Bringing Medicine to the Hamlet: Exploring the Experiences of Older Women in Rural Bangladesh Who Seek Health Care

The purpose of this study was to explore the experiences of older women in rural Bangladesh who seek health care. Qualitative methods were used to collect data from 17 older women in Bibirchar Union, Sherpur District, Bangladesh in June 2006. The study is intended to generate findings to help policy makers plan appropriate strategies to improve the health of this highly vulnerable population group. The findings reveal that women’s culturally and socially determined roles greatly impair their health and play an important role in health-seeking behaviour through a complex web of social, economic, religious/cultural and behavioural interrelationships and synergies that pervade every aspect of their lives. Both demand factors—which include age, gender, cost, quality, geographic accessibility, availability of resources, the seriousness of the condition, and traditional and religious beliefs—and supply factors which include health system barriers such as perceived high cost of health services, geographical distance, scarcity of female health workers, understaffing, inadequate supply of drugs, discrimination and disrespectful treatment based on class, age and gender lead to reduced use of health services. The social determinants of health perspective informing the study shapes the conclusion that there is an urgent need for changes to the publicly funded health care system that would make it more accessible to older women in Bibirchar. These changes include ensuring an adequate supply of medications and equipment in the primary health centres, provision of free medications, and training of health service providers in geriatrics. Further, it is recommended that the referral system among the various health services be strengthened, collaboration between traditional health providers and modern health providers be provided, and that spiritual beliefs be integrated into health care provision. Training in how to treat older patients respectfully is recommended for all health providers working in government-funded organizations as is the hiring of more female health care providers. Incentives to attract physicians to work in publicly-funded facilities in rural areas are suggested and provision of free hospital and preventive testing services for older adults. In the longer term, recommendations are made that would increase the status, respect and resources commanded by older women in Bangladesh. These include health promotion programs to change public attitudes about the importance of providing health care to older women, investment in the social development of rural areas in Bangladesh, empowering local communities in health care decision making, and enhancement of economic opportunities for women. Finally a need is identified to redefine health from a limited understanding of it as “the absence of disease” to one grounded in a determinants of health perspective