Readiness of primary health-care facilities for the management of non-communicable diseases in rural Bangladesh: a mixed methods study

Abstract

Background: Non-communicable diseases (NCDs) account for 67% of all deaths in Bangladesh. Several programmes are being implemented at the primary health-care level for NCD control in rural Bangladesh. This study aimed to assess the readiness for NCD health services provision in primary health-care facilities in rural Bangladesh, and explore health-care providers' perceptions about NCD care provision at the facilities. Methods: This study was conducted in the Parbatipur sub-district of Bangladesh using an embedded mixed method design. We used the modified WHO Service Availability and Readiness Assessment tool to assess primary health-care facilities and completed in-depth interviews with health-care providers (community health workers, nurses, and doctors with experience in management of NCDs). We used descriptive statistics to analyse quantitative data and mean domain score was based on the availability of the items as a percentage for each facility type. Service readiness score for each NCD was calculated across facility types as the mean score of all domains of service readiness (management guideline, trained staff, equipment, medicine). Higher scores indicated better service readiness. Thematic analysis was used for qualitative data. Findings: Between Nov 18 and Dec 3, 2018, we assessed 24 primary health-care facilities and completed 15 in-depth interviews. Of the 24 facilities surveyed, 23 were government-owned and one was a non-governmental organisation facility. Overall readiness score was highest for cardiovascular disease (22·6% [SD 28·8]) followed by diabetes (17·2% [25·0]) and asthma (13·2% [12·2]). Health-care providers mentioned lack of training, unavailability of medicine, and inadequate supervision as barriers to achieving readiness for NCD services. Interpretation: That functions and resources required for NCD care such as management guidelines, medicine, equipment, and trained staff were unavailable in the primary health-care facilities suggests a need to integrate NCD services into the Essential Services Package in government facilities. A limitation of the study is that the small sample size did not allow analysis to assess differences in service readiness between facility types. Funding: Masters dissertation funded by BRAC James P Grant School of Public Health, BRAC University.