Skills and need for institution and home-based supplementary health care services in post-pandemic Bangladesh

 

The unprecedented pandemic of COVID-19, a classic ‘low probability, high impact’ event, has shaken both developed and developing countries alike with its adverse health and livelihood consequences. The demand for an appropriately trained and motivated health workforce has been phenomenal during this crisis. As such, the global shortage of health workforce has come to the forefront of discussion, including measures to overcome this for the necessary surge in capacity under resource constraints.

Before the pandemic, Bangladesh was among the 57 countries with critical shortages of health workforces. Its health system is characterised by a “shortage, inappropriate skill-mix and inequitable distribution” of the health workforce. The COVID-19 pandemic has exacerbated this already vulnerable situation. Besides doctors and nurses, the country experienced a critical shortage of medical and nursing aids, medical technologists and technicians, and various categories of health workers who provide physiotherapy, elderly care, disability care, and palliative care, including home-based care. This situation can be considered both a crisis and an opportunity, especially for generating employment for women and facilitating inclusive economic growth.

A study was conducted in late 2020 to explore the types of healthcare services in demand during a pandemic situation, emerging opportunities to provide these services at home and institutions, and the training and accreditation of healthcare workers for specific services. Under the ongoing pandemic situation,  telephone-based interviews were conducted to gather relevant data from the respondents The study  adopted a cross-sectional design and applied a combination of a) rapid review, b) quantitative assessment using a semi-structured questionnaire, and c) qualitative assessment (e.g., key informant interviews (KII)) with the stakeholders) using interview guidelines.

Factors influencing job satisfaction of CHWs in Bangladesh

 

Community Health Workers (CHWs) play a crucial role in countries like Pakistan (43%), India (46%), and Bangladesh (42%) in promoting health, preventing diseases, providing curative care, and offering referral services at the primary healthcare (PHC) level, especially in remote areas. Bangladesh’s health system is supported by about 3.8 CHWs per 10,000 people across public, private, and NGO sectors who are the primary point of contact with the health system and the backbone of Bangladesh's PHC system. Frequently, these CHWs are overloaded with various programme activities and need incentives and remuneration for motivation. To strengthen the PHC system in Bangladesh, understanding these motivators that determine CHW job satisfaction is essential for optimum performance and retention over time.

A cross-sectional convergent parallel mixed-method study collected census data from four sub-districts (upazila) from four corners of the country (Sulla, Tetulia, Chowgacha and Teknaf), This was supplemented by in-depth interviews (IDIs), Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with CHWs, their supervisors and relevant key stakeholders . CHWs came from the public, private, and NGO sectors and the study explored their job satisfaction factors.

Progress of health-related SDGs in Bangladesh: A mid-term evaluation study

(excerpts from proposal)

The 2030 Sustainable Development Goals, i.e., the SDGs have 17 Goals and 169 targets, was passed by UN General Assembly on 25 September 2015, and crafted the path of development for the next 15 years. Health is a key component of these goals (SDG 3), prioritizing healthy lives and promoting well-being for all to achieve universal health coverage (UHC). SDG 3 has 13 targets, with UHC at its centre, and is linked to many other goals and targets in an integrated manner. In order to move towards UHC, WHO recommends reorienting health systems using a primary health care (PHC) approach. ‘PHC is central to achieving UHC and health-related SDGs as enshrined in the 2018 Astana Declaration and WHO’s South-East Asia regional strategy’ respectively.

 

Thanks to the “pluralistic” health system, Bangladesh has made remarkable progress in human health and well-being rapidly in recent times, under resource constraints. This has also been reflected in the last SDG progress report. For example, under-five mortality declined from 36 per 1,000 live births in 2015 to 29 in 2018, and the neonatal mortality rate decreased from 20 in 2015 to 16 per 1,000 live births in 2018. This progress aligns with the Global Action Plan (GAP), which identifies seven accelerator themes (‘SDG accelerators are initiatives voluntarily undertaken to accelerate the SDG implementation by governments and any other non-state actors - individually or in partnership’) for advancing health-related SDG targets.

 

Bangladesh has made remarkable progress in human health and well-being in recent decades, however, there has been stagnation in the last decade, as reflected in various surveys conducted for assessing, e.g., maternal and neonatal health (MNH). These surveys also identified shortfalls in the quality of care (QoC) offered at Bangladesh’s primary health care (PHC) level. Globally, QoC is of concern as “more deaths in low- and middle-income countries are now occurring as a result of poor-quality care than owing to a lack of access to care”. Also, the rapidly changing socio-economic conditions in Bangladesh, urbanisation and population ageing have led to a shift in disease patterns and increased the burden of NCDs, another emerging public health problem in the country.  NCDs like hypertension (HTN) and diabetes mellitus (DM) put enormous pressure on health systems and society and risk congesting primary care and referral facilities while causing high out-of-pocket (OOP) expenditure for patients. PHC has been positioned as the cornerstone of the universal health coverage (UHC) movement. It emphasizes a “whole-of-government” and “whole-of-society” approach to health and combines “multisectoral policy and action, empowered people and communities, and integrated health services.