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...

Wednesday, 8 September 2021

Trauma Registry and Trauma System Improvement Project (TSIP)

 

Bangladesh is currently undergoing an epidemic of road traffic accidents (RTAs) and hardly a day passes without a report of such an incident in the media. The latest Global Status Report on Road Safety registered some improvements for Bangladesh concerning safer roads and mobility and safer vehicles but poor performance in areas like gathering accident data, safer road users and post-crash care. A recent Rapid Review found the near absence of pre-hospital care and poor hospital-based care for the victims of the Road Traffic Crashes (RTC) which needs to be addressed urgently if we are to reduce morbidity and mortality from the RTAs.

The importance of Trauma Registry ("a collection of data on the incidence, diagnosis, and treatment of trauma victims that (should) drive a performance improvement program for the care of an injured patient,") for improving trauma care from RTIs and reduce mortality and morbidity, especially in the LMICs cannot be overemphasised. The trauma registry has been an invaluable tool for informing the design of quality trauma care system including planned allocation of resources and injury surveillance over time. However, its implementation in the LMICs face many barriers and challenges, the solutions of which need to be contextualised to the particular situation of a country. The commonly identified barriers include: data quality including missing data, lack of resources, insufficient pre-hospital care, and difficulty with administrative duties and hospital organisation. A Trauma System Improvement Programme (TSIP) informed by a Trauma Registry, and which builds on the existing emergency services, has a better chance of success due to buy-in from the relevant stakeholders, incremental changes that are acceptable and less costly, and contextualised to the real-life situation of the country in question. There are many models of TSIPs in the LMICs but all have some common components: systematic needs assessment involving relevant stakeholders, co-ordination of different components, and corrective actions to address system weaknesses to improve current system.

Thursday, 25 February 2021

Assessment of post-crash care system following road traffic accident in selected areas of Bangladesh

 

Bangladesh is currently undergoing an epidemic of Road Traffic Crashes (RTC) and hardly a day passes without a report of such an incident in the media. The annual road crash deaths per capita in Bangladesh are twice the average rate for high-income countries and between 1990 and 2017, the increase in the road crash fatality rate per capita was three times higher in Bangladesh than that across the South Asia region[1]. The levels of mortality and morbidity are quite high and the economic loss from RTC is estimated to be around 2 to 3% of the gross domestic product (GDP)[2]. Thus, the issue has become both a public health concern as well as a development challenge…

 

The achievements of Bangladesh in the UN road safety decade have been mixed and not to the expectation, mainly due to an unruly transport sector and lack of strategic investments and governance. A new Road Transport Act 2018 (approved in October 2018), replaced the Motor Vehicle Ordinance of 1983 after long deliberations. It also has a National Road Safety Strategic Action Plan that has recently been updated to 2020 with a vision of fulfilling the SDG target 3.6 of reducing the deaths and disabilities to around 50% by 2020. However, substantial gaps remain for improving vehicle safety, road user safety regulations, and post-crash response services…

The study assessed the current pre-hospital and hospital-based post-crash care services to get a holistic picture of the post-crash system existing in Bangladesh… A cross-sectional study design was applied, with a combination of approaches that included: a) Rapid review of literature on existing post-crash care in the country; b) pre-hospital and hospital-based trauma care assessment guided by WHO tools and on-site verification; c) qualitative studies [e.g., key informant (KIIs) and in-depth interviews (IDIs) with stakeholders, informal/focus group discussions (FGD), and observation] to elicit perceptions and experiences of the key stakeholders and have their insight regarding the opportunities and challenges of designing a state-of-the-art post-crash care system in the country…

 

The study population covered both supply and demand sides for pre-hospital and hospital-based trauma care assessment. In the demand-side, the study population included community people, RTC victims/ caregivers. In the supply-side, the study population included service providers, facility authorities’ and relevant key stakeholders from the local and national level. The study population also included public and private ambulance service providers in pre-selected areas.

 

Wednesday, 2 December 2020

Research and Innovation in the Bangladesh Pharmaceutical sector

 

Introduction

Bangladesh, a low middle-income country, developed a burgeoning pharmaceutical sector thanks to its pioneering Drug Policy of 1982.[1] Now it claims a market share of around 98 % of total drug sales compared to 25 % before the National Drug Policy was enacted in 1982. Specialized products like ant-cancer drugs, vaccines and hormonal preparations are imported to meet the remaining demand. According to the Bangladesh Association of Pharmaceutical Industries (BAPI) and Directorate General of Drug Administration (DGDA), approximately 257 licensed pharmaceutical manufacturers (allopathic) are operating in Bangladesh and about 150 are functional[2]. Currently, it is the second-highest contributor to the national exchequer (1.83% to GDP in 2017-’18) after the Readymade Garments industry. The industry is largely protected from external competition and is projected to grow beyond US$ 6 billion by 2025, with an export potential of US$ 450 million.[3] It currently exports to 144 countries including the UK, EU and USA.

 

Current Scenario and R&D vulnerability

Though there are around 150 functional manufacturers, the pharmaceutical market in Bangladesh is highly concentrated and limited to a few big companies. The top ten companies have 70 % of the market share and the top 20 have 78 %. Eighty per cent of the drugs produced are generic and 20% are patent drugs. Bangladesh pharmaceutical sector enjoys the benefits of TRIPs i.e., exempted from patent protection by WTO for an extended period until 2033.

This comfort zone has produced a kind of vulnerability related to investments in R&D, found to be highest in the pharmaceutical sector in Bangladesh consequent on TRIPS agreement[4].  A recent study on the relationship of R&D investments and firm performance concluded that “investors of Bangladesh do not consider R&D expenditure to be a creator of innovation rather they seem to be affected negatively in their assessment of the firm’s financial condition by R&D expenditure”.[5] The study found 80% of the sampled farms below average levels of innovativeness. “The tendency has been to utilise the TRIPS flexibilities to reverse engineer existing products and focus on earning quick money rather than going for long-term investment keeping future strategic interests in the focus”.[6] The top 30 local companies have well-equipped product development (PD) department instead of full-fledged R&D.[7] As pharmaceutical companies shy away from innovativeness, it will become difficult for them simply to rely on producing generic medicines in the long term.

 

Friday, 16 October 2020

Skills demand analysis of institution and home-based supplementary health care services in Bangladesh, 2020

The health system of Bangladesh is characterized by “shortage, inappropriate skill-mix and inequitable distribution” of its health workforce which is essential for improving health outcomes and health status of a country (Ahmed et al. 2011). It is also among the 57 countries with a critical shortage[1] of health workforce (WHO, 2006). The prevailing COVID-19 pandemic situation has exacerbated this already vulnerable situation. Besides doctors and nurses, the country is experiencing critical shortages of medical and nursing aids, medical technologists and technicians, and various categories of health workers who provide physiotherapy, elderly and disability care and palliative care including home-based care.

Thus, this situation is both a crisis and an opportunity for building an “adequate health workforce” as an investment in the health workforce is increasingly being recognized as a generator of employment opportunities, especially for women, and a facilitator for inclusive economic growth (Buchan, Dhillon and Campbell, 2017). A survey was done with the following objectives to explore a) types of health care services in demand in the pandemic situation; b) emerging employment opportunities for providing these services, including home-based services; c)  the responsible authority tasked with certifying such cadres and the probability that they would certify the future emerging cadres; d) the availability of trainers for current and probable new courses; e) current entry requirements for the existing courses and probable requirements for the new courses, and finally, f) the health care organizations that are likely to expand their business during and beyond COVID-19 pandemic. To address these objectives, it adopted a cross-sectional design to elicit relevant information 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.