Antenatal care, postnatal care, under-5 vaccination, healthcare of emergency and chronic illness patients, elderly people and persons with disabilities suffered worse
A rapid assessment on the situation of essential healthcare in Bangladesh during the Covid-19 stresses that a number of areas of public health need enhanced effort to continue the fruits the nation had gained until the pandemic broke out last year.
According to the study report, pregnant mothers, mothers with newborns, vaccination of children below five years of age, patients needing emergency care and those with chronic illnesses, elderly people and persons with disabilities are suffering worse than others in terms of healthcare services during the ongoing pandemic situation. To remedy this situation, the report recommends that multi-faceted initiatives should be undertaken on a short and long term basis.
The findings and recommendations of the study titled “Impact of COVID-19 on Essential Health Services in Bangladesh: A rapid assessment” were shared at an online event organised by BRAC today on Sunday (11 April 2021). BRAC’s Advocacy for Social Change programme and Bangladesh University of Health Sciences (BUHS) conducted the study, which was commissioned by BRAC’s Health, Nutrition and Population Programme (HNPP).
Professor Meerjady Sabrina Flora, additional director general (planning), Directorate General of Health Services (DGHS),and Asif Saleh, Executive Director, BRAC were in presence as Chief Guest and Special Guest respectively.
In her speech, Professor Meerjady Sabrina Flora said covid-19 not only created sufferings for coronavirus patients or non-covid patients only, but it has also affected the government’s successful health programs and disease prevention programs as well.
“Along with the general people, the government wants to work together with committed associate organisations not only for covid-19 containment, but also to ensure essential healthcare facilities for all where partnering organisations will have equal partnership in the process being led by the government,” she said.
BRAC executive director Asif Saleh said, “Strengthening of the community system has become extremely important since covid-19 is not going away within two or two and a half years. BRAC wants to work in the field of prevention, protection and mobilisation.”
He also said, “Last year, we worked on community mobilisation in Gazipur and later expanded the service in six districts with support from FCDO. The project brings fruitful outcome as the transmission rate is lower in the districts now and the rate of vaccination is comparatively higher. Now, we want to spread this program to the areas across Bangladesh, particularly in areas where transmission rate is higher. Also, BRAC is ready to provide technical assistance to other NGOs in places where BRAC does not operate.”
Following the presentation on findings, a panel discussion was addressed by, among others, Dr Morseda Chowdhury, associate director, HNPP, and Professor Faridul Alam, vice chancellor, BUHS. Professor Dr Malabika Sarker, associate dean, James P Grant School of Public Health at BRAC University, and Dr. Md. Touhidul Islam, National Professional Officer at World Health Organization also spoke in the panel. KAM Morshed, senior director, BRAC, moderated the panel discussion.
Carried out between April and August in 2020, the rapid assessment covered randomly selected 2,483 households with an average family size of 4.89 people in 16 districts of eight divisions. The survey found that 167 of the households had pregnant women during the survey period. A total of 49 babies aged from 0-28 days were found in the surveyed households. There were 794 under-five children which covers 32% of total household members.
According to the report, 60.8% of households experienced some form of sickness (other than COVID-19), while 28.6% reported higher clinical costs. 10% of households reported difficulty in availing health services from hospitals. Two fifths of households reported that their health status had deteriorated due to lack of proper healthcare.
The situation was particularly worse for women and children. 54% of pregnant women did not get all the services which were provided to pregnant mothers before the pandemic. According to the 2017-18 data of DGHS, on average 47% pregnant women received 4 visits for antenatal care (ANC). This study found that 37.6% pregnant women received 4 ANC services during the survey period, which is around 10% lower than the national average. 20% of deliveries were conducted by untrained midwives during the survey period. One in seven children was not taken to hospitals when they fell seriously ill mainly due to the high transportation cost and fear of covid-19. The overall situation was much worse in rural areas compared to the urban ones.
Patients with chronic diseases also suffered significantly. 56.32% of chronic disease patients reported that fear of coronavirus barred them from seeking treatment, while 54.51% reported financial difficulties. Treatment for mental illnesses and disabilities was of particularly poor state, more so in rural areas.
Despite high initial demand, telemedicine services were only utilised by 6% of households surveyed. The most common reason cited was that service seekers could not explain their symptoms properly.
Speaking at the panel discussion, Professor Faridul Alam, vice chancellor, BUHS said, the health sector in Bangladesh is poorly structured and this is why it cannot face any emergency. He demanded to transfer the healthcare system to the local health authority.
Professor Dr Malabika Sarker, associate dean, James P Grant School of Public Health at BRAC University, called upon the authorities to provide technological training and other institutional support to the field level health workers to build their capacity.
Dr. Md. Touhidul Islam, National Professional Officer at World Health Organization, said, “The government need to shift its focus from infrastructural development to more human development and invest in places where it is needed.”
To mitigate the challenges in the healthcare service delivery caused by the pandemic a number of recommendations were made in study. Priorities among these are, revisiting the national service delivery system in the context of the ongoing pandemic, robust utilisation of information and communications technologies, strengthening of health information systems and boosting the efficacy of coordination tasks. Adequate recruitment of health workforce and training to equip them with necessary mix of skills, while installing modern diagnostic and medical equipment are also crucial. Improving the effectiveness of referral mechanisms should be focused. Lastly, rethinking of the health financing is essential to build and sustain an adequately strong universal healthcare system in Bangladesh.