Sustainable Development Goals

Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh.

Background: The world has been passing the most critical time of the century with the COVID-19 pandemic since late December 2019, and numerous people, including a significant portion of health care providers, got the infection and are still sacrificing their lives. Objective: The study was aimed systematically to assess the severity of the SARS-CoV-2 infection, especially in health care sectors, and to appraise the physical, psychological, and social effects of the COVID-19 epidemic among frontline fighters in Bangladesh. Methodology: The keywords: “COVID-19”, “SARS-CoV-2”, “health care system in Bangladesh”, “health care providers”, etc. were searched to collect the desired articles by utilizing various search engines like google, google scholar, pub med, and science direct journals. Data were extracted and finally, were summarized, discussed, analysed, and reported the study results. Result: Numerous specialist doctors, nurses, and all other healthcare workers are immolating their lives to save human entities amid the current coronavirus pandemic, 2019 (COVID-19). In Bangladesh, till August 9, 2020, 73 doctors, including some senior specialists, died of COVID-19 infection reported by various national newspapers. At the early phase of this epidemic in Bangladesh, around 10% of the total infection was found among health workers, alarmingly reported by the Bangladesh Medical Association (BMA). These frontline fighters are additionally confronting numerous challenges, including psychological sufferings, and furthermore, they are assaulted by the society. Conclusion: Since these fighters are relinquishing their beloved lives to protect us from this brutal virus, we are trying to show our profound gratitude, appreciation, thousands of salutes, and undying tribute to these health care fighters with this publication. [Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S8-S15]

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Impact of COVID-19 pandemic among health care providers in Bangladesh: a systematic review.

The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.

https://www.mdpi.com/1660-4601/16/18/3295/pdf

A Hybrid Decision-Making Approach for the Service and Financial-Based Measurement of Universal Health Coverage for the E7 Economies.

Achieving universal health coverage (UHC) requires health financing reforms (HFR) in many of the countries. HFR are inherently political. The sustainable development goals (SDG) declaration provides a global political commitment context that can influence HFR for UHC at national level. However, how the declaration has influenced HFR discourse at the national level and how ministries of health and other stakeholders are using the declaration to influence reforms towards UHC have not been explored. This review was conducted to provide information and lessons on how SDG declaration can influence health financing reforms for UHC based on countries experiences. We conducted a rapid review of literature and followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guideline. We conducted a comprehensive electronic search on Ovid Medline, PubMed, EBSCO, Scopus, Web of Science. In searching the electronic databases, we combined various conceptual terms for “sustainable development goals” and “health financing” using Boolean operators. In addition, we conducted manual searched using google scholar. Twelve articles satisfied our eligibility criteria. The included articles were analyzed thematically, and the results presented narratively. The SDG declaration has provided an enabling environment for putting in place necessary legislations, reforming health financing organization, and revisions of national health polices to align to the country’s commitment on UHC. However, there is limited information on the process; how health ministries and other stakeholders have used SDG declaration to advocate, lobby, and engage various constituencies to support HFR for UHC. The SDG declaration can be a catalyst for health financing reform, providing reference for necessary legislations and policies for financing UHC. However, to facilitate better cross-country learning on how SDG declaration catalyzes HFR for UHC there, is need to examine the processes of how stakeholders have used the declaration as window of opportunity to accelerate reforms.

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How has sustainable development goals declaration influenced health financing reforms for universal health coverage at the country level? A scoping review of literature

Bangladesh has attained notable progress in most of the health indicators, but still, health system of the country is suffering badly from poor funding. Issues like burden of out-of-pocket expenditure, low per capita share in health, inadequate service facilities, and financial barriers in reducing malnutrition are being overlooked due to inadequacy and inappropriate utilization of allocated funds. We aimed to review the current status of health care spending in Bangladesh in response to national health policy (NHP) and determine the future challenges towards achieving universal health coverage (UHC). National health policy suggested a substantial increase in budgetary allocation for health care, although government health care expenditures in proportion to total public spending plummeted down from 6.2% to 4.04% in the past 8 years. Overall, 67% of the health care cost is being paid by people, whereas global standard is below 32%. Only one hospital bed is allocated per 1667 people, and 34% of total posts in health sector are vacant due to scarcity of funds. The country is experiencing demographic dividend with a concurrent rise of aged people, but there seems no financial protection schemes for the aged and working age populations. Such situation results in multiple obstacles in achieving financial risk protection as well as UHC. Policy makers must think effectively to develop and adapt systems in order to achieve UHC and ensure health for all.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/hpm.2666

Financing health care in Bangladesh: Policy responses and challenges towards achieving universal health coverage

This study was designed to explore sources of funds for health expenditure of patients if they are hospitalized. We have included 379 patients of 3 private and 7 public hospitals to estimate total expenditure. Of them, 229 (60.4%) were from public and 150 (39.6%) from private hospitals. Mean expenditure was Tk 60,613.3 and 8,262.7, and duration of hospital stay was 10.7 and 11.8 days in private and public hospitals respectively. More than half (55%) of the patients from middle class were treated in private hospitals. Of them, 278 (74.0%) were funded by themselves, 48 (12.8%) by loan with interest rate of 100% to 180%, 23 (6.1%) by loan without interest, 17 (4.5%) by losing their fixed asset, and 4 (1.1%) by begging in the street. Most of the patients did bear expenditure by themselves, followed by loan with high interest rate. ‘Distress’ selling of property was also a source. Middle-class patients could be comfortable with expenditure if they were in public hospitals.

Funds for treatment of hospitalized patients: evidence from Bangladesh.

Further utilization of hospital facility is influenced by the provision of hospital care and cost of services. This study was conducted among patients of public and private hospitals of Dhaka city, Bangladesh to explore the relationship of further utilization of hospital care and cost of services incurred during previous visits. A total 199 patients of 2 private and 2 public hospitals were included. Of them, 100 (50.25%) were from public and 99 (49.74 %) from private hospitals. Male: female ratio of the respondents was 111:88. The level of services was scored by patients on a 1-5 Likert scale on the aspects of services of doctors, nurses, other staffs; medicine supply; cleanliness; and investigation facilities. Poor people usually sought the services from public hospitals. About three-quarter of the respondents (76.9 %) mentioned that they would avail the facility of same hospital for their further ailment. Seventeen patients (17%) who were treated in government hospitals will not further utilize the services, and this was significantly higher ( p -0.02) in the case of patients from private hospitals (29.3%). Regression analysis explored that quality of services ( p= -0.000) and cost of services ( p= 0.001) influenced the plan of future consumption of hospital facility and quality of services having stronger influences. This study concludes that further utilization of the hospital facility was strongly influenced by the quality of services and next to that is cost of services. So we recommend for best and successive utilization of hospital services to improve facilities and minimization of cost are the essential needs. South East Asia Journal of Public Health Vol.6(1) 2016: 14-19

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Farhana Begum

Papers

Financing health care in Bangladesh: Policy responses and challenges towards achieving universal health coverage

Funds for treatment of hospitalized patients: evidence from Bangladesh.

Consumer subsequent plan for selection of hospital in the perspective of hospital services and expenditure