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.

Bangladesh’s current health sector programme is coming to an end in 2024, and a new 5^th Health Sector Programme is being developed. To inform its design, a review of the past programmes was carried out which found that the progress on health indicators is not uniform across the different regions in the country. For instance, divisions like Sylhet and Chattogram are lagging behind the other divisions. The GoB and World Bank are therefore preparing a strategic Program-for-Results Financing project (PforR) to support the transformation of Bangladesh’s PHC system with a focus on MNH and NCD services, adapt these to climate change, and strengthen the MIS targeting these two divisions.

The Lancet Global Health Commission on High-Quality Health Systems advocated for ‘service delivery redesign’ (SDR), a foundational improvement strategy that rationalises the health system so that high-quality services are provided at the right level, by the right provider, and at the right time to optimise outcomes. The current study aimed to explore and understand the current situation of health service delivery at different tiers of the healthcare system, including provider knowledge and performance and patient satisfaction, to weigh in on redesign solutions for PHC service delivery related to MNH and NCDs. The findings are expected to inform both the government's next health sector programme and the PforR project in Chattogram and Sylhet. 

From Executive Summary of the draft report on

“Health system assessment for system-level quality improvement in Bangladesh”

by BRAC JPG School of Public Health, BRAC University