Welcome to my Public Health World of Bangladesh!

Welcome! If you are interested about the health and health systems of Bangladesh, its problems and prospects, you have come to the right place! Be informed...

Sunday, 5 November 2017

Countdown on health and climate change: Report of the Lancet Commission

In a freshly released Lancet Commission Report (published online 30 Oct. 2017), monitoring data on health impacts of climate change in the past 25 years are presented for 40 indicators identified in the earlier Lancet Commission of 2015. Some of the key findings of the report include 1) climate change and increasing global warming are affecting the health of the population,  the vulnerable population in the LMICs are being affected disproportionately; 125 million more vulnerable people over the age of 65 years were exposed to heatwaves in 2016 than in 2000. This is effecting their earnings as data showed that Global labour capacity of rural dwellers such as farmers, has fallen by 5·3% from 2000 to 2016 due to rising temperatures and the inability to work when it's too hot. 2) most of the indicators tracked since the UN Framework Convention for Climate Change (UNFCCC) in 1992, the adaptation and mitigation efforts have been quite slow, with increase in carbon emissions and global temperature and only modest improvement in reduction of carbon emission from electricity generation occurred due to continued burning of Coals (while coal use increased globally since 1990, it appears to have peaked in 2013 and is now declining due to decision by a growing number of countries have committed to ensuring coal is completely phased out over the next decade); a particularly severe heat wave in the summer of 2003 resulted in more than 70 000 excess deaths across Western Europe; air pollution from a range of sources contributed to over 1·9 million premature deaths across southeast Asia in 2015 

Tuesday, 8 August 2017

The private retail drug shops market in Bangladesh is largely unregulated and unaccountable, giving rise to irrational use of drugs and high Out-of-pocket expenditure on health. These shops are served by salespersons with meagre or no formal training in dispensing.This facility-based cross-sectional study was undertaken to investigate how the drug shops currently operate vis-a-vis the regulatory regime including dispensing practices of the salespersons, for identifying key action points to develop an accredited model for Bangladesh.  About 90 rural and 21 urban retail drug shops from seven divisions were included in the survey. The salespersons were interviewed for relevant information, supplemented by qualitative data on perceptions of the catchment community as well as structured observation of client-provider interactions from a sub-sample. 

In 76% of the shops, the owner and the salesperson was the same person, and > 90% of these were located within 30 minutes walking distance from a public sector health facility. The licensing process was perceived to be was cumbersome, lengthy, and costly. Shop visits by drug inspectors were brief, wasn’t structured, and not problem solving. Only 9% shops maintained a stock register and 10% a drug sales record. Overall, 65% clients visited drug shops without a prescription. Forty-nine percent of the salespersons had no formal training in dispensing and learned the trade through apprenticeship with fellow drug retailers (42%), relatives (18%), and village doctors (16%) etc. The catchment population of the drug shops mostly did not bother about dispensing training, drug shop licensing and buying drugs without prescription. Observed client-dispenser interactions were found to concentrate mainly on financial transaction, unless, the client pro-actively sought advice regarding the use of the drug.  

Knowledge and practice of qualified physicians regarding management of tuberculosis in Bangladesh: are they following the national guidelines?

  From a forthcoming paper

This study explored current knowledge and practice of in-service trainee physicians (interns) and general practice physicians (GPs) regarding management of tuberculosis cases according to the TB DOTS (Directly Observed Treatment, Short course) guidelines of the National TB control Programme (NTP). The study was conducted during first quarter of 2013 in conveniently selected 20 public and private medical college hospitals. Relevant data were collected from interns working in these hospitals (n=1,474) and GPs (n=539) practicing within half kilometer distance of these hospitals, using a self-administered questionnaire. About 75% physicians were  knowing about community based DOTS programme, but only 36% knew the details. Around 40-60% of the physicians treated TB suspects with non-specific antibiotics, 39-44% advised for further tests and a 37-50% did not refer TB patients and suspects to the nearest DOTS corner. Around 39% of the physicians perceived that current curriculum was not conducive for managing TB suspects and patients, and 75% reported that they sought TB information beyond classroom. 

Wednesday, 7 June 2017

On the march towards UHC in Bangladesh!

We are aware about the recent laudable performance of Bangladesh in achieving the health related MDGs in the country, despite the existence of a health system frequently characterized as ‘weak, fragmented and poorly resourced.’ During the last decade, Bangladesh has managed to expand health service coverage, reduce disease burdens, and improve overall population health outcomes, at a ‘low cost’ compared to its neighbours of comparable socioeconomic conditions. Key to these changes has been sustained commitment for health sector over the years in situations of political unrest, economic crises, and natural disasters. Consistent and coordinated policy and programme inputs in the health sector, investments enhancing women’s empowerment (e.g., girls’ education, microcredit, and garments manufacturing), interventions for WASH and poverty reduction, improving nutrition and food security, and infrastructure development (e.g., roads and highways improving accessibility) played key roles in attaining such achievements.

Activities facilitating UHC in Bangladesh has gained new momentum following the commitment of the Prime Minister in the 64th World Health Assembly in May 2011 to achieve universal health coverage (UHC) by 2032. Some strategic initiatives undertaken since then include the formulation of the Health Care Financing Strategy 2012-2032, Communication strategy for UHC 2014-2016, and Bangladesh National Health Accounts 2015. Further, the National Health Policy which was first promulgated in 2000 has been revised in 2013/14 incorporating the principle of the ‘right to health’ for all. Besides, the Health Workforce Strategy 2015 and the Health Protection Act 2014 are finalized for implementation.

The support of the Rockefeller Foundation through its Transforming Health Systems (THS 2010) initiative in 2009 (RF) (to facilitate UHC in LMICs countries like Bangladesh through a ‘multi-pronged’ approach) was crucial in taking up the above initiatives. A recently published Working paper delineates how investments in strategic areas of health sector in the initial stages can generate a momentum for UHC in a LMIC like Bangladesh. To further catalyse the process, RF funded the establishment of the Centre of Excellence for Universal Health Coverage (www.coe-uhc.org) in 2011 at the JPGSPH, BRAC University. The centre works to generate essential evidence on UHC in the context of Bangladesh, develop core competencies for implementing UHC, and provide a forum for disseminating and sharing knowledge, experiences and best practices around UHC and related issues.