Policy Framework and Strategic Implementation Plan for Establishing a GP Practice System in Bangladesh

Part 5: Proposed Policy Framework for GP Practice System in Bangladesh

1. Primary Healthcare (PHC) Strengthening:
   • Establish GPs as the first point of contact in a reformed PHC system to ensure equitable, accessible, and continuous care.
   • Ensure comprehensive, patient-centered care for all, including diagnosis, treatment, preventive care, and referrals to specialized services when needed.
2. Referral System Creation:
   • Develop a structured referral system where GPs serve as gatekeepers to specialist and hospital services.
   • Mandate referrals from GPs for access to secondary and tertiary care, reducing self-referrals, minimizing system inefficiency, and preventing unnecessary overcrowding in hospitals.
3. Public-Private Partnership (PPP):
   • Facilitate collaboration between public and private sectors for GP services, utilizing private sector facilities and resources to complement government initiatives.
   • Encourage the private sector to establish GP clinics under a government-regulated framework.
4. Human Resource for Health (HRH) Development:
   • Focus on training and deploying more family physicians/GPs, addressing the HRH shortage by upgrading medical training programs and increasing GP residency slots.
   • Incentivize medical graduates to choose general practice as a specialization with attractive career pathways.
5. Universal Health Coverage (UHC) Integration:
   • Integrate the GP practice system within UHC objectives, ensuring GP services are covered under government health insurance schemes, making them affordable and accessible to all citizens.
   • Make essential GP services free or highly subsidized, especially for vulnerable populations.
6. Decentralization of Services:
   • Decentralize healthcare delivery, empowering local health authorities to manage GP clinics under national guidelines, increasing responsiveness and efficiency.
7. Digital Health and E-Health Integration:
   • Implement digital health records (EHRs) across GP practices to ensure continuity of care and effective information sharing between primary, secondary, and tertiary levels.
   • Encourage telemedicine services for GP consultations in rural areas to bridge geographical gaps in access.

Strategy for Implementation

1. Pilot Programs and Regional Rollout:
   • Launch pilot GP clinics in strategic urban and rural areas, linked to existing Community Clinics (CCs) and Union Health Centers (UHCs).
   • Use pilot data to gradually expand the GP system nationwide, ensuring regional adaptability and sustainability.
2. Infrastructure Development and Resource Allocation:
   • Allocate resources for developing GP infrastructure, including physical facilities, medical equipment, and digital infrastructure for telemedicine and e-health platforms.
   • Leverage underused private hospital infrastructure for GP services under PPP models.
3. Capacity Building and Continuous Medical Education:
   • Provide continuous medical education (CME) for GPs, updating them on advancements in diagnostics, treatment, and healthcare technology.
   • Develop a certification and accreditation program for GPs to maintain high service quality.
4. Performance-Based Incentives for GPs:
   • Introduce performance-based incentives tied to patient satisfaction, continuity of care, and health outcomes.
   • Ensure GPs are adequately compensated to retain skilled professionals in the public sector.
5. Health System Governance and Regulation:
   • Strengthen governance and oversight mechanisms to monitor GP service quality, efficiency, and patient outcomes.
   • Establish clear guidelines for GPs, including minimum service standards, referral protocols, and ethical practices.
6. Community Engagement and Health Promotion:
   • Engage local communities in health education and promotion activities led by GPs, focusing on preventive care, vaccination, and chronic disease management.
   • Ensure GP clinics serve as community hubs for health promotion and public health campaigns.
7. Referral Coordination and Integration with Hospitals:
   • Develop formal agreements between GP clinics and hospitals (public and private) for seamless patient referral and back-referral, supported by shared health records.
   • Create dedicated referral coordinators at UHCs and District Hospitals (DHs) to streamline communication between GPs and hospitals.

Key Performance Indicators (KPIs)

1. Increase in PHC Utilization Rate: Measure the number of patients using GP services versus secondary and tertiary care directly.
2. Reduction in Hospital Overcrowding: Track the decrease in non-urgent visits to hospitals by improving the referral system.
3. GP Satisfaction and Retention: Monitor GP job satisfaction and retention rates, ensuring HRH stability.
4. Patient Health Outcomes: Assess improvements in patient health, particularly for chronic conditions, managed by GPs.
5. Coverage and Accessibility: Evaluate geographical and population coverage of GP services, aiming to reach underserved rural areas.

This policy and strategy, tailored to Bangladesh’s pluralistic health system, can build a strong foundation for a GP system modeled on the NHS, addressing challenges such as HRH shortages, system inefficiencies, and lack of quality PHC.