Medical record keeping practices among the urban poor in Bangladesh

Background: The lure of employment opportunities in Bangladesh’s cities accelerate rural to urban migration which has made the capital, Dhaka, one of the fastest growing mega cities in the world. The majority of new poor... [ view full abstract ]

Background: The lure of employment opportunities in Bangladesh’s cities accelerate rural to urban migration which has made the capital, Dhaka, one of the fastest growing mega cities in the world. The majority of new poor migrants settle in slums where health hazards are many, and access to affordable health services is limited. NGOs play an important role in providing community-based primary health services, with a particular focus on maternal, newborn and child health. Considering the mobility and vulnerability of poor urban dwellers, medical record keeping is a particular challenge.
Objectives: This paper explores the medical record keeping practices of urban poor and their experience regarding the existing health information system of different NGOs.
Methods: Formative qualitative research was conducted in six NGO-run MNCH facilities (2 from 3 different NGOs) in Dhaka in 2015. In-depth exit interviews were performed with 25 poor patients and 15 semi-structured observations were made at facility and community levels.
Findings: The majority of respondents reported residing in crowded and poor quality housing structures where safe storage systems are rare in the context of insecurity and environmental hazards such as flooding. As a result, medical documents are often damaged or lost. Frequent moves due to employment and eviction also necessitate changes in where healthcare is sought. However, it is difficult for clients to bring medical records as they are paper-based and not easily transferred. As a result, many low-income patients are required to perform additional diagnostic tests.
Conclusion: Due to the paper-based medical record keeping systems prevalent in NGOs working in urban areas, costs to patients are increased as repeated tests may be necessary, and opportunities to address other health needs may be missed. Digitized shared medical record systems could reduce the vulnerability of the urban poor to missed or inappropriate diagnosis or treatment, and unnecessary costs.