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
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.
Thursday, 20 April 2017
Non-communicable diseases (NCD) constitute a major challenge for the low- and middle-income (LMIC) countries. Globally, the NCDs are receiving increasing attention from the policy-makers and practitioners, as reflected in the new 3.4 Sustainable Development Goals (SDG) target (“reduce mortality from NCDs and promote mental health”). The LMICs like Bangladesh are fast undergoing “epidemiological transition”, thanks to the spectacular success of modern medical science, substantial control of the communicable diseases from improved water and sanitation, and economic development. So far so good! But, the flip side of the coin is that these countries are becoming “old before they are rich”, and burdened with the rapid rise of non-communicable diseases (NCDs). Bangladesh is no exception. This is posing a major challenge to its existing health systems (primarily geared to address communicable diseases of women and children) as the government is yet to pick up the momentum for the ever expanding needs for policies and plans, services, and infrastructures for preventing NCDs.
Bangladesh Health Watch, a civil society initiative since 2006, is producing analytical reports on issues related to improvement of the health system from a critical perspective, and do the relevant advocacy activities. So far, five reports on equity (BHW, 2006), health workforce (BHW, 2007), governance (BHW, 2009), universal health coverage (BHW, 2011), and urban health (BHW, 2014) have been published. In 2016, this emerging problem of NCDs for health and health system of Bangladesh in the era of the SDGs is taken up for analysis and discussion. We limited our inquiry to the four major NCDs responsible for major chronic disease burdens e.g., cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases. Each NCD is discussed critically around four central themes: current epidemiology and prevalence of risk factors, existing policies and strategies including challenges of implementation, inventory of ongoing NCD programmes and finally, an assessment of the current health infrastructure preparedness vis-a-vis addressing the challenge of NCD management in the coming years. Based upon these, challenges are identified and recommendations made for addressing the NCD agenda in Bangladesh in the context of universal health coverage and SDGs.