Taking doctors where the ultra poor are: assessment of the panel doctor scheme of CFPR/TUP program

To facilitate access of ultra poor households to qualified allopathic care, especially for moderate-to severe and chronic morbidities, the Challenging the Frontiers of Poverty Reduction/Targeting the
Ultra Poor (CFPR/TUP) programme appointed a panel of doctors in its Area Offices.

This study assesses the current status of the Panel Doctor Scheme. The authors argue that the beneficiaries have received the scheme favourably and are in general satisfied with the services of the panel doctors. However, some concerns were raised with respect to responsiveness of the scheme due to financial restrictions imposed e.g. capping the costs of medicines and lab tests.

In order to improve the program, the authors make the following recommendations:

Physical infrastructure

• hygienic environment of the consulting room should be ensured
• the maximum number of patients should not exceed 12 per hour
• the appointments should be sequenced over two hours to reduce waiting time
• proper waiting arrangements are needed and the waiting time should be used to e.g. hold health education forums
• all preparations for consultations should be completed by the relevant program organiser before the session begins

Panel doctors

• panel doctors should be involved in the planning, management and supervision of the scheme to increase belongingness
• outreach services through satellite clinics may be organized at difficult- to- reach out-posts
• referrals for chronic conditions should be organized and followed-up by panel doctors with assistance from BRAC health staff

Responsiveness

• target households should be clearly informed about the types of services and financial assistance offered in the scheme
• the illness condition and its management should be explained to the patient or the attendant in as plain language as possible
• to avoid patients waiting for long time to receive prescribed medicines, some antibiotics and analgesics may be stocked at the areas office before the session begins

Financial assistance

•  measures need to be undertaken to cover the total costs of medicines or tests performed for reducing ‘health shock’ to the ultra poor households
• the financial assistance should be extended for chronic conditions as well as to the ‘graduated’ ultra poor for at least one more year to reduce the impact of ‘health shock’ on the road to sustainable livelihood for the ultra poor households.