Mohammad Abdul Bari
Fellow Since 1992
Arifabad Housing Society
This profile was prepared when Mohammad Abdul Bari was elected to the Ashoka Fellowship in 1992.
The New Idea
Dr. Bari was born in Patuakhali, part of the coastal belt in southern Bangladesh. One of the most backward areas even by Third World standards, Patuakhali is regularly lashed with cyclones and tidal waves. Transportation and communications facilities are rudimentary, turning a simple six-mile journey into an odyssean task. Dr. Bari grew up accepting as inevitable the squalor and illiteracy that make people, especially children, victims of one avoidable disease after another. Later, when he started medical school at the age of eighteen, he was appalled to realize how much of the suffering was preventable. Unfortunately, as time passed, the situation worsened. The population swelled and nutritional and health problems increased, especially among children. Dr. Bari was shaken to realize that there were few child specialists in the country--a total of seventy-six in 1988 for a juvenile population of nearly fifty million. In his region, he was the first. He knew that to provide more than token help, he would have to find very new ways of practicing medicine. For the foreseeable future, doctors could not do the job alone. What other human resources could be brought to bear? The most obvious possibility was the mothers. He knew how much they cared and how closely they watched their children. When he sought to find out when a child had last urinated (a key question in judging the risk in a diarrhea dehydration case), the mothers alone knew. Over the last five years he has experimented, and now has a powerful local organization of 10,000 local mothers who come together in local groups weekly to discuss health issues and to organize a range of support activities. They are also an organized pressure group that is beginning to hold the formal medical system accountable, notably by demanding government doctors get out of their comfortable central office and get out to the villages. Dr. Bari knows that such pressure alone will not suffice to draw in these doctors: he has got to create a new structure attractive to the doctors. Toward this end, he has persuaded the mothers to pay fifteen taka per patient visit, thus cumulatively adding roughly 3,000 taka to a doctor's monthly salary ($750). To further modify the economics facing these doctors, he has pressed for them to be provided with speedboats, a step that avoids days and revenues being lost in transit. In addition to this and changing the incentives, Dr. Bari has worked skillfully to win the support of the district's senior-most public officer. It has not quite happened yet, but Dr. Bari hopes eventually that one doctor after another at the government health post will begin to go out and serve the villages and that this will become their new group professional norm. Since most of the country's medical capacity is tied up in the government's health system, one that barely reaches the majority, connecting this resource with organized client groups in the villages could, if sustained and spread, have enormous impact. Dr. Bari is now making the transition from developing this model in Patuakhali, even though it still needs further maturing there, to thinking through and beginning the work of changing the national health care system so that it will finally reach the children who need it. He wants to spread the Patuakhali model, with mothers taking charge and thinking through and solving their own problems together and then winning over effective support from the local doctors. Second, he knows he has to train and motivate both the current local doctors and those now coming up in medical school. They must be committed and able to serve the country's tens of millions of children. The Patuakhale model gets at the underlying economic incentives and helps to create an educated group of clients able to carry through once the doctor is gone. For all this work, however, the doctors need to know how to care for children and, more particularly, for the children faced with Bangladesh's health realities, not those of Paris or New York. He hopes to produce over a dozen videos to help bring the current generation of general practitioners up to a good level of competence, self-confidence, and interest. He also wants to initiate reforms in the medical schools. Specifically, he wants to cut one year off the too theoretical course in order to beef up more practical clinical training. He also wants to build a strong child care element into the curriculum with the further goal of ensuring that half the medical graduates will be well equipped to handle the real daily problems that arise in child health care.