Academic journal article Journal of Health Population and Nutrition

Effectiveness of Depot-Holders Introduced in Urban Areas: Evidence from a Pilot in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Effectiveness of Depot-Holders Introduced in Urban Areas: Evidence from a Pilot in Bangladesh

Article excerpt


Community-based volunteers, and local women, who are paid a small financial incentive, have been used in many parts of the world. In the 1990s, female community volunteers were introduced by the governments to improve access to family-planning services in rural areas of Nepal (1) and in a pilot programme in Bangladesh (2). They have been used for improving access to oral rehydration salts (ORS) in Peru (3) and for the distribution of iron and folic acid tablets in India (4). They were effective for increasing access to postpartum care in Colombia (5) and for community-based tuberculosis, malaria and filiariasis programmes in different countries (6-11). Volunteers have also been used in urban areas, for example in Lagos, Nigeria, for promotional, curative and preventive primary healthcare activities (12).

In Bangladesh, 'depot-holders' have been used for improving access to family-planning services in rural areas. These are women from the community, who keep a stock of commodities (contraceptive pills, condoms, ORS) in their home to supply other women, and promote good health practice and use of clinics. They are not strictly volunteers, since they receive some financial incentives. The Government introduced them in 64 sub-districts (upazilas) in the 1990s (13). The Rural Service Delivery Partnership (RSDP), a non-governmental programme, provided health services in rural areas from 1997, with depot-holders working at village level promoting the use of satellite and static clinic services. The programme served over 11 million people each year and employed over 6,000 depot-holders throughout the country (14). In 2002, it became part of the NGO Service Delivery Program (NSDP) which provides most services of the Government's essential services package (ESP) in certain rural and urban areas through 41 local partner NGOs.

The ESP covers five types of services: reproductive health and family planning, child health, control of communicable diseases, limited curative care, and behaviour change communication. Amajor aim of service delivery of the ESP is convenience and accessibility for women, children, and the poor. The Health and Population Sector Programme (HPSP) 1998-2003 of the Government focused on improving access for the poor to the ESP, but only in rural areas. The urban poor are particularly deprived in terms of child healthcare services, and studies have reported high prevalence of diarrhoeal diseases and acute respiratory infection (ARI) among children, low use of oral rehydration therapy (ORT) and immunization, and high infant mortality (15,16). Many parts of towns and cities in Bangladesh lack government healthcare facilities and outreach services, and NGO clinics provide most services.

Results of studies in Dhaka in the early 1990s showed that female community volunteers improved access to health facilities and ORT, particularly in areas served by NGO clinics, and mothers found their services to be useful (17). Based on these findings, the NSDP introduced depot-holders in three urban areas in 2003 as a pilot aimed at improving access to the ESP, particularly among the poor. ICDDR,B: Centre for Health and Population Research worked with the NSDP to design a study to: (a) establish a baseline at the beginning of the pilot intervention for measuring the impact of activities of depot-holders on a comprehensive range of indicators of the use of health and family-planning services in the long-term, (b) monitor the activities of depot-holders and use of services and conduct a follow-up at the end of a pilot phase to make a preliminary assessment of the impact of the activities of depot-holders on the use of selected ESP services and other indicators, and (c) ascertain the cost of introducing depot-holders and running their activities for a year as a basis for a longer-term assessment of cost-effectiveness in the future.


Study design

The study design for this preliminary assessment of the impact of depot-holders was based on measurement of selected indicators before and after the pilot intervention period in the intervention and non-intervention (comparison) areas. …

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