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Private Tutoring in English for Secondary School Students in Bangladesh

Author(s): M. OBAIDUL HAMID, ROLAND SUSSEX and ASADUZZAMAN KHAN


Source: TESOL Quarterly , June 2009, Vol. 43, No. 2 (June 2009), pp. 281-308
Published by: Teachers of English to Speakers of Other Languages, Inc. (TESOL)

Stable URL: https://www.jstor.org/stable/27785005

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Private Tutoring in English for
Secondary School Students in Bangladesh
M. OBAIDUL HAMID
The University of Queensland
Queensland, Australia
ROLAND SUSSEX
The University of Queensland
Queensland, Australia
ASADUZZAMAN KHAN
The University of Queensland
Queensland, Australia

Private tutoring in English (PT-E), a special and important subclass of


private tutoring (PT), is a common phenomenon in ESL/EFL educa
tion in many parts of the world. Nevertheless, it has received little atten
tion in TESOL, applied linguistics, or language education research.
This article investigates the nature and practice of PT-E in a disadvan
taged rural area of Bangladesh, a context where the circumstances of
ESL/EFL education give it a particularly acute role. The study relates
PT-E to scholastic achievement in English, investigates student attitudes
and motivations in PT-E, and establishes a core profile of PT-E in rela
tion to the school system, parent and student expectations, attitudes
and motivations, and outcomes. The study follows a mixed-methods
approach. Quantitative data analysis demonstrates some positive links
between PT-E and English achievement, which is elaborated through a
broader qualitative analysis, showing that the students had clear and
structured views about PT-E, which they saw as imperative for successful
learning achievement. A set of social, psychological, and institutional
factors are identified which contribute to the popularity of PT-E in a less
affluent society like rural Bangladesh. There are also implications for
educational policy and planning, if English language education in the
mainstream school system is to hold its own in the face of competition
from PT-E in terms of quality and image.

As English continues
"low proficiency" to spread
English countries across
(Graddol,the
2006,globe, governments in
p. 110) are
reappraising its importance and responding to the changing global
order of English by updating their language and language-in-education
policies (Tsui & Tollefson, 2007). It often happens that such responses

TESOL QUARTERLY Vol. 43, No. 2, June 2009


281

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result in English gaining more space in the national curriculum: English
may be made a compulsory subject, where before it was only an elec
tive; or it may be introduced in earlier grades, following the principle
of "the earlier, the better" (Medgyes, 2005, p. 276). The limited space
in the curriculum (Kaplan, 2000) is thus forced to make room for more
English, and more resources are reallocated to promote its teaching
and learning, at the potential expense of other components of the
curriculum.
It is not yet known whether extending the space for English in the
curriculum and increasing budgetary allocations for English teaching
actually deliver the desired effects. Parents in many countries have pre
empted this question by investing in private tutoring in English (PT-E)
for their children. Whether this private investment in children's English
learning pays off, and whatever the attitudes and perceptions of those
who participate in PT-E, the scale of its popularity worldwide suggests
that it is either successful or considered to be so (Greaney & Kellaghan,
1995, p. 12).

PRIVATE TUTORING IN THE LITERATURE

PT-E is a special and important subclass of private tutoring (PT). PT,


or after-hour supplementary schooling, is a macro-phenomenon of mod
ern education. Recently, it has grown dramatically in Asia, Africa, Europe,
and North America (Baker, Akiba, LeTendre, & Wiseman, 2001; Bray,
2003, 2006; Ireson, 2004). This "shadow education" (Bray, 2003, p. 21)
sits at the interface between education and commerce and has become
a multibillion-dollar industry (Aurini, 2004; Davies, 2004; Mischo Sc
Haag, 2002; Stevenson Sc Baker, 1992). Family investment in private
tutoring in wealthier East Asian countries like Korea, Japan, Hong Kong,
and Taiwan amounts to billions of dollars annually (Bray, 1999; Lee,
2005; Stevenson & Baker, 1992). Research suggests that in the Anglophone
and European countries PT tends to be principally remedial and supple
mentary in nature (Mischo & Haag, 2002; Davies, 2004). In parts of East
Asia, however, it has established a position as an essential part of educa
tion, culture, and society (Foondun, 2002; Kwok, 2004). This trend is
evidenced by the strong presence oijuku, or private after-hour classes, in
Japan (Harnisch, 1994; Roesgaard, 2006; Rohlen, 1980). Private tutor
ing is also embedded in South Korean society, where it is known as ha
gwuan, or cram schools; US$12.4 billion was spent on this form of
education in 2003, equivalent to 56% of the country's national educa
tion budget (Lee, 2005). Private tutoring is an integral part of education
in Hong Kong, which also consumes substantial family resources (Bray &
Kwok, 2003). Research shows that a complex set of factors?including
the value of education in the Confucian tradition, the parental role in

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educating children, the system of high-stakes examinations for admis
sion to higher education, the role of education in the job market, eco
nomic prosperity, and the high priority given to these factors in the
overwhelming majority of middle class families?account for the popu
larity of PT in East Asia. Not all these factors hold equally in less affluent
societies; nevertheless, PT is popular and well-subscribed in these societ
ies as well (Bray, 2006; Buchmann, 2002; Greaney & Kellaghan, 1995;
Tansel 8c Bircan, 2006).
Despite some progress in research on PT, this phenomenon still
"remains very firmly in the shadows" (Ireson, 2004, p. 110). Moreover,
the existing research on PT mostly addresses issues related to its nature,
scope, scale, and motivation. Only a few studies have been directed at its
evaluation or effectiveness, and they have reported only inconclusive
findings (Bray, 2006). Furthermore, the small body of PT research has
largely concentrated on relatively affluent societies. We know much
less about the nature, practice, impact on achievement, and socio
educational implications of PT in less affluent societies. This article
responds to this need in investigating the nature and practice of PT, and
specifically PT-E, in a region, a country, and a context at the opposite end
of the affluent scale: a disadvantaged rural area in Bangladesh.
Research that exclusively focuses on PT-E, which is of substantial inter
est to TESOL, applied linguistics, and language education, is apparently
restricted to only two studies. The first, by Mischo and Haag (2002), eval
uates the effectiveness of PT in Germany in a pre- and post-control
group design. The study involved 122 students in a PT group and the
same number in a control group. Both groups' school marks in English,
French, Latin, and mathematics in the pretest and the posttest were
recorded and compared. T-tests showed that the posttest scores of the PT
group in all four subject areas were significantly higher than the pretest
scores (p< 0.001), though whether this should be attributed to their par
ticipation in PT is not certain.
The other study on PT-E is Khuwaileh and Al-Shoumali (2001), which
explores the reasons and conditions which contribute to the success of
PT-E in Jordan. Fifty students from two Jordanian universities partici
pated in a questionnaire survey. These students and a sample of 10 par
ents were subsequently interviewed. The study records positive attitudes
on the part of parents and students toward PT-E. It also shows that the
prevalence of PT-E was mainly due to such factors as the poor teaching of
English at the school level, the students' desire for good grades in their
tertiary courses, the importance of English, family affordability, and fam
ily social class and prestige.
This paucity of research on PT-E does not match the scale of its popu
larity. English is one of the key subjects in juku, which is an integral part
of the high-stakes tests in Japan (Locastro, 1990). In Hong Kong, "English

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typically has the greatest demand [in private tutoring] because it is impor
tant not only as a subject but also as a medium of instruction for other
subjects" (Bray & Kwok, 2003, p. 614). English is also one of the most
commonly taught PT subjects in Korea (Lee, Kim, & Yoon, 2004). In
short, English constitutes an essential component of the national curricu
lum in many countries, and thus it has a major position in the PT market.
Poor EFL results in these countries (Baldauf et al., 2008) provide an addi
tional motivation for PT-E.
In the current study we focus on PT-E as a substantial area of English
language teaching and learning. We describe the phenomenon of PT-E
in Bangladesh; relate PT-E to scholastic achievement in English; investi
gate student attitudes and motivations in PT-E; and start to build an over
all profile of PT-E in relation to the school system, parent and student
expectations, attitudes and motivations, and outcomes. These objectives
are important for TESOL and language education researchers and prac
titioners worldwide, because they draw attention to the question of how
TESOL pedagogy is implemented, accommodated, and supplemented
by PT-E in less affluent societies.

BANGLADESH

Bangladesh is a medium-sized country in South Asia with a substantial


population of 140 million. The annual per capita income is US$411; the
literacy rate of the population aged 7 and over is 45.3% (Bangladesh
Bureau of Educational Information and Statistics [BANBEIS], 2004).
Bangla (Bengali) is spoken by 98% of the population in Bangladesh.
English was introduced during British rule and still enjoys a position of
dominance and prestige (Banu 8c Sussex, 2001; Kachru, 2005). English is
taught as a compulsory subject from the 1st to the 12th grade and also at
the tertiary level.

Private Tutoring in Bangladesh

PT is a common phenomenon in Bangladeshi education. It is widely


spread in urban as well as rural areas, and shows some complex charac
teristics which are to some extent different from its implementation in
East Asia, Europe, or North America.
Private tutoring in Bangladesh is delivered by mainstream teachers,
teachers from other institutions, or even nonteachers. Lessons occur one
to-one, in small groups (5-10 students), or in large groups (20 students
or more). The venue of the teaching can be the tutor's place of residence
(one-to-one or small groups), the tutee's place of residence (usually one
to-one), or special teaching centres (large groups) known as coaching

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centres. These coaching centres are comparable to Japanese juku, or pri
vate after-school classes. Finally, in our study the focus of PT is on school
based examinations or school-leaving national examinations rather than
college or university entrance examinations, although PT is equally prom
inent for these latter goals in higher education in Bangladesh.
PT is widely implemented at all stages of pretertiary education in
Bangladesh. Education Watch 2006 (Campaign for Popular Education
[CAMPE], 2007) reported that PT participation rate at the primary
level averaged 37%. However, at 86.5% it was predictably much higher
at the secondary level. The PT participation rate at the secondary level
in our study is somewhat lower (75%), consistent with the location of
the study in a rural disadvantaged area. One crucial factor for the pop
ularity of PT in Bangladesh is inadequate public investment in educa
tion. Education Watch 2006 shows that the public investment per student
per month is US$2.05 at the primary level and US$4.50 at the second
ary level. This investment accounts for 41% and 29% of the total edu
cation expenditure at the two levels, respectively. The low investment
accounts for poor infrastructure and logistics, which in turn, contrib
ute to the poor quality of teaching and learning (Hamid & Baldauf,
2008).
Poor teacher salaries are another reason why school teachers offer pri
vate after-hour lessons to their own students for extra income. Although
ethical issues are involved here (Nuland, Khandelwal, Biswal, Dewan, 8c
Bajracharya, 2006), PT is a common practice all over Bangladesh. Mainly
teachers of English, mathematics, and sciences have the opportunity to
earn this extra income through PT. There are tensions between these
teachers and those whose subjects are not in demand for PT (e.g., Bangla
and the social sciences).
The cost of PT is hard to calculate, because it depends on the fre
quency of lessons taken, the duration of the lessons, the subjects taught,
teacher quality and reputation, the mode of lessons (one-to-one/groups),
and the geographic location (urban/rural) of teachers and students.
Education Watch 2006 (CAMPE, 2007) shows that the annual average cost
for PT per student was US$49 at the secondary level. Importantly, the PT
cost constitutes a significant proportion (42% for government schools;
29% for nongovernment schools) of the total education cost borne by
families, which is substantially higher than the cost of any other items
(Table 1). On average, the proportion (35.5%) is higher than the total
contribution of public expenditure per student at the secondary level,
which is 29%.
The wide popularity of PT in Bangladesh prompts questions about its
quality and societal perceptions. Although there have been no objective
studies exploring these issues, such perceptions appear to be complex
and mixed. Negative evaluations of PT prevail in the literature, but it is

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TABLE 1
Item-Wise Average Annual Expenditure Per Secondary Student (Rural-Urban and Male-Female
Combined) by Type of Institution (in Taka and in Percent of Total Cost)

Nongovernment
Government schools schools

Types of institutions Taka % Taka %


Private tuition 4,700 42 2,210 29
Books 796 7 686 9
Stationery 1,099 9 992 13
Fuel 461 4 709 9
Tiffin 804 7 751 10
Health service 591 5 471 6
School dress 515 5 410 6
Transport 833 8 315 4
Others 1405 13 1030 14
Total 1,1204 100 7,574 100

Source: Campaign for Popular Education (2007, p. 51); reprinted with permission.
Note. US$1 = 70 Taka approximately; Government secondary schools are fully funded by the gov
ernment. Nongovernment schools are not private schools because they are substantially funded
by the government in the form of teacher salaries and school infrastructure; tiffin is a snack
taken by students as a substitute for lunch at school.

widely believed that PT participation influences student performance in


school and school-leaving examinations. For example, Deabnath (2007)
analyzes the results of the Secondary School Certificate (SSC)1 examina
tion in 2007, and observes:

This year's Secondary School Certificate (SSC) exam results warn of


the country's secondary school education system becoming dependent
on private tuition as they show students of the urban areas who can afford
private tutors fared well while students in the rural areas suffered
dearly, (n. p.)

However, PT, particularly in its institutional form (i.e., coaching centres),


is questioned on the grounds of poor quality of teaching and its business
orientation (Chakroborty, 2002). One-to-one or small-group PT, on the
other hand, has the potential to offer quality remedial lessons because
the teaching conditions in this case differ clearly from those of formal
schooling. In formal Bangladeshi schools, class sizes are commonly
larger than 50, which compromises individualized instruction and even

1 The Secondary School Certificate (SSC) examination is the first public examination in the
Bangladeshi education system. Students have to sit this examination at the end of Year 10.
Successful performance in this examination allows students to study at the higher second
ary level for 2 years before they can undertake undergraduate studies.

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interactions with and feedback from the teacher. Resources are poor in
terms of books, study aids, and other support, whereas the conditions of
individual or even group PT are qualitatively and quantitatively distinctly
more favourable.

The Current Study

The current study is based on PT-E data from Hamid (2009), a wider
ranging investigation of English language teaching and learning in a
rural context in Bangladesh, specifically the relationships between sec
ondary school students' family economic, cultural, social capital, and
their scholastic achievement in English. The main study was conducted
in a disadvantaged area?a medium-sized subdistrict in Bangladesh.
Located about 500 kilometres from the capital city of Dhaka, Nadiranga
(a pseudonym adopted for ethical reasons and anonymity) is a rural
agriculture-based subdistrict with a small town at its centre. The total
land area of the subdistrict is 224.97 square kilometers, and its popula
tion is 114,350 (56,506 males, 57,844 females; BBS, 2005). It is one of
the poorest subdistricts in Bangladesh (Rahman, Asaduzzaman, &
Rahman, 2005). The literacy rate of the population aged 7 and over is
33.47% (cf. the national rate of 45.3%). There are 12 secondary schools
in the subdistrict, from which around 700 tenth graders participate in
the Secondary School Certificate examination every year. English con
stitutes 2 of the 11 papers which all examinees must sit in this national
examination. Although English is emphasized in the curriculum, its
teaching and learning in rural areas like Nadiranga are supported by
only very limited resources. English is not required in everyday commu
nication. Students do not have access to self-study resources such
as print or electronic materials other than the set textbooks. Comput
ers and the Internet, which could potentially introduce learners to
virtual communities, are yet to be available in schools or homes in
Nadiranga.

THE MAIN STUDY: PARTICIPANTS AND INSTRUMENTS

The sample for the quantitative phase of the parent study consisted of
228 tenth-grade students (15-16 year olds) who were selected from eight
schools in Nadiranga. Fourteen of these 228 students were later selected
for one-to-one interviews in its qualitative phase. There were three
instruments used for collecting numerical data: (1) a student survey ques
tionnaire, (2) an English proficiency test which had been designed by an
English Teaching Task Force (BEERI, 1976) commissioned by the Ministry
of Education of the Bangladesh Government, and (3) school records of

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students' grades in English in the school test2 as well as the SSC examina
tion in 2007.

Survey Questionnaire

The questionnaire (see Hamid, 2009) collected data on students'


family economic, cultural and social capital, and attitudinal and motiva
tional characteristics and dispositions (habitus). It was administered,
together with the English test, to students in the schools in October
November 2006. Appointments were made with the head teachers of the
schools. On the appointed days the first author met the 10th-grade stu
dents in their class, briefed them about the study, and requested their
participation. They were then given the proficiency test, followed by the
questionnaire.

English Proficiency Test

This 60-point test is a national test designed in Bangladesh, and


has been widely tested there in different schools for reliability and valid
ity (Zaman, 1999). Divided into three parts, the test content focuses
on grammar items in scripted dialogues (30 points), vocabulary items
(20 points), and reading comprehension questions (10 points).

Student Interview

After the proficiency test and the questionnaire survey, 14 students


were interviewed at their homes in December 2006. The interviewees
were selected on the basis of their performance in the English proficiency
test and in the English papers of the school test. Our aim was to interview
both the best performing and the lowest performing students in both
tests in order to determine whether the two types of students differed in
terms of their habitus (i.e., a set of attitudes, motivations, values, career
goals and expectations, and academic self-concepts) and family back
ground factors (e.g., parental education, occupation, income, and paren
tal involvement in their education). The interviews were semistructured,
and most of the questions focused on aspects of family social and cultural
capital and the students' attitudes, motivations, English-learning experi
ences, future education plans, and career goals, and their perceptions of

2 The school test is the SSC-qualifying test arranged by secondary schools. The schools nomi
nate candidates for the SSC examination based on their performance on this test.

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the influence of their family situations on their academic performance
(for interview questions, see Hamid, 2009), with participation in PT-E a
prominent topic. The interviews were conducted by the first author, and
took place in the homes of the students, lasting between 40 and 60 min
utes. All interviews were audio-tape recorded with the students' and their
parents' permission. The interviewer also took notes in case there were
technical problems in retrieving the recorded interviews. All interviews
were conducted in Bangla, the LI of the interviewer and the
interviewees.

PT-E Data for the Current Study

In the main study (Hamid, 2009), private tutoring was shown to be one
source of cultural capital (Buchmann, 2002) that families exploit to
enhance their children's achievements in English. Over 75% of the 10th
graders who participated in the study took private lessons in English out
side mainstream schooling. This high rate of participation in PT-E, par
ticularly in a disadvantaged area, obliges us to investigate the relationship
of PT-E to academic achievement in English and to ask why so many stu
dents are attracted to it. In addition, PT-E emerged as a dominant issue
in interviews with students selected from the survey sample. The students
had clear and patterned views about PT-E, issues which are, so far, unre
searched in the literature. We therefore isolated all PT-E data-both quan
titative and qualitative?from the main study in order to carry out a
separate, in-depth analysis in this article. This analysis has a dual focus:
on the possible links between private tutoring and academic achieve
ment, and student perceptions of PT-E, which is designed to reveal
whether PT-E does indeed deliver clear benefits, and to probe what other
factors might explain the large-scale participation in PT-E.

Methodology and Data Analysis


The dual focus of the paper involves a mixed-methods approach
(Bryman, 2006; Creswell 8c Piano Clark, 2007; Greene, 2008; Johnson 8c
Onwuegbuzie, 2004; Tashakkori & Teddlie, 1998; Teddlie 8c Tashakkori,
2003). This methodology calls for the collection, analysis, and mixture of
both quantitative and qualitative data at different stages of the research
process. This research design is based on the "premise that the use of
quantitative and qualitative approaches in combination provides a better
understanding of research problems than either approach alone"
(Creswell & Piano Clark, 2007, p. 5). The growing field of mixed method
ology suggests various rationales, objectives, and strategies for mixing
quantitative and qualitative data in a single study (Greene, 2008; Greene,

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Caracelli, & Graham, 1989; Johnson & Onwuegbuzie, 2004; Creswell &
Piano Clark, 2007). The literature also includes a number of typologies
for mixed-methods research design (Creswell 8c Piano Clark, 2007;
Johnson & Onwuegbuzie, 2004; Teddlie & Tashakkori, 2006).
Our approach to integrating quantitative and qualitative data in the
present paper benefited from the set of mixed methods designs pre
sented in Creswell and Piano Clark (2007). They discuss four types of
mixed-methods designs?triangulation, embedded, explanatory, and
exploratory. The design types include three dimensions: (a) time of mix
ing the qualitative and quantitative phases (concurrent or sequential),
(b) weighting (equal or unequal weight of the phases), and (c) type of
mixing (merging, embedding, and connecting). Our methodological
integration was mainly based on their fourth design type (exploratory),
with explanation and complementation as two objectives or principles
for the mixing. Our design was guided by the belief that different aspects
of a single phenomenon require different methods of inquiry, and the
findings complement each other to yield a broader and deeper under
standing of the phenomena under investigation (Greene, 2008). Our
data analysis and results are presented in two distinct phases?a quantita
tive phase, followed by a qualitative phase, and are "integrated during the
interpretation of the findings" (Johnson & Onwuegbuzie, 2004, p. 20).
Thus, among the three models of mixing suggested by Creswell and Piano
Clark (2007)?merging, connecting, and embedding?we follow the sec
ond method: we connect the two data sets, and the connection is sequen
tial, because the two phases are chronologically ordered in the research
process. In terms of the relative weight of the two phases, we depart from
much customary practice in that our notation is quan^QUAL: We place
more weight on the second, qualitative phase. In our view, the qualitative
phase, which investigates students' attitudes, motivations, and percep
tions of PT-E, yields more and richer information than the quantitative
phase, which associates students' participation in PT-E with English
achievement data. The two phases of our study are "broadly complemen
tary, providing different kinds of insights into the different aspects"
(Brannen, 2005, p. 180) of the social phenomenon of PT-E.

QUANTITATIVE DATA ANALYSIS AND FINDINGS


The students' participation in PT-E was assessed using a dichotomous
yes or no response in the questionnaire. The participation rate for girls
(80%) was higher than that for boys (71%), although the difference was
not statistically significant on a %2 test.
Table 2 presents percentage distributions of the students' (n = 228)
parental occupation, education, and family income levels. The monthly
income of almost half of the families (47%) was below Taka 2000, and

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TABLE 2
Percentage Distribution of Parental Background Characteristics

Characteristics Number %
Father's occupation
Salary service 62 27.2
Business 50 21.9
Farming 74 32.5
Manual and other 42 18.4
Father's education
No formal education 30 13.2
Primary 58 25.4
Secondary 63 27.6
Higher secondary and above 77 33.8
Mother's education
No formal education 46 20.2
Primary 83 36.4
Secondary and above 99 43.4
Parental income per month (Taka)
Less than 2000 106 46.5
2001-5000 70 30.7
5001 or more 52 22.8

only 23% of the families earned Taka 5,000 or more per month. The
income levels of the families point to the poor socioeconomic conditions
of the subdistrict. Nonetheless, over three-quarters of the students par
ticipated in PT-E.
As previously noted, the study includes two measures of English achieve
ment: students' scores in the 60-point English test, and their scores in
English in the SSC examination, 2007. The latter data were collected
from the schools. The SSC English scores were available only in the form
of letter grades, which were converted into number grades following the
grading system used in the SSC examination. This grading system was
also used to convert the English test scores, which were raw scores, into
number grades. As can be seen from Figure 1, student representation in
the upper grades (3 or above) was very modest in both sets of grades.
Therefore, students obtaining these grades were regrouped into one
grade (grade 3) for comparison purposes. The %2 test assessing the rela
tionship between the categories of proficiency test grades and SSC grades
shows a significant statistical association between the two measures of
English achievement (%2 = 101.61, df = 9, p < 0.0001).
Figure 1 shows that the majority of the students either failed or
obtained only lower grades (1 = D, 2 = C) in English. Although three stu
dents were able to obtain the highest grade (5 = A+) in the English test,
none did so in the SSC examination. Furthermore, 37% of the students
in the present sample failed in the SSC examination in 2007, which is
higher than the national rate of failure for that year (30%). Thus, these

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FIGURE 1 Comparison of Students' SSC English Grades and English Test Grades.

Comparison of SSC English grades and

SSC grades
Test grades

0 1 2 3 3.5 4 5
English grades
Source : Hamid and Baldauf (2008, p. 19), reprinted with permission.

data confirm the lower educational standards and English achievement


of students in rural schools (see Hamid 8c Baldauf, 2008).
Multivariate logistic regression, specifically ordered logistic regression,3
was used to investigate factors that were independently associated with
the SSC English grades and the English test grades. The results are pre
sented in the form of odds ratios (OR) and their confidence intervals
(CI). OR values greater than 1 indicate a probability of higher grades in
English; OR values less than 1 indicate a probability of lower grades in
English. The specific predictor variables are PT-E, gender, and mother's
education.
We included gender as a potential predictor in order to investigate
whether gender had any influence in the relationship between the
students' participation in PT-E and their academic achievement in
English. We were interested in this variable because other studies have
shown that in Bangladesh the female enrolment rate in secondary educa
tion is higher than that of males, although females were still behind

3 Since the achievement variables were ordered, ordered logistic regression was used to find
possible associations between the students' grades in English and the selected predictors.
The implementation of ordered logistic regression was based on the proportional odds
model, which for each independent variable estimates a single parameter to describe the
relationship between each pair of ordered categories. Father's occupation, education, and
parental income (see Table 2) were dropped from the analysis because of their substantial
association with mother's education.

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males in terms of achievement, particularly in rural areas (CAMPE, 2007;
Raynor, 2005).
As displayed in Table 3, multivariate logistic regression analysis revealed
that
students who took private lessons had double the chance of attaining
higher grades than their counterparts who did not take private les
sons (OR = 2.13; 95% CI = 1.12-4.04);
students whose mothers had secondary education or above were 3.8
times more likely to secure higher grades in English than those whose
mothers did not have any formal education (95% CI = 1.79-8.26);
male students had a tendency to achieve higher grades in English in
the SSC examination than their female counterparts (OR = 1.6, p =
0.087), although this result was not statistically significant;
neither gender nor mother's education was found to be significantly
associated with grades in English in the SSC examination;
for student achievement in the English test, the other measure of the
dependent variable, only PT-E (among gender, mother's education,
and private tutoring) was found to be significantly associated. Students
who had access to PT-E were 2.8 times more likely to secure higher
grades in the English test than those who did not have such access
(95% CI = 1.72-5.03).
The regression analysis thus shows a positive association between PT-E
participation and English achievement, after adjustments for mother's
education and gender. However, each model represented approximately
TABLE 3
Ordered Logistic Regression Analysis of the Association of English Grades and Specific
Predictors

Outcome variables

Secondary School Certificate


English English proficiency test
95% Confidence 95% Confidence
Predictors Odds ratio interval Odds ratio interval
Private tutoring
No 1.0 1.0
Yes 2.13* 1.12-4.04 2.82*** 1.72-5.03
Gender
Female 1.0 1.0
Male 1.62 0.93-2.80 1.21 0.74-2.01
Mother's education
No formal education 1.0 1.0
Primary education 1.87 0.87-4.04 0.61 0.30-1.22
Secondary education 3.84** 1.79-8.26 1.66 0.84-3.30

Note. Value of 1.0 = reference category. * 0.05. ** 0.001. *** 0.0001

293 IN BANGA
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10% of the total variability, which limits the validity of the findings. We
therefore analyzed the qualitative data, in order to explore possible link
ages between factors operating in PT-E in a more fine-grained manner
from the students' subjective perspective.

QUALITATIVE DATA ANALYSIS AND FINDINGS


The interpretive phase of the study aimed to construct, describe, and
analyze the interviewees' perceptions of PT-E. We drew on Potter's (1996)
template for qualitative data analysis, supplemented by the data manage
ment and analysis methods outlined in Huberman and Miles (1998),
Miles and Huberman (1994), and interpretive or qualitative content
analysis (Ahuvia, 2001; Hsieh & Shannon, 2005). In particular, we fol
lowed Hsieh and Shannon's (2005) "conventional approach" (p. 1279)
to qualitative content analysis. Instead of applying predetermined catego
ries, this approach generates categories from the data and is thus
described as inductive category development.
We first present a summary of the interviewees' participation in PT-E
and the different measures of their English achievement in Table 4.
The table serves as a quick reference to individual interviewees, their
family capital profiles,4 the extent to which they took private lessons in
English, and the different measures of their performance in English.
The information about PT-E presented in a descriptive form both verifies
and extends the yes/no responses in the quantitative phase of the study.
Eleven out of 14 interviewees participated in PT-E to varying degrees.
This participation rate (78%) is close to that (75%) for the survey
sample.
Table 4 shows that male and female students were from a range of fam
ily capital backgrounds, from high to low; both groups of students partici
pated in PT-E to varying degrees, and were high as well as low achievers.
In other words, none of these categories showed gendered patterns.
Thus, although we had anticipated that gender might influence the stu
dents' participation in PT-E and consequently their academic achieve
ment, this was not actually the case. The student interview data also
showed that gender was not an issue to this sample of 10th graders.
The process of our data analysis was divided into three subprocesses,
as described by Huberman and Miles (1998): data reduction, data dis
play, and drawing conclusions. First, all 14 interviews were transcribed
verbatim, following the transcription conventions suggested by Richards

4 The family capital profiles (see Table 4) were based on information from student inter
views, student responses to the survey questionnaire, and the first author's notes of the
students' home visits. See Hamid (2009) for the constituents of the family capital profile
categories.

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5.00 3.88 4.50 4.81N/A N/A N/A
4.75 3.31 3.50 5.00

SSC GPA F F

absent

A C A A absent FC C D B
absent

N/A
A+ A+ A A+ A+ B BA+ A+ A A B

Proficiency Grade Actual

English grade test score expected37grade in


52 (A+) 48 (A+) 17(F) 28 (C) 14 (F) 25
17(F) (C) 13 (F) 14(F) 19(F) 14 (F)
27 (C)

(A-) 40 (A-)
(school test) (out of 60) in SSC SSC

A+ A C A+ A D FC F C C A B

TABLE 4

Interviewees' Participation in Private Tutoring in English (PT-E) and Performance in English

but has stopped recently for time constraints.


2 months ago. Took lessons previously,
Takes Description
lessons everyday. Attended coaching,
Has taken lessons at tutor's house throughout
of PT-E
the
Has had a home tutor year. Goes
sincegone
Has
Hastogone
4thtograde.
a tutor
to a coaching
a coaching centre.centre for a year.
for 6 months.
Started taking private lessons 1 month ago.

Takes No private lessons now. Took lessons for Started private lessons at tutor's house
Took private lessons previously No with
Started private lessons private
a tutor lessons now. Took 3 months'
Started coaching a few months ago. Took private lessons for 1 month NeverNever
Took infrequentNever
lessonstook private lessons. tooktook private
private lessons.
lessons.
a month in grade 9. but not regularly.

but has stopped now. lessons in grade 10.


lessons everyday.
1 month ago.
in grade 10.
previously.

Above average
Below average Note. SSC = Secondary School Certificate.
Above average
gender profile
Below average
Below average
High High
Samira F Above average
Neeman M Below average

Name and Family capital low


low low

Sophia F low

Rajib M low
Monir M
Moumi F
Shathi F Mitun F

Tuhin M Kazal M Silan Afrin


M F Tania F Konka F

5wHaHo2 o M or O H aw2:H 2

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(2003). Student responses to questions about PT-E were then located and
highlighted in the interview transcripts. The next steps were reading the
data, making senses, summarizing, and entering them in English on a
word processor. We broadly followed the tactics suggested by Huberman
and Miles (1998) for generating meaning such as noting patterns and
themes, clustering themes, counting, making contrasts and comparisons,
subsuming particular categories into general categories, and factoring.
These techniques generated a small number of key themes/strands in
the interviewees' perceptions of PT-E.

Private Tutoring and Affordability

The analysis and interpretation of the interview data showed that partici
pating in PT-E was common for students in the community. However, the
quantity and quality of this participation were mediated by family affordabil
ity. Table 4 shows that the students from the high and above average levels of
family capital took more private lessons in English than the students from
the below average and low levels of family capital. The three students who
did not take such lessons cited financial reasons; as Sophia noted, "Most stu
dents take private lessons. Only a few don't because they don't have money."
Konka also emphasized financial problems due to which she could not con
tinue private lessons after 1 month:

R: Ok. Have you taken any private lessons in English this year?
K: Yes, Sir.
R: You did?
K: Yes [nods]
R: Ok. For how long?
K: One month.
R: One month! Why did you stop after one month?
K: I had financial problems so I had to stop.
R: I see. Do you think you were benefitted by one month's lessons?
K: Yes, Sir.
R: So you see you took private lessons for a month and you are also
taught English at school. Which one is better in your opinion?
K: Sir, the private lessons are better.
R: Alright. Did you take those lessons from your school teacher, or a dif
ferent teacher?
K: A different teacher.
R: Ok, why are the private lessons better?
K: Sir, we are only five or four girls at the private lessons. [The private
tutor] explains lessons more and clearly. But at school we are a large
number of boys and girls.

In addition, she mentioned the quality and effectiveness of PT-E in rela


tion to school English teaching, which we discuss later as a separate

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theme. Moumi and Tuhin both took more lessons in English than the
other students. They belonged to relatively affluent families, unlike the
other students. Poorer families also did their best to arrange private les
sons for their children. For instance, Sophia's mother was present during
the interview with Sophia. The mother intruded in the interview on sev
eral occasions, and on one such occasion she said:

If I had some poultry, I could sell eggs and give her the money.
She could then pay an English teacher and get some private lessons.

Even if the mother could manage some money by selling eggs, Sophia's
PT-E lessons would not be able to match Moumi and Tuhin's in quantity.

Imperative of Private Tutoring

The students' responses show that they regarded PT-E as imperative.


Tuhin stressed the need for PT-E: "Definitely, one can't do well just depend
ing on schools, without private lessons or coaching." Likewise, Samira and
Silan pointed out that if a student went only to school, he or she could
never do well in the examination. Tuhin pointed this out unambiguously:

R: Are you satisfied with the lessons given by him [private tutor] ?
T: Yes, satisfied.
R: Do you go to any coaching centre as well?
T: Yes.
R: Now [...] do you think you could or would do well in your studies
without the private lessons in English from your tutor and the coach
ing centre?
T: You mean without private lessons or coaching, just depending on
school [English] ? Certainly not.

The imperative for PT-E was described by the students in several ways. The
students who did well in the English proficiency test as well as the school test
( e.g., Moumi, Tuhin, and Samira) said that they could not have done well if
they had not taken private lessons in English. This evaluation was also
reflected by the other students who did not do as well in these tests. When
asked to explain their relatively less satisfactory performance, they explicitly
attributed it to their inability to take private lessons. Afrin, Mitun, Neeman,
and Shathi observed that compared with other students they did not do well
because they could not take private lessons or attend coaching classes. Rajib,
who never participated in PT-E but did relatively well in English, also claimed
that PT-E was essential for students:

R: Is there anything that you consider very important for your studies
but you haven't got from your family? Is there any such thing? Your
family has not given you but it is essential for your studies?

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Rajib: For instance, private lessons, which is . . .
R: [right]
Rajib: Essential, but my family has been unable to arrange for me.

However, Rajib's case does not challenge the value of PT-E. Rajib was a
high-achieving student who had higher expectations in the SSC examina
tion. He made it clear during the interview that he was confident of obtain
ing higher grades in all subjects except English. He pointed out that he
could manage other subjects on his own, even if they were not taught ade
quately, in his view, at school. But he could not manage English on his own
and so he needed PT-E. His performance in the SSC examination reflects
an accurate self-assessment of his self-concept and academic expectations.
Although his GPA5 of 5.00 in the SSC examination was the same as Moumi's,
his grade in English was B (see Table 4). He was thus far behind Moumi,
Tuhin, and Silan, who took PT-E and obtained A or A- in English.
The interviewees reinforced the imperative for PT-E when they were
placed in hypothetical situations during the interview. When asked what
she thought could happen to her studies if their family situations were
not as favourable as they were now, Moumi explained:

Probably I couldn't [do well] because I wouldn't learn much at school.


And if I were born in a farmer's family, my parents could not arrange
private tutoring or coaching for me which I have access to now. (emphasis added)

The hypothetical situation for the interviewees from low-income families


was reversed: If money were not a concern, what measures would you take
to improve your studies in English? Interestingly, the measure that was com
mon to the majority of the students' responses was PT-E:

For example, [I could] take private lessons and I could go to coaching


centres. Then, I could buy the things that I need for my studies. I could
thus sustain my interest in my studies because I didn't have to worry about
money. (Shathi)

Schools and Schooling in English

The poor quality of English teaching at schools, as repeatedly empha


sized by the students, was behind the imperative need for PT-E, as repre
sented by the interviewees:

Private tutoring is needed because of the failure of school in English


teaching. If English was taught properly at school, there would not be any
need to take private lessons. (Monir)

5 Grade point average (GPA) marks the overall performance of students in the SSC examina
tion. GPA 5 is the highest achievable grade point.

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Critiquing school English teaching was a recurrent theme in the data,
where the students consistently expressed dissatisfaction and complaints.
Their critiques also pointed out the causes of poor English teaching.
These causes were both administrative and pedagogical. A common com
plaint was that classes were not held regularly. However, it was not clear
whether lessons were unavailable due to teacher absenteeism or student
absenteeism. More serious causes of school failure in English teaching, as
the students explained, were teacher incompetence and lack of experi
ence, sincerity, and commitment.
The interviewees reacted to the poor quality of school English in vari
ous ways. To some extent, their responses were influenced by their family
socioeconomic conditions. Moumi, Samira, and Tuhin were more critical
of school teaching than the other interviewees, and it is likely that their
more favourable family situations lent force and confidence to their cri
tique. To them school was "a waste of time," because in their view, they
could use their time more efficiently if they stayed at home and took pri
vate lessons from tutors. Their ability to take private lessons all year round
freed them from the need to attend lessons at school; they admitted that
they attended school infrequently. However, it was not clear how they
could stay away from school for an extended period because students of
their age are obliged to attend school regularly.
The other students, whose families were disadvantaged or less affluent,
were also critical of school English, but less so than Moumi, Samira, and
Tuhin. Self-withdrawal from school, for them, was out of the question.
Schools did not fulfill their academic needs in English, but they could
not stop attending school, which they saw as an unhappy necessity:

Now, what else we can do. So, whatever is taught at school, we have to
[be happy with that]. If we had the financial capability, we could take les
sons from other teachers. (Rajib)

It is significant that the students identified poor quality of teaching as a


sufficient reason for not attending school. In their view, the role of the
school is to teach the curriculum and prepare them for the school-leav
ing examinations. This is a very functionalist, pragmatic approach. Their
perceptions suggest little role for the school in socialization in a sense
common in contemporary educational thinking?in introducing stu
dents to the values and practices of the literate world.

Expectations of Private Tutoring in English

The students, then, expected that PT-E would help them to learn the
language as well as to obtain higher grades in English in the SSC exami
nation. They stressed that English was required for their future education

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and careers, and showed strong motivation for learning the language.
However, it was mainly the expectation of good grades?the highest for
the more capable and ambitious students and average for the struggling
ones?that drove them to PT-E. This explanation is confirmed by several
factors. First, it is a commonplace in Bangladeshi society that students are
as good as their grades; it is also their grades which are valued above all
in higher education and the job market. Second, PT-E, which is examina
tion-oriented, tends to teach within the curriculum of the school-leaving
tests. This social expectation of good grades provided the students with a
framework where they viewed the schools as syllabus-teaching, examina
tion-preparing institutions. This framework also helps to explain the stu
dents' comparative evaluation of mainstream schooling in English and
PT-E, which we illustrate in the next section.

Effectiveness of Private Tutoring

Did PT-E-participation fulfill students' expectations of good grades in


English? As previously noted, the interviewees gave high priority to PT-E,
which they found interesting and helpful for learning English as well as
for examinations. PT-E lessons were both individualized and examination
focused, which assessed their progress toward examination preparation
every week. However, their strong support for PT-E, and its effectiveness
as understood from their perceptions, were not fully corroborated in
their test performance. Although there were positive links between PT-E
participation and measures of English achievement, these links were not
very strong (see Table 3). Moreover, despite their participation in PT-E to
varying degrees, there were consistent gaps between the grades that they
had expected and the grades that they actually obtained in the high-stakes
examination (Table 4). For instance, although six students had expected
A+, none of them obtained this grade in the SSC examination. There can
be several explanations for this gap. First, it points to the fact that although
higher grades are highly valued in society and are thus socially desirable,
rural schools (and PT-E in rural areas) simply do not have the required
standards or resources to prepare students adequately for their expected
grades in the national school-leaving examinations. Second, the business
orientation of PT-E, particularly in its institutional form, might have led
students to expect higher grades than their real potential suggested.

Private Tutoring Versus Mainstream Schooling


It is this perceived or experiential evaluation of PT-E on the one hand,
and their narrow view of schooling on the other, that provides key insights

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into the interviewees' comparative evaluation of mainstream schooling and
PT-E. This comparison is a recurrent theme in the data. Like Konka, Silan
also illustrates this theme:

R: So how do you like the lessons there [at the coaching centre you go to] ?
S: I really like them there. Better than at school.
R: Ok, but why do you like it more than school teaching?
S: I like it there because the Director [of the coaching centre] has
appointed reasonably good teachers. They are good teachers.
Teaching is done by highly educated teachers.
R: Highly educated means?
S: They are actually college teachers.
R: That means, you are saying that college teachers are more efficient
than your school teachers?
S: Yes, I think so.

The students noted that PT-E was more effective than school English, and
given their perceived low evaluation of the latter, in an either/or choice
they would prefer PT-E to mainstream schooling. This preference was
turned into action, as exemplified by Moumi, Samira, and Tuhin, who
relied more on private tutoring than on school-delivered instruction.
Their example, however desirable in terms of examination results, could
not be followed by other students because they could not afford PT-E
throughout the year, and thus they had to keep attending school, will
ingly or unwillingly.

DISCUSSION
The quantitative analysis shows that there was a positive association
between the students' participation in PT-E and their academic achieve
ment in English, as measured by their scores on the proficiency test and
their grades in the SSC examination. However, each regression model
explained a smaller proportion of variability, which limits the validity of
the findings concerning the links between PT-E and academic achieve
ment. The qualitative phase of the study, on the other hand, shows unam
biguous and consistent patterns in students' perceptions of PT-E. What is
particularly important to note from our interview data is that PT-E has
become a common?even a default?socioeducational phenomenon,
which was desired by secondary students irrespective of gender, family
socioeconomic conditions, and parental characteristics. Our data thus
corroborate the positive attitudes of students toward PT-E in Khuwaileh
and Al-Shoumali (2001) in Jordan. In both studies, grades are strong
motivators for student participation in PT-E.
The participants in the current study saw PT-E as not only imperative,
family circumstances allowing, but also preferable to school English

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teaching. This was particularly the case with students from more affluent
families who could afford PT-E all year round. Thus PT-E in the present
context can be argued to overshadow the formal system in quality and in
terms of the returns for investment of resources and energy, at least in
the perceptions of these students. Interestingly, not a single interviewee
was critical of PT-E. Even those students who did not participate in PT-E
were positive about its effectiveness.
Integrating the findings from the two phases of the study suggests
some useful insights. First, it is the students' perception of the effective
ness of PT-E?which may or may not be related to its actual effective
ness?that most of all motivates them to undertake PT-E. By default, they
place their faith in PT-E because they consider that school English teach
ing is inadequate. Our data also suggest that there is a social chain effect
which reinforces the popularity of PT-E. The interviewees frequently
referred to other students in their cohort who had been taking PT-E;
other students' participation in PT-E exerted social/peer pressure on
them to believe that PT-E was necessary for enhanced learning and
achievement; if it were not, then their classmates would not participate in
it. Finally, it is the social expectation of good grades, as previously argued,
which coloured their perceptions of PT-E and schooling. Based on these
perceptions, we can conclude that the students gave an enhanced assess
ment of the value or effectiveness of PT-E on the one hand, and gave a
lower assessment of the role of school in learning English and passing
examinations on the other.
The popularity of PT-E in the present context, then, can be attributed
to these socioeducational and psychological issues, in which the actual
effectiveness of PT-E remains relatively less prominent. Even though our
interviewees emphasized that PT-E was superior to mainstream school
ing in English, their evaluation was subjective, attitudinal, or experien
tial, or derived from second-hand reports. In some cases, this reflected
the real effect of PT-E on learning or achievement; in others it clearly
did not.
Khuwaileh and Al-Shoumali (2001) found that among other reasons,
the Jordanian university students took private lessons in English to dis
play their social class and prestige. Our students' perceptions of private
tutoring did not suggest such social prestige issues. One explanation is
that most students belonged to low-income families in a disadvantaged
locality. A more plausible explanation, however, is that PT-E is viewed as a
need rather than a luxury in the Bangladeshi context: as a necessary con
dition for academic success. Students from affluent families participated
more in PT-E than other students. However, their higher rate of partici
pation was motivated by expectations of higher returns which suited their
class interests, and contributed to parental satisfaction that they were

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doing their best for their children's education (see Lynch & Moran,
2006). That PT-E is a necessity and not luxury is also attested by the fact
that our participants did not raise questions relating to English teachers'
professional ethics in relation to the teachers' participation in delivering
PT-E lessons. The students accepted the reality that PT-E was indispens
able for students as well as for teachers: for students because schools
could not guarantee good grades in English, and for teachers because
they needed the extra income.

IMPLICATIONS AND FURTHER RESEARCH


As an investigation into the relatively underresearched area of PT-E,
the current study measured student participation in PT-E in terms of
binary yes/ no responses in the quantitative phase. Our results will make it
possible for subsequent research to conduct quantitative research with
more focused and discriminating categories of analysis, for instance to
investigate the dimensions of type, quantity, intensity, and quality in PT-E.
Our strategy to access more detailed information about PT-E emerged in
the qualitative and interpretative phase, which yielded clear patterns in
the students' perceptions of PT-E. Overall, the insights generated by the
two phases of the study imply that the policy and practice of mainstream
English teaching and research on PT-E in Bangladesh are in need of sub
stantial review. PT-E is widespread; it is highly regarded by the students. It
is desired by educational consumers, and is seen as a default, family cir
cumstances permitting, for secondary students. The mainstream school
system, on the other hand, is regarded as second best. PT-E, by the mere
fact of its existence, prestige, and success, is therefore exerting pressure
on the school system, which will need to find a way of responding to its
out-of-hours partner, and of establishing a viable role and profile in the
context of overall English language education.
If the national policy is committed to equality of opportunity, then the
balance between the school system and PT-E will need to be redressed.
That would require a substantial increase in investment in public educa
tion (Hamid & Baldauf, 2008), in order to provide an incentive for par
ents to place their resources for enhanced learning in the public, rather
than the private, sphere, the better to enhance teaching, learning, facili
ties, and infrastructure. The mainstream system would need to develop
mechanisms for remedial teaching. English teaching skills, as well as the
status and morale of teachers in the school system, need to be reinforced
if it is to reassert its position vis-?-vis the PT-E system.
It is highly unlikely that the popularity of PT-E will decline dramati
cally in the near future. The middle class will continue to invest in their

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children's education to help them secure a competitive advantage in
education and in the job market. Education experts and social policy
makers need to think seriously about ways of supporting students
from low-income and disadvantaged backgrounds, so that they are less
disadvantaged in the competition with their peers from more affluent
families.
At the same time, there is a need to inform and educate students and
parents about the realistic expectations of PT-E. Insights from the current
study highlight this gap between expectation and reality. As Table 4 sug
gests, despite their participation in PT-E, none of the students were able
to obtain the grades in English in the SSC examination that their school
examination would have led them to expect. Neither the school system
nor the PT-E system, either individually or in combination, was able to
deliver this result.
The current study has shown how, in less affluent societies, the popu
larity of PT and PT-E can be attributed to a set of social, psychological,
and institutional factors, among which the effectiveness or outcome of
private tutoring is only one of several operational considerations. It will
now be possible for more extensive investigations, in both quantitative
and qualitative terms, to verify these parameters of private tutoring on
the one hand, including its learning outcomes, and its standing in the
students' and parents' perceptions on the other.
Exploring the nature of PT-E and the factors contributing to its popu
larity in a disadvantaged context in Bangladesh is important for TESOL
on pedagogical as well as contextual grounds. Pedagogically, the learning
of English in Bangladesh is shown to have a complex relationship with
PT-E because of the demonstrably unsuccessful performance of the
school system on the one hand, and the virtual absence of appropriate
self-study resources on the other. Contextually, it shows how English in a
country with limited and not very satisfactory teaching performance out
side the larger cities (e.g., Dhaka) places strains on curricula, family
resources, parents, and school learners. Less affluent areas, where the
imperative of English not only encourages the practice of PT-E but also
creates tensions between the formal system and the informal system, and
makes parents and students find balances between them in the context of
resource constraints, are highly relevant to an international perspective
on TESOL.

ACKNOWLEDGMENTS

The authors are grateful for the contribution of Richard Baldauf and Nanette
Gottlieb, and for the comments and suggestions of three anonymous reviewers and
the Editor's feedback, which were invaluable in revising the article.

304 TESOL QUARTERLY

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THE AUTHORS
M. Obaidul Hamid teaches English language and applied linguistics at the University
of Dhaka, Bangladesh. He has submitted his PhD thesis at the University of
Queensland, Australia. He is interested in the sociology of English learning, cultural
politics of English, and English language teaching in Bangladesh.

Roland (Roly) Sussex is professor of applied language studies at the University


of Queensland. His research is located in the triangle formed by language, society,
and technology. He has had a long involvement in issues of language teaching and
learning, languages in contact, bilingualism, and language policy, especially in
Australia.

Asaduzzaman Khan is a senior lecturer in statistics at the University of Queensland.


His most recent research and publications focus on various topics relevant to statisti
cal modelling, program evaluation, assessment in education, determinants of health
and social well being, and health care management in primary care settings.

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