Understanding demand and provision of eye care services among slum-dwellers in Dhaka, Bangladesh

• What types of facility are offering eye care services in the targeted areas?
• What are their characteristics?
• What is the willingness-to-pay for refractive error services (spectacles)?
• What are the implications in terms of pricing and sustainability for eye care providers targeting slum-dwellers?
• What is the community attitude and practice around eye care?
• What are the main reasons for consulting, where do patients go and why?
• What is the perceived advantage of each type of facility?
• What are the main barriers to accessing eye care services in poor urban communities?
• Do eye care facilities targeting slum-dwelling communities deliver effective services to the poor?

The overall aim of this study is to better understand the demand and provision of eye care services in Dhaka, with a specific focus on urban slum-dwelling communities. We employed a mixed method approach, using both quantitative and qualitative methods for data collection.

The study shows that there is a high proportion of ocular morbidities in Dhaka’s slum population, and many slum-dwellers would benefit from accessible eye care services. The demand for services however is low and constrained by both individual and community factors, including knowledge and education, direct and indirect costs of services and perception of treatment in the light of other competing needs.

More emphasis should be given to awareness campaigns and changing behaviour/attitudes in order to increase service uptake. Our study also shows that slum-dwellers are not a homogeneous community.

A market-based approach to delivering spectacles to slum-dwellers seems to be a viable option that needs to be explored further. However, mechanisms for identifying the poorest individuals and enabling them to access eye care services remains crucial.

The willingness to pay (WTP) approach used in this study prove to be a useful tool to accurately estimate communities WTP for a health commodity; despite certain reservations in the literature about the use of such approach in lower socio-economic groups. We recommend replicating this approach in other studies of health-seeking behaviour and demand for eye care services.

The findings of this study should be used as the evidence base for future policies and programmes to increase the uptake of eye care services by urban slum-dwellers, particularly the poorest among them.

• Read the report