Lab on the paper

 

According to the World Health Organization (WHO), a counterfeit medicine is a pharmaceutical product “which is deliberately and fraudulently mislabeled with respect to identity and/or source”. This definition of counterfeit medicines falls within the broader concept of “substandard medicine” but the two categories should not be confused. The category of substandard medicines includes medicines that may present an unintentionally incorrect package or have an incorrect quantity or ratio of ingredients. The difference with counterfeit medicines is that substandard medicines may not have an intentional attempt but result from inaccurate production due to inadequate resources and structures. Globally 10–15% of the supplied medicines are counterfeit. The prevalence is higher in developing countries in where up to 30–60% of medicines on the market are counterfeit. India is a major supplier of poor quality medicines producing 35–75% and China 20% of fake/counterfeit medicines globally. 

Counterfeit/sub-standard/poor quality medicines are a major cause of therapeutic failure, serious adverse events, deaths, economic burden, medicine resistance, and loss of public confidence in medicines and health services. Many factors contribute to the increased prevalence of substandard and counterfeit medicines, including corruption.  Besides, weak or absent medicine regulatory authority, proliferation of small pharmaceutical companies, complex transactions involving many intermediaries, a lack of good manufacturing practices (GMP) are other reasons in most developing countries. Though the WHO has issued guidelines for combating Counterfeit/sub-standard/or poor-quality medicines, most developing countries are struggling to implement them.

Bangladesh context

In Bangladesh, where out-of-pocket healthcare expenditure is high for medicines, counterfeit/sub-standard/low-quality medicines pose a greater threat to public health. Such medicines range from pain killers to antibiotics to even anti-cancer medication. According to a media report in 2009, 24 children died of acute renal failure after taking adulterated Paracetamol syrups made by a local medicine company.  Diethylene glycol, a chemical used in the dyeing and leather tanning industries, was detected in the syrup. In the same year, government authorities visited 193 pharmaceutical companies, examined their performance levels, and divided them into A, B, C, D, E and F categories. According to their report, companies ranked A-C produced medicines in compliance with the GMP, an international standard for medicine quality control; those ranked D-F did not. 

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.