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Workforce and Health Care Services for Young Children in Bangladesh
Md Monir Hossain Shimul1, Md Kamrul Hossain2,3, Salamat Khandker1
1Department of Public Health, Daffodil International University, Dhaka, Bangladesh.
Insights
Public hospitals in Bangladesh offer better pediatric care services for children under 5 than private facilities, highlighting critical gaps in private sector infrastructure and workforce. Addressing these disparities is vital for equitable child healthcare access and outcomes.
Area of Science:
- Pediatric Health Services Research
- Health Systems Analysis
- Global Child Health
Background:
- Persistent inequities in pediatric healthcare services in Bangladesh disproportionately affect children under 5.
- Significant disparities exist between public and private hospitals, impacting access to quality care and health outcomes.
Purpose of the Study:
- To evaluate healthcare workforce and service availability for young children in Bangladeshi public and private hospitals.
- To identify gaps in pediatric infrastructure, workforce distribution, and adherence to care standards.
Main Methods:
- A cross-sectional study analyzed 102 private and 7 public hospitals across 6 subdistricts in Bangladesh.
- Data collection involved facility assessments, questionnaires, and observations using WHO-adapted tools.
- Outcomes measured included pediatric departments, neonatal facilities, trained personnel, and adherence to WHO standards.
Main Results:
- Public hospitals demonstrated superior availability of pediatric inpatient departments (100% vs 39.2%), newborn wards (100% vs 12.8%), and trained nurses (100% vs 32.4%).
- Private hospitals exclusively offered neonatal intensive care units (6.9% vs 0%), while public hospitals had more pediatricians for consultations (71.4% vs 26.5%).
Conclusions:
- Substantial disparities in pediatric healthcare services exist between public and private hospitals in Bangladesh.
- Investment in workforce and infrastructure is crucial to address these inequities and improve child health outcomes.
Importance:
Inequities in pediatric health care services persist in Bangladesh, with critical disparities between public and private hospitals, particularly for children younger than 5 years. These disparities hinder progress toward equitable health care access and quality outcomes.
Objective:
To evaluate the availability and quality of health care workforce and service coverage for children younger than 5 years in public and private hospitals in Bangladesh to identify gaps in infrastructure, workforce distribution, and adherence to pediatric care standards.
Design, Setting, And Participants:
This cross-sectional study was conducted from October 13, 2023, to May 24, 2024. Data collection included facility assessments, structured questionnaires, and direct observations using World Health Organization (WHO)-adapted tools. The study covered both private and public hospitals across 6 subdistricts in Bangladesh, representing a mix of urban and rural populations. Senior hospital staff and administrators were surveyed. Inclusion criteria were general inpatient and outpatient pediatric care delivered in hospitals. Diagnostic centers and specialized facilities were excluded.
Exposures:
Availability of pediatric infrastructure, workforce, essential medications, and adherence to clinical guidelines assessed against WHO standards.
Main Outcomes And Measures:
The primary outcomes included the presence of pediatric-specific departments, neonatal care facilities, and trained personnel and adherence to WHO care standards. Data were analyzed using descriptive statistics and χ2 tests to highlight disparities.
Results:
The study sample included 102 private and 7 public hospitals. A significantly higher proportion of public hospitals compared with private hospitals had pediatric inpatient departments (100% vs 39.2%), newborn wards (100% vs 12.8%), and trained nurses (100% vs 32.4%). Only private hospitals in the sample had neonatal intensive care units (6.9% vs 0%). Pediatricians were available for extended consultations at a greater proportion of public hospitals compared with private hospitals (71.4% vs 26.5%).
Conclusions And Relevance:
These findings show substantial disparities in the availability of pediatric health care services between public and private hospitals in Bangladesh. Addressing these disparities through workforce investment and infrastructure improvements is crucial for equitable child health care and better health outcomes.
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