Q&A with Dr. Taufique Joarder, adjunct assistant professor, Health Systems Program

Dr Taufique Joarder completed his Doctorate in Public Health (DrPH) degree from the Department of International Health at Johns Hopkins Bloomberg School of Public Health (JHSPH) in 2015. He is now an adjunct assistant professor with the Health Systems Program, based in Bangladesh, where he is also serving as an assistant professor at BRAC James P Grant School of Public Health, BRAC University. Three of the articles based on his doctoral thesis have been published recently in Health Policy and Planning, BMC Health Services Research and PLoS ONE. Dr. Joarder discusses his work and the impact of his research in rural Bangladesh below:

1. What was the specific topic of your thesis while you were a student in the Health Systems Program?

The overall goal of my thesis was to understand the elements of responsiveness of physicians in rural Bangladeshi context, to develop a reliable and valid scale to measure the responsiveness of physicians, and finally, to demonstrate the application of the scale. The title of my thesis was ‘Understanding and measuring the responsiveness of human resources for health in rural Bangladesh.’

2. What qualities define ideal responsiveness in physicians, and why is this important in the context of rural Bangladesh?

In my study context, the responsiveness of physicians is defined in terms of five domains: friendliness, respecting, informing and guiding, gaining trust and financial sensitivity. As the name of the domains suggests, an ideally responsive rural Bangladeshi physician should communicate with the patients in a friendly manner; explicitly show respect to the patients; empower them by providing information and guidance; gain the trust of the patients, or refrain from doing something that may breach trust; and understand the financial need of the patients and provide support if needed, even if it requires going beyond the consultation.

Responsiveness of physicians is important in general because it improves the trust of patients in the physicians. Lack of responsiveness may dissuade marginalized groups of patients, such as the elderly, chronic care patients, expectant and new mothers, and the LGBT community from care-seeking.

Responsiveness of physicians is particularly important in the Bangladeshi context, as we have observed a massive rise of incidents of assaulting the physicians physically and vandalizing the health facilities by patients, alleging the physicians to be discourteous or unresponsive. As a response, the physicians also frequently hold strikes and refuse to provide care. These unexpected events eventually compromise the health and wellbeing of many innocent, helpless and mostly poor patients, often leading to their death.

3. What methods did you use to compare private vs. public sector responsiveness?

I used both quantitative and qualitative methods: the qualitative part included in-depth interviews with public and private sector physicians and patients; focus group discussion with male and female patients; and observation in the consultation rooms of public and private sector physicians. The qualitative part was followed by the quantitative part, which included structured observation of actual consultations in 195 public sector settings and 198 private.

4. Your study found that each sector needed improvements in order to reach optimal performance. What can each sector do better to improve their respective areas of weakness?

In the public sector, we found that physicians scored lower in friendliness, respecting, and informing and guiding domains. We also found that public sector physicians consulted a higher number of patients and spent less time per patient compared to their private sector counterparts. So, in order to improve their performance, the policy-makers may consider restricting the number of patients a physician can consult per day. There should be a minimum average consultation length made mandatory for the physicians. Engaging auxiliary service providers, such as nurses and paramedics, can also reduce the burden of the physicians and help them serve the patients with increased responsiveness.

In the private sector, we found that physicians scored lower in gaining trust and financial sensitivity domains. We believe that developing and implementing a strong regulatory mechanism is the way to go for the private sector. Secondly, at present in Bangladesh, there is no mediatory body, which may listen to the grievances of the patients and resolve their complaints. Such a body is very essential.

5. What implications does this study have for human resources for health and health service delivery in low-income settings?

This study found a deficiency of overall responsiveness of physicians; it also explored the situation of responsiveness categorized into five domains. This domain-specific understanding of responsiveness of Bangladeshi rural physicians can help the policy-makers to develop a more nuanced and targeted intervention to handle the problem. For example, in areas or sectors where friendliness, respecting, and informing and guiding domains are suffering, provision of training for the service providers (both during the medical education period and in-service), coupled with improved health systems support may be helpful. In improving the trust of the patients in the physicians, better regulatory and mediatory mechanism should be implemented.

The implications of this study are not limited to the policy-makers. Informed by the domain-specific findings of responsiveness, physicians themselves can strive for improving their own consultation practices and managers can guide their employees to improve their conduct with their clients and aim for better satisfaction. Also, the teachers of medical education institutions can derive the context-specific examples from this study and guide their students to become more responsive physicians.

Read more about Dr. Joarder and his work in his faculty profile. His research was conducted from August 2014 – January 2015. Other Program faculty involved in this research include Dr. David Peters, chair of the Department of International Health, and Dr. Krishna Rao.