Village Doctors: Are They a Friend or a Foe?

This post originally appeared on the Joint Learning Network

Sabrina Rasheed is an Associate Scientist, working at International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). She is a nutritionist specializing in maternal and child nutrition. During the past 12 years, her work has focused on community nutrition, health equity, and community development.

In this interview, Ms. Rasheed discusses the role of village doctors in Bangladesh and how they contribute towards Universal Health Coverage.


Q. What is your role within icddr,b?

A. I am an Associate Scientist, working at Centre for Equity and Health Systems of icddr,b in Bangladesh.

Q.  Who are village doctors?

A. Village doctors are the largest group of informal healthcare providers in rural area of Bangladesh. They are the first providers that rural people visit for health information and service.

Q. I understand you have done a great deal of field work with village doctors. What is your take on the role of village doctors?

A. The village doctors occupy the largest market share of health care provision in Bangladesh. They have gained trust of the community and established a successful business model. The village doctors have created a space in the health arena as Bangladesh suffers from a serious dearth of trained medical providers at all levels both in terms of the number and distribution.

We have research to show that village doctors can be trained and incorporated in some vertical health programs such as TB to improve coverage. However, we have also seen that they have little training and their prescriptions contain many unnecessary and harmful drugs.

Q. The role and necessity of village doctors have often been debated in the past. In your opinion, how do village doctors contribute/not contribute to Universal Health Coverage?

A. As I said before, village doctors have occupied an important part of the health market specially for the rural poor. Some researchers have attributed the widespread availability of life saving drugs through the partnership between pharmaceutical companies and village doctors as important contributor to maternal mortality reduction in Bangladesh. However, our experience of working with them have shown us that training village doctors about appropriate prescription practices is not adequate to improve their practices. The powerful push of the pharmaceutical companies to train village doctors to sell drugs cannot be contained with education only.

Q. What parts of your job do you find most challenging?

A. We believe that the village doctors need to be brought under regulation that requires that they are trained and monitored. However, right now there are no regulations that allow us to get government engaged in working with village doctors. Without the presence of the government enforcement of regulation become problematic.

Q. What do find most enjoyable?

A. In our work with village doctors we have found that many have strong commitment to their communities. It’s refreshing to see such commitment. I believe we can learn a lot about engaging successfully with the community if we look at the business model of the village doctors.

Q. Did you have prior experience in global health, specifically, in Universal Health Coverage?

A. In centre for Equity and Health Systems we are engaged in experimenting with different aspects of strengthening health systems starting from evidence generation, testing innovative models, evaluating large scale programs and conducting poly dialogues. We are currently working with a community health insurance model to reduce financial barrier for health services.

Q. Would you like to add anything else (either about village doctors, UHC, or yourself)?

A. We started our work with village doctors because we knew that we can’t ignore their presence. It’s important that we keep on engaging with them to understand how we can enhance universal health care coverage from community perspective. 


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