Essential health service delivery during Covid-19
Covid-19 was a shock to Bangladesh in more ways than one. Both the disease itself and its economic and social aftershocks have disrupted the lives of every citizen, and the crisis has exposed existing gaps and weaknesses in the country's health system. With the Delta variant surging and the mass vaccination program lagging, building the health system's capacity to prevent, treat and manage COVID-19 cases is particularly important.
In 2020, to generate insights on the scale and dynamics of COVID-19 impacts on the health system, ThinkWell conducted a comprehensive assessment together with the Planning Wing and Health Economics Unit of the Ministry of Health and Family Welfare (MOHFW) and the Institute of Health Economics at the University of Dhaka.
Building on the insights gained in this study, ThinkWell made several recommendations to the government and other stakeholders to strengthen the health system's ability to respond to the pandemic and ensure the continuity of essential health services. The study found that in April, at the onset of the pandemic in the country, the utilization of essential health services declined significantly compared to the same month in 2019. Compared to May 2019, the rate of antenatal care in May 2020 had decreased by 23 per cent. In the same month, the rate of facility-based delivery and post-natal care also declined by 18 per cent and 9 per cent, respectively.
Despite these early declines, a substantial rebound in service utilization was seen from June to October 2020. During this period, the number of antenatal care consultations increased by 1.3 times, and post-natal care consultations increased by 2 times. From the period of October to December 2020, service utilization was within 20 per cent of the previous year's level and continued to recover more gradually than before.
The key to regaining essential health service provisions so quickly in 2020 was manifold. Firstly, a holistic approach of (leadership, commitment, and collaboration) was central to the recovery of the provision of essential health services. MOHFW, DGHS, and DGFP were committed to ensure basic health care along with COVID response activities.
Secondly, the governmentleveraged the historically strong sub-national level administrative network, local government, and practice of community engagement of the country, which was all crucial factors in enabling local response and action. This kind of holistic approach along with local engagement will help prepare the Bangladesh health system for the worst case in the coming months.
Thirdly, the governmentrecruited 5,000+ nurses and 2,000+ doctors from a prequalified waiting list in the early stages of the pandemic. This initiative supported sustaining the essential health services delivery given the long-standing human resources shortages in the health sector. This signifies the importance of maintaining a prequalified list of health professionals forrapid deployment during any such future shocks. To increase health system preparedness for future health emergencies, the government should consider maintaining a list of prequalified candidates for each health cadre (doctors, nurses, lab technologists, and others).
An interesting finding of this collaborative study was that a few district- and sub-district-level hospitals were struggling to make full use of the funds allocated by MOHFW to address COVID-19 related expenses. This seems to be due to administrative complexities, procedural barriers and a lack of financial management understanding within the health managers. Coordinated planning to reduce the procedural barriers and enhancing the capacity of health managers should be considered to increase the efficiency of budget utilization in regular times as well in a pandemic context.
Additionally, duringthe first wave of the COVID-19 pandemic, patients were more likely to visit community-level health centers, especially the community clinicsand union health and family welfare centers,as transport restrictions prevented them from seeking care at more distant facilities. Capacity building of the staff at these health centers, together with infrastructure improvements, could help to reduce the additional pressure on higher-level facilities atupazila, district, and tertiary levels.
Taken together, these recommendations could help to improve the resilience and capacity of the health system to respond to COVID-19 and other emerging health threats in future. ThinkWell and its partners call on the health community of Bangladesh and policymakers to take a closer look at the nuances of COVID-19, its effects, and how to address them.
This article was jointly authored by Dr. Shamima Akhter, Dr. Nurul Amin, Prof. Syed Abdul Hamid, Afroja Yesmin, Md. Tarek Hossain,Prof. Nasrin Sultana, and Dr. Mursaleena Islam from ThinkWell Bangladesh, MOHFW, and IHE