title: What do they do? Interactions between village doctors and medical representatives in Chakaria, Bangladesh.
abstract: BACKGROUND
  Informally trained village doctors supply the majority of healthcare services to the rural poor in many developing countries. This study describes the demographic and socio-economic differences between medical representatives (MRs) and village doctors in rural Bangladesh, and explores the nature of their interactions.
  
  
  METHODS
  This study was conducted in Chakaria, a rural sub-district of Bangladesh. Focus group discussions and in-depth interviews were conducted, along with a quantitative survey to understand practice perceptions. Data analysis was performed using grounded theory and bivariate statistical tests.
  
  
  RESULTS
  We surveyed 43 MRs and 83 village doctors through 22 focus group discussions and 33 in-depth interviews. MRs have a higher average per capita monthly expenditure compared to village doctors. MRs are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less (p<0.001). MRs are the principal information source about new medications for the village doctors. Furthermore, incentives offered by MRs and credit availability influence the prescription practices of village doctors.
  
  
  CONCLUSIONS
  MRs being the key player in providing information about drugs to village doctors might influence their prescription practices. Improvements in the quality of healthcare delivered to the rural poor in informal provider-based health markets require stricter regulations and educational initiatives for providers and MRs.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA hrahman@jhu.edu.
authors.forename: M Hafizur
authors.initials: MH
authors.lastname: Rahman
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Smisha
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Tuddenham
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Peto
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka 1000, Bangladesh.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Iqbal
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka 1000, Bangladesh.
authors.forename: Abbas
authors.initials: A
authors.lastname: Bhuiya
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Peters
mesh_terms: D000328:Adult; D001459:Bangladesh; D003142:Communication; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards; D004345:Drug Industry; D004522:Educational Status; D005260:Female; D017144:Focus Groups; D006801:Humans; D007182:Income; D033181:Information Dissemination; D008297:Male; D040541:Marketing; D008875:Middle Aged; D010820:Physicians; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs; D012424:Rural Population; D011795:Surveys and Questionnaires
chemical_list: D055553:Prescription Drugs
keywords: Bangladesh; Developing country; Healthcare market; Medical representative; Village health worker