JAHANGIRNAGAR UNIVERSITY

A Research Proposal on
“Perceptionsof the Citizens Towards
Government Hospital Services in Bangladesh”

Course Name: Marketing Research

Course Code : MKT- 410

Submitted To: Dr. Tamgid Ahmed Chowdhury

Guest Faculty
Department of Marketing
Faculty of Business Studies
Jahangirnagar University

Submitted By: “Spectra”

3rd Batch
4th Year, 2nd Semester
Department of Marketing
Faculty of Business Studies
Jahangirnagar University

Date of Submission: 24th December, 2015

 GROUP PROFILE

Group Name: “Spectra”

Course Name: Marketing Research
Course Code: MKT- 410
Topic:Perception of the citizens towards government hospital services
in Bangladesh.

ID Name

1391 Jahidul Islam

1392 Md. Ruhul Amin
2290 Rokeya Tamanna Laizu
2291 Nusrat Jahan Priti

2294 Zannat-E-Hium

2295 Nandita Rani Saha Nitu

2299 Md. Ashraful Alam
Introduction:
This research attempts to explore the perceptions of general people with public health care
services, understanding their expectation and demands of health care towards Government
hospitals. The public health service delivery network has been operated through three tiers:
primary care at Upazilla (sub- district) level, secondary care at district level and tertiary care
at divisional level. However, in recent times, the Government of Bangladesh (GOB) has
taken broader initiatives to deliver primary health care at the door step of grass root people
through establishing Community Health Clinic (CHC) at the village level and Union Health
and Family Welfare Centre (UHFWC) at the union level; specialized postgraduate hospitals
are available only at the divisional level. It is shown that in 2006, the total number of
hospitals in Bangladesh was 1685; among those hospitals 678 were governmental hospitals
and 1005 were non-government hospital (cited in Rahman et al. 2005). Despite such progress,
the health and population sector has been characterized as poorly coordinated and inefficient
delivery of health care services. A major government report, Bangladesh: Unlocking the
Potential (2005) recognized that public health services have been rated the lowest among all
types of service providers in term of user’s satisfaction. In spite of all of these government
initiatives there may be some underlying problem which should be addressed properly.

Objectives:
The general aim of the study is to know the patient’s satisfaction over different health care
services provided by government hospitals and health centers. Therefore the specific
objectives are:

 to explore clients self-perception of health, understand expectation and demands of

health care towards government health practitioners and service providers;
 To know their experiences of getting health care services provided by the
governmental hospitals; identify patients’ people’ssatisfaction or dissatisfaction in
getting those services;
 To know the present situation of government hospitals.
 To evaluate the health service quality in government hospital.
 To identify the problems.
 To provide recommendations for betterment of the health services ofgovernment
hospitals.

Rationales:
People generally think that the services of government hospitals are not good and to some
extent it is true. They prefer private hospitals over the government hospitals even with a
higher cost. According to Bangladesh Health System Review, Health Systems in Transition
Vol. 5 No. 3 2015(WHO)most of the people of our country can hardly afford the high cost of
private hospitals. By this research we are going to spot the service delivery gaps and suggest
some recommendations for the betterment of government hospitals services.
Literature Review:
From online and secondary data search we have found few research papers. Some significant
findings are as follows:

The National Health Policy (2013) approved by the GOB aims to ensure good health through
developing an easy and sustained availability of health services for the people. Such efforts of
the government to improve its health care system require strong emphasis to the notion of
quality health care. For understanding the notion of quality health care, majority of the
quality assessment studies usually try to measure three types of outcomes: medical outcomes,
cost and client satisfaction (Aldana, 2001). Recent studies also reveal that services or client
satisfaction can significantly enhance patient’s quality of life (Dagger and Sweeney, 2006)
and enable service providers to determine specific problems of customers, on which
correction can be taken (Oja et al., 2006). Some other studies suggest that dissatisfied clients
of health services tend to complain to the establishment or seek redress from it more often to
relieve cognitive dissonance and failed consumption experiences (Nyer, 1999). In addition,
dissatisfaction might have serious ramifications: patients are unlikely to follow treatment
regimen, may fail to show up for follow up care and in extreme cases, may resort to negative
word of mouth that can dissuade others from seeking health care services from the existing
system or persuade them to seek it privately or from abroad. However, in Bangladesh the
government has begun to strategically integrate the health sector into its poverty reduction
plan; the public health sector is plagued by uneven demand and perceptions of poor quality
(Andaleeb et al. 2007). One study shows that the overall utilization rate for public health care
services is as low as 30 per cent (Ricardo et al., 2004). Another study revealed that the trend
of utilization of public health care services has been declining between 1999 and 2003, while
the rate of utilization of private health care facilities for the same period has been increasing
(CIET, 2003). The study identified the unavailability of doctors and nurses as well as their
negative attitudes and behaviors including the lack of drugs, long travel and waiting times as
the major factors of dissatisfaction and barriers to utilization of public hospital services.

http://www.ti-bangladesh.org/research/ES_DMCH.pdf observes the central point of public

health services of all the government hospitals in Bangladesh. Every day, on an average of
1,432 patients come to the outdoor and 450 to the emergency units of the hospital, while 184
patients are admitted to the indoor for further treatment. The patients are supposed to receive
medical treatment at a lower cost as it is a government-run hospital. However, alleged that the
patients are regularly deprived of the health facilities due to a number of irregularities and
corrupt practices. Patients are attended at the outdoor between 8:30am to 1:30pm; however,
71% of the patients informed that they had to wait for the doctors for 78 minutes on an
average. 35% of the outdoor patients were suggested by the doctors to visit the doctors’
private chamber. 29% of the outdoor patients gave average Tk.21 as bribe for visiting the
doctors breaking the serial. Among the admitted patients, 20% of the patients alleged that
doctors did not visit them regularly. There are numerous allegations against the nurses. 33%
of the patients did not receive good behavior and 16% of them did not get regular services
from the nurses. 58% of the patients did not get the ward boys or cleaners in the time of need.
The most conspicuous crisis is the shortage of beds. It was found that 70% of the patients got
bed immediately after admission through bribes (creating artificial crisis first and then
managed), 20% stayed on the floor and 10% shared beds with others for 5 days. The patients
were asked to comment on the overall service quality of the hospital. According to the
findings, 30% of the indoor and 19% of the outdoor patients were satisfied with the service,
while 30% and 35% respectively were dissatisfied with the quality of service.

Andaleeb (2000) comments that since private hospitals are not subsidized and depend on
income from clients (i.e. market incentives); they would be more motivated than public
hospitals to provide quality services to patients to meet their needs more effectively and
efficiently. This premise was supported. Patient perceptions of service quality and key
demographic characteristics were also used to predict choice of public or private hospitals.
The model, based on discriminant analysis, demonstrated satisfactory predictive power.

Variables:
 Number of bed
 Reference frequency of visit by Doctor’s private chamber
 Availability of doctors during their shift
 Prescribe low quality medicine
 Extra doctors fees
 Unnecessary tests recommended by doctors
 Doctor’s contractual agreement of doctors with the diagnostic centers.
 Behavior of doctor toward patient
 Knowledge of the doctors
 Experiences of the doctors
 Regularity of nurses.
 Availability of nurses during their shift.
 Behavior of nurses towards patient
 Quality of knowledge of the nurses
 Bribe practice of nurses for unfair advantage
 Sufficient ward boys
 Regularity of word boys
 Diagnostic facilities
 Availability of Vaccine in time
 Maintenance of vaccination time order
 Ambulance facilities
 Operation theatres
 Hygienic environment within the hospital
 Equity of service towards the patient coming from different economy classes
 Quality of food
 Enriched pharmacy
 Number of cleaners
 Back-up power supplier
 Admission process
 Information sharing process
 Cleanliness outside the hospitals
 Fairness in treating the patients of all classes
  Variety of food
 Appearance of food
 Flavor of food
 Temperature of food
 Dietary counseling provided

Hypothesis:
Variables of this research are converted into the following null hypothesis-

 Number of bed is not sufficient.

 Doctors don’t refer to their private chamber.
 Doctors are not available during their shifts.
 Doctors don’t prescribe low quality medicine.
 Doctors don’t receive any extra feesdon’t have good knowledge about their services.
 Doctors don’t suggest any unnecessary tests.
 Doctors don’t receive any contractual commission from diagnostic centers for
reference.
 Doctor’s behavior towards the patient isn not satisfactory.
 Nurses are not regular.
 Nurses are not available during their shifts.
 Nurses don’t behave properly with the patient.
 Nurses are not well trained.
 Nurses take bribe for unfair advantage.
 Ward boys are not sufficient.
 Ward boys are not regular.
 Diagnostic facilities are not enough.
 Vaccines provided by the government are not available in time.
 Vaccination facilities are not in proper order.
 Ambulances are not available 24 hours.
 Indoor environment is not hygienic.
 Services are not equal towards different economy classes of people.
 Hospitals don’t provide quality food.
 Prescribed medicines are not available hospital pharmacy.
 Cleaners are not sufficient.
 Functional power generators are not available during load-shading.
 Admission process is complicated of the hospitals.
 Uncooperative help desks in hospital.
 Hospitals are not clean enough.
 All classes of people don’t get fair treatment in the hospitals.
 Instruments are not available in the operation theater.
 Variety of food is not available in the hospital canteen
 Food flavor is not satisfactory
 Temperature of food is not consistent
 Appearance of food is not appealing
Diet counseling facilities is not appropriate
Research Methods:
This study will be conducted to explore the experiences of individuals who get health care
services from govt. hospitals and their satisfaction and perception to their services. The
research will go through formal procedure based on large representative samples. And the
data obtained will be subjected to quantitative analysis. So it is Conclusive research. This
conclusive research will describe the perception of general people towards the govt. hospital
estimate the percentage of each variable for a specific prediction. So it will be a Descriptive
research. We are going to collect data once from one sample of respondent drawn from the
target population. So it will be Single cross-sectional design.Although the study will based
on primary data, a number of secondary sources, such as policy documents, journal articles,
academic books, official documents, etc. will be used to conduct the study.

Note: