Questionnaire number:

Date: ..
Questionnaire Survey
On
Healthcare Inequality among the Poor in Rural Bangladesh
By
Md Fazlul Haque
Name of Respondent: .
Mobile Number: ..
House Holding Number: ..

Village:

Union/Ward:

Upazila:

District: Rajshahi, Bangladesh

Age of Respondent: .Years

Sex: Male/Female

Marital Status: Unmarried/Married/Widow/Divorced

Religion: Muslim/Hindu/Christian/ Buddha/ Others
Educational Level:
None/Signature/Primary/Secondary/Intermediate/Undergrade/Masters/Higher
Occupation: Farmer/Business/service/Professional/Daily
laborer/Housewife/Student/Retired/others
Remark:
(All information from this questionnaire will be used for research only.
For any query please contact: Md Fazlul Haque. E-mail:
niloyhaq@yahoo.com. Mobile: 01712040001 )
Regional and Rural Development Planning (RRDP)
School of Environment, Resource and Development (SERD)
Asian Institute of Technology (AIT)
Thailand
September 2016

Part A: Profile of the Households

1. Demographics
1.1 Name, Gender, Age, Educational level, Occupation and Annual
Income of the households members:
Sl.
No

Name

Gen
der
(M/F
)

4
5

6
7

Age
(Year/m
onth)

Educational
level
(primary/seco
ndary/interme
diate/undergra
duate/masters/
Higher)

Occupation
(Farmer/Busine
ss/Service/Profe
ssional/Daily
laborer/Housew
ife/Student/Reti
red/Unemploye
d/Unable/Other)

Annual Income
(in Taka)

M=
Tot
al

Size of family=

(Households
income)=

F=
-

1.2 Assets of Households

Assets type
Land (in Katha):
1. Homestead:

2. Agricultural: ...
3. Non-agricultural: ..
Television; nos (Color/Black & White)
Mobile Phone:..
Goat: ..
Cow:
Bicycle/Rickshaw/Van/Auto-bike:

Hen/Duck: .
:Number of living rooms.
Kitchen: Yes/No
Brick-built House:
Sanitary Latrin :Yes/No
Tube-well: Yes/No
Others:
Total:

Value of assets (in Taka)

(approximate)

Part B: Households Prevalence of Diseases

1. What type of diseases they have in your households members
(within one year)?
Type of Diseases
Prevalence

Patients profile
Name

Chronic Diseases
(NCDs):
1.Heart Attacks
2.Stroke
3.Cancer
(Brain,Breast,Col
on,Blood)
4.Diabetes
5. Arthritis (joint
pain)
6.Respiratory
7. Others
Common
Diseases:
1. Fever
2. Allergy
3. Headache
4. Asthma
5. Autism
6. Back Pain
7. Diarrhea and
Dysentery
8.Tetanus
9.Pneumonia

Age(y
ear/m
onths)

Sex
(M/F)

Length of
prevalence
(year/month
s)

Cost of
Treatment
(in Taka)

Current
recovery
condition
(recovered/impro
ved/deteriorate/id
entical)

10. Malaria
11.Skin Diseases
12.Ear and Eye
infection
13. Others ..

2. Was anyone died in your family within three years suffering from any
diseases (only unnatural or due to ailment)? Yes/No
If yes, then answer the following questions in sub-section 2.1
2.1 Causes of death in your family and relevant information
No. of
Death

Causes of Death
(Type of Diseases)

Length of
prevalence of
Disease
before Death
(year/month)

Cost of
Treatment
(in Taka)

Profile of Died People

Age at the time
being died
(year/month)

Sex
(Male/Female
)

Part C: Households Availability of Healthcare

1.1 Distance of Health care Center (in kilometer):
a) District govt. hospital: km b) Upazila govt. hospitalkm c)
Community Clinic km
d) Private clinic (nearest) :..km e) Others (mention)km
1.2 Travel time to health care center (hour and minutes):
a) District govt. hospital: hr
c)Community Clinic..hr

b) Upazila govt. hospitalhr

c) Private clinic (nearest):..hr d) Others (mention)hr

1.3 Households facing problems to go to health care center due to natural
conditions (rain, flood, night time etc) :
Yes / No

If the answer of 1.3 is yes then

1.3.1 How many times in a year? ..times
1.3.2 Please explain what type of problem you were facing?

2. Communication and Transportation Availability

2.1 What type of transportation you usually use to go to healthcare center
(hospital, clinic etc.)? a) Ambulance b) Bus c) Tempo d) Rickshaw e) None
If you use any of these transportation, then
2.1.1 How much your families pay for this transportation?
Transportation cost to travel to health care center (for one-way trip)
For Male Patient

For Female Patient (including accompany cost)

Tk

Tk..
Part D: Affordability of Healthcare

1. Annual Households Healthcare expenditure

Type of Cost
Visiting Doctor
Diagnosis
Medicine
Hospital Bed
Food in Hospital
Therapy
Transportation
Regular Check-up/Tests
Others
Total

Amount (in Taka)

Part E: Quality of Health Care

1. Households Psychological and socio-cultural Characteristics on taking
Health care Facilities
1.1. Psychological (For those who are suffering from chronic illness)
1.1 What type of chronic illness your family is suffering from?
Type of Chronic Illness

Sufferings

1.

2.

3.

1.2 Do they feel any discomfort like stress or isolation? Yes/No

1.3 Do you think social relation and social support is helpful to improve your
health condition? Yes/No
If yes then
1.3.1 What type of help that your family member expect from society or family?
a)..
..
b)..
.
c)
.
3. Socio-cultural
3.1 Is women allowed to go to doctor alone in your family? Yes/No

3.2 Do your family member think that women doctor is available whenever you
need to visit? Yes/No
3.3 Do doctor always shows good behavior with your family member when they
are visited? Yes/No
If No then
3.3.1 What type of problem your family members were facing at the time of
visiting doctor? Please mention the level of satisfaction/dissatisfaction
Degree of Satisfaction/Dissatisfaction
Issue

Strongly
Satisfied

Satisfied

Neutral

Dissatisfied

Women patient treated by men

doctor
Treated by Nurse
Treated by Staff
Discussion about problem with
doctors
Overall satisfaction
Part F: Others

1. How long you have to wait to visit the doctor?

Type of Hospital/Clinic

Waiting Time ( hours/minutes)

a) Government

b) Private

.....

c)Community Clinic

Strongly
Dissatisfied

2. How your family members feel about the recovery rate after visiting the
doctor?
Type of Hospital/Clinic

Satisfaction about Recovery Rate

Fully
Recovered

Partially
Recovered

Identical

Mostly
Deteriorate

Deteriorate

1. Government
2. Private
3. Community Clinic
2.1 Whenever you/your family member face health problem or diseases where
are you used to go for treatment?
a) Govt. Hospital

b) Private hospital/clinic c) Homeopathic doctor

d) Ayurveda

e) Indigenous medicine (Kobiraji) f) No treatment

2.2 Why your family members choose this type of treatment? Give reasons
Choice of Treatment
from

1. Govt.
Medical/Hospital
2.PrivateMedical/Hos
pital/Clinic
3. Homeopathic
4. Ayurveda

5. Indigenous
(Kobiraj)

Reasons to choose
Cheap
est

Recover
y Rate is
High

Recovere
d Quickly

Easily
Accessibl
e/
Available

Faith
on

Motivat
ed by
others

Near
to
Hous
e

Oth
ers

3.2 In your locality medicine/dispensary is available? Yes/No

If No then
3.2.1 How long you have to go for buying medicine? ..km
3.2.2 How much time it will take to go there?

.hour

3.3 Have any of your family members been vaccinated? Yes/No

3.3.1 If yes, please answer the following questions
Type of
Vaccination

Vaccinated person
Age

Sex

No.
of
Vac.

Where
Age being
Vaccinated

Why vaccinated

(govt.hos/private/C
ommunity
Clinic/other

Cos
t/Fr
ee
of
cost

1. Cholera
2. Smallpox
3. B.C.G
4. Polio
5. T.A.B.C
6.Immunization
(Children)
7.other
3.4 Do your family member know why we do the following things?
Things your family member know

Yes/No

Level of knowledge
Satisfactory

1.Clean hand after using toilet

2.Drinking Clean water
3. Keep clean the house

Not
satisfactory

4. Cut our nails and keep them clean

5.Cover food
6. Clean hand before eating
3.5 Do your family member know how the following diseases are caused?
Name of Disease

Causes and way of

spreading

Prevention

Level of knowledge
Satisfactory

1. Dysentery
2. Diarrhoea
3. malaria
..
Thank you for your kind cooperation!!!!

Not
satisfactory

Date:
Key Informant Interview
On
Inequality in Healthcare to the Poor People in Bangladesh: A Case Study in Rajshahi
District

By
Md Fazlul Haque

Name of Key Informant:

Mobile No: E-mail:
Occupation:
Position: ..
Name of Institution/Organization:
Education Level: .
Address: ...
Remark:
..
(All information from this questionnaire will be used for research only. For any query please
contact: Md Fazlul Haque. E-mail: niloyhaq@yahoo.com. Mobile: 01712040001)

Regional and Rural Development Planning (RRDP)

School of Environment, Resource and Development (SERD)

Asian Institute of Technology (AIT)

Thailand
September 2016

1. Do you think the poor people are mostly vulnerable in taking health care facilities?
Why they are most vulnerable?

2. Is there any inequality in health care access between rural and urban people? Yes/No
Who are most vulnerable, rural poor or urban poor? Explain why?

.
3. Which factor is more responsible for health care inequality within households between
rural and urban people? Between poor and rich? Can you please explain in detail?
..

4. Why the poor people go for homoeopathic/indigenous treatment? Is it only the reasons of
less cost or any other reasons persist? What are those reasons?

5. Do you think the development of private sector (hospital and clinic) health care business is
one of the main reasons for prolong the health care inequality? How?
..
......................
6. Is there any special reasons for the people of rural area in Rajshahi district are most
vulnerable in access to health care services? What are these reasons?

7. Do you think the poor people in rural areas are not conscious about their diseases, how to
get treatment and how to conduct with health care providers?

.
8. Would you please give your suggestions to convey to the poor people of those areas for
their better access with their existing affordability (ability) in health care services intake and
quality health care service?
9. What role can play by the elected representatives/local leaders, civil society, existing
NGOs, and social activist etc.to reduce the health care inequality of those poor people
integrated?
Role of
1.Doctor/Nurse

2.Homieo/Ayurveda/Indigenous
Doctor

3.Medical Representative

4. Teacher/ Civil Society of that

area
5. Elected Representative

5. Local Leader

Role/Responsibility

6. Journalist

10. In your opinion, what type of policy changes in health sector by the government of
Bangladesh will be helpful to reduce the healthcare inequality of poor people in Bangladesh?

Policy on
1. Govt. Health Care Expenditure/ Budgetary
Allocation

2. To improve health care service in Govt.

Hospital

3. Establishment of Govt. Hospital

4. Posting/Recruitment system of Govt. medical

officer (doctor)

5. Others

Your Suggestions


Thank you so much for your valuable comments and kind cooperation!!!

Date:

Focus Group Discussion

On
Healthcare Inequality among the Poor in Rural Bangladesh

Name of Union:
Upazila: .
Number of Participants..
Remark:

(All information from this questionnaire will be used for research only.
For any query please contact: Md Fazlul Haque. E-mail:
niloyhaq@yahoo.com. Mobile: 01712040001)
Regional and Rural Development Planning (RRDP)
School of Environment, Resource and Development (SERD)
Asian Institute of Technology (AIT)
Thailand
September 2016

Engagement Questions:
1. What type of illness you usually face?
2. Can you afford the cost of treatment for common diseases?
3. Which type of treatment (Modern, Homeopathic, Ayurvedic, and
Indigenous) you would like to get when you are sick? Why?
Exploration Questions:
4. In your locality, are the healthcare facilities available? Are the
Hospital, Doctor, Medicine, and Dispensary sufficient and easily
available in your village/union/upazila?
5. When you get sick, is your family member/family head responsible to
get treatment? What type of problem you were facing getting treatment
from your family side and from the healthcare provider side?
6. What type of financial/economic and social barrier do you face getting
treatment?
7. Ill-health condition is a barrier to earning and leading a happy life- do
you know about that? What do you know? Please explain.
Exit Questions:
8. In your opinion, how can you get better treatment? What type of
barrier you would like to overcome in this regard? How?

..
Thank you so much for your valuable comments and kind cooperation!!!

Union at a glance

Union:
Upazila:
District: Rajshahi, Bangladesh
1. Total Population:
2. Total Household:
3. Rate of Poor Family (%):
4. Rate of Extreme Poor Family (%):
5. Literacy Rate:
6. Village Doctor (Quack):
7. Indigenous Doctor:
8. Midwife:
9. Community Clinic:
10. Community Latrine:
11. Hospital: a) govt. :.. b) private:..
12. Dispensary:
13. VGD:
14. VGF:
15. Maternal Allowance:
16. Old-aged Allowance:
17. Others:

..
N.B: Please collect the Union Map