BackgroundThe health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential.MethodsThis scoping study applies a combination of research tools to explore 26 eHealth and mHealth initiatives in Bangladesh. A screening matrix was developed by modifying the framework of Arksey & O’Malley, further complemented by case study and SWOT analysis to identify common traits among the selected interventions. The WHO health system building blocks approach was then used for thematic analysis of these traits.ResultsFindings suggest that most eHealth and mHealth initiatives have proliferated within the private sector, using mobile phones. The most common initiatives include tele-consultation, prescription and referral. While a minority of projects have a monitoring and evaluation framework, less than a quarter have undertaken evaluation. Most of the initiatives use a health management information system (HMIS) to monitor implementation. However, these do not provide for effective sharing of information and interconnectedness among the various actors. There are extremely few individuals with eHealth training in Bangladesh and there is a strong demand for capacity building and experience sharing, especially for implementation and policy making. There is also a lack of research evidence on how to design interventions to meet the needs of the population and on potential benefits.ConclusionThis study concludes that Bangladesh needs considerable preparation and planning to sustain eHealth and mHealth initiatives successfully. Additional formative and operational research is essential to explore the true potential of the technology. Frameworks for regulation in regards to eHealth governance should be the aim of future research on the integration of eHealth and mHealth into the Bangladesh health system.

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours of service. A total of 1041 HSDPs were mapped, of which 80% are privately operated and the rest by NGOs and the public sector. Phamacies and non-formal or traditional doctors make up 75% of the private sector while consultation chambers account for 20%. Most NGO and Urban Primary Health Care Project (UPHCP) static clinics are open 5–6 days/week, but close by 4–5 pm in the afternoon. Evening services are almost exclusively offered by private HSDPs; however, only 37% of private sector health staff possess some kind of formal medical qualification. This spatial analysis of health service supply in poor urban settlements emphasizes the importance of taking the informal private sector into account in efforts to increase effective coverage of quality services. Features of informal private sector service provision that have facilitated market penetration may be relevant in designing formal services that better meet the needs of the urban poor.

Background: In many low-and middle-income countries (LMICs), health system challenges relating to weak governance, health workforce shortages, and geographic and economic barriers to care impede effective delivery of health services to those in need. The rapid development of information and communication technologies over the last few decades offers the potential for addressing some of these challenges with innovative solutions, especially if offered at scale. This review reflects on the features of larger and more established eHealth interventions that may contribute to their utilization, scale-up and sustainability and, ultimately, to improved health outcomes. Methods: Eight researchers conducted a literature review of eHealth innovations in LMICs of Asia and Africa. Peer-reviewed literature published between March 2010 and March 2015 was considered for inclusion in the review. Major online databases searched included Medline (via PubMed) and Web of Science. Some minor databases were also accessed. Articles addressing eHealth innovations were selected based on the following criteria: interventions located in LMICs of Asia and Africa; interventions of more than 1 year in duration; and interventions that cover at least one district or province of a country. Selected articles were analyzed and compared using a framework approach. Results: Based on specified inclusion and exclusion criteria, 14 peer-reviewed articles (eight intervention studies, six reviews) were identified that reported on eHealth innovations. Six key dimensions were identified as influential for the successful implementation, utilization and scale-up of an eHealth innovation. eHealth projects need to: be designed in response to identified health needs and priorities; be supported by an enabling environment; ensure IT systems integration; establish effective partnership between stakeholders; ensure implementation requirements are met; and preempt and address issues related to end users' abilities to access, trust, accept, and utilize an eHealth product. Conclusion: Consideration of the features identified in this review may be useful to health policy makers, program implementers, and innovators involved in the planning, design, and implementation of effective eHealth innovations intended to address large-scale population health needs in resource-constrained settings.

Since August 2017, more than 744,400 stateless Rohingya refugeesan ethnic Muslim minority group from the Rakhine Statehave entered Bangladesh to escape serious crimes against humanity conducted by the Myanmar Army. Extensive level of deforestation and hill cutting activities took place in Cox's Bazar District (CBD) in Bangladesh to accommodate them. The refugee camps are sitting on hills and loose soil and are highly vulnerable to rainfall-triggered landslides. Notably in June 2017, landslides in the same region killed at least 160 people. From this perspective, the study aims to develop a localised landslide early warning system (EWS) for the Rohingya refugees and their host communities in CBD. A novel method, combining landslide inventory and susceptibility maps, rainfall thresholds and dynamic web-based alert system, has been introduced to develop the landslide early warning system (EWS) by applying advanced geoinformation techniques. Results suggest that approximately 5,800 hectares of forest land cover disappeared due to the 2017 Rohingya influx. Land cover changes through hill cutting andslope modifications, and unplanned urbanisation are predominantly responsible for slope failures and consecutive 5-day periods of rainfall between 95-220 mm could initiate landslides in high susceptible areas. The EWS would support the local authorities and international organisations in reducing disaster risks and saving lives from landslides in a humanitarian context.

Ensuring access to healthcare in emergency health situations is a persistent concern for health system planners. Emergency services, including critical care units for severe burns and coronary events, are amongst those for which travel time is the most crucial, potentially making a difference between life and death. Although it is generally assumed that access to healthcare is not an issue in densely populated urban areas due to short distances, we prove otherwise by applying improved methods of assessing accessibility to emergency services by the urban poor that take traffic variability into account. Combining unique data on emergency health service locations, traffic flow variability and informal settlements boundaries, we generated time-cost based service areas to assess the extent to which emergency health services are reachable by urban slum dwellers when realistic traffic conditions and their variability in time are considered. Variability in traffic congestion is found to have significant impact on the measurement of timely access to, and availability of, healthcare services for slum populations. While under moderate traffic conditions all slums in Dhaka City are within 60-minutes travel time from an emergency service, in congested traffic conditions only 63% of the city’s slum population is within 60-minutes reach of most emergency services, and only 32% are within 60-minutes reach of a Burn Unit. Moreover, under congested traffic conditions only 12% of slums in Dhaka City Corporation comply with Bangladesh’s policy guidelines that call for access to 1 health service per 50,000 population for most emergency service types, and not a single slum achieved this target for Burn Units. Emergency Obstetric Care (EmOC) and First Aid & Casualty services provide the best coverage, with nearly 100% of the slum population having timely access within 60-minutes in any traffic condition. Ignoring variability in traffic conditions results in a 3-fold overestimation of geographic coverage and masks intra-urban inequities in accessibility to emergency care, by overestimating geographic accessibility in peripheral areas and underestimating the same for central city areas. The evidence provided can help policy makers and urban planners improve health service delivery for the urban poor. We recommend that taking traffic conditions be taken into account in future GIS-based analysis and planning for healthcare service accessibility in urban areas.