo Clinic has been piloted to provide essential health services to low-income urban residents, including slum dwellers.

objectiveThis study aimed to assess how this model affects health care-seeking behavior from medically trained providers (MTPs) for managing chronic diseases.

methodsWe conducted implementation research from October 2021 to August 2023 using a cross-sectional study design. To assess the effectiveness of the Aalo Clinic model, the baseline survey was conducted from January to February 2022, and the end-line surveys were carried out from April to June 2023 in the Korail, Mirpur, Shyampur, Dhalpur, and Tongi-Ershadnagar slums, which are adjacent to the clinics. In the baseline survey, we randomly selected 2000 households (with 9196 members), while 2033 households (with 8223 members) were interviewed in the end-line survey. We considered 8919 individuals in the baseline and 7994 individuals in the end-line, all aged 1 year or older. We used descriptive analysis and chi-squared tests to assess changes in health care usage from MTPs and applied logistic regression models to assess the model's influence on health care usage from MTPs while controlling for other factors.

resultsAmong slum dwellers, awareness of Aalo Clinic increased by approximately 62 percentage points, from 11.46% (n=227) at baseline to 73.36% (n=1473) at end-line. The usage of health care for the management of chronic diseases from Aalo Clinics' MTPs was significantly higher at the end-line period (n=63, 11.13%) compared to the baseline period (n=6, 0.59%). Regression analysis indicated that slum dwellers were approximately 23 times more likely (95% CI 8.77-61.80) to use health care from Aalo Clinic for chronic diseases in the end-line period compared to the baseline. However, there was no substantial change in health care usage from non-MTPs, which remained stable at around 38% (baseline: n=388; end-line: n=218) in both periods, and local drug stores continue to be the primary source for managing chronic diseases.

conclusionsUsage of Aalo Clinic MTPs for chronic disease care increased substantially compared to other MTPs among slum dwellers. However, reliance on non-MTPs, particularly local drug stores, remained stable. Ensuring the availability of essential medicines may further reduce dependence on non-MTPs among low-income urban slum residents. Future longitudinal studies are needed to evaluate the long-term impact on chronic disease management in Bangladesh.