Assessing service availability and readiness to manage Chronic Respiratory Diseases (CRDs) in Bangladesh
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Published on: April 6, 2019
Progga Paromita1, Hasina Akhter Chowdhury2, Cinderella Akbar Mayaboti2
1Kirtipasha Union Health and Family Welfare Centre, Jhalokathi Sadar Upazila, Barishal, Bangladesh.
Insights
Chronic respiratory disease management in Bangladesh is critically lacking outside tertiary hospitals. Only these top-tier facilities meet readiness standards, highlighting significant gaps in essential resources and trained personnel elsewhere.
Area of Science:
- Public Health
- Health Services Research
- Non-communicable Diseases
Background:
- Chronic Respiratory Diseases (CRDs) are leading non-communicable diseases (NCDs) globally, with disproportionately high impacts in low- and middle-income countries (LMICs).
- Limited data exists on the quality of CRD management within Bangladeshi healthcare facilities.
- Assessing service availability and readiness is crucial for improving CRD care in resource-limited settings.
Purpose of the Study:
- To evaluate the availability and readiness of Chronic Respiratory Disease (CRD) services across all levels of health facilities in Bangladesh.
- To identify specific gaps in CRD management capacity using a standardized assessment tool.
Main Methods:
- A cross-sectional study utilizing the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) tool was conducted.
- Data was collected from 262 health facilities in Bangladesh between December 2017 and June 2018.
- Facility readiness was quantified using a Readiness Index (RI) score, with a 70% threshold indicating adequate capacity.
Main Results:
- Only tertiary care hospitals (3.1% of facilities) achieved a readiness index above 70% (RI 78.3%), signifying adequate CRD management capacity.
- District Hospitals (40.6%), Upazila Health Complexes (33.3%), and Private NGOs (39.5%) demonstrated significantly lower readiness scores.
- Key deficiencies included inadequate medicines, lack of trained staff, absence of treatment guidelines, and insufficient equipment and diagnostic capabilities.
Conclusions:
- CRD management readiness in Bangladesh is severely limited, with only tertiary hospitals adequately equipped to handle these conditions.
- Significant disparities exist in healthcare facility readiness for CRD management across different tiers.
- Addressing shortages in essential medicines, trained personnel, guidelines, and diagnostic tools is imperative to improve CRD care nationwide.
Introduction:
Chronic Respiratory Diseases (CRDs) are some of the most prevailing non-communicable diseases (NCDs) worldwide and cause three times higher morbidity and mortality in low- and middle-income countries (LMIC) than in developed nations. In Bangladesh, there is a dearth of data about the quality of CRD management in health facilities. This study aims to describe CRD service availability and readiness at all tiers of health facilities using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) tool.
Methods:
A cross-sectional study was conducted from December 2017 to June 2018 in a total of 262 health facilities in Bangladesh using the WHO SARA Standard Tool. Surveys were conducted with facility management personnel by trained data collectors using REDCap software. Descriptive statistics for the availability of CRD services were calculated. Composite scores for facility readiness (Readiness Index 'RI') were created which included four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. RI was calculated for each domain as the mean score of items expressed as a percentage. Indices were compared to a cutoff of70% which means that a facility index above 70% is considered 'ready' to manage CRDs at that level. Data analysis was conducted using SPSS Vr 21.0.
Results:
It was found, tertiary hospitals were the only hospitals that surpassed the readiness index cutoff of 70%, indicating that they had adequate capacity and were ready to manage CRDs (RI 78.3%). The mean readiness scores for the other hospital tiers in descending order were District Hospitals (DH): 40.6%, Upazila Health Complexes (UHC): 33.3% and Private NGOs: 39.5%).
Conclusion:
Only tertiary care hospitals, constituting 3.1% of sampled health facilities, were found ready to manage CRD. Inadequate and unequal supplies of medicine as well as a lack of trained staff, guidelines on the diagnosis and treatment of CRDs, equipment, and diagnostic facilities contributed to low readiness index scores in all other tiers of health facilities.
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