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.

 

Blood transfusion (whole blood and components of blood) has become a critical healthcare service and has gained the status of essential medicine, especially in the LMICs. Blood transfusions are critical for treating severe anaemia, maternal haemorrhage, trauma-related injuries, supporting surgeries, managing chronic conditions, and improving overall healthcare quality. Despite their importance, there is a significant global shortage of blood and blood products, particularly in LMICs like Bangladesh, which requires over 900,000 units of blood annually. Currently, there are 204 BT centres in the public sector and 164 in the private sector in Bangladesh . These BT centres provide screened whole blood; only 24 centres provide blood components (e.g., packed blood cells, platelets and plasm concentrates).