A Qualitative Assessment of the Essential Health and Nutrition Service Delivery in the Context of COVID-19 in Bangladesh: The Perspective of Divisional Directors

Abstract

Bangladesh suffered disruptions in the utilization of essential health and nutrition services (EHNS) during the COVID-19 pandemic. The magnitude of the pandemic has been documented, but little is known from the perspectives of health administrators. A rapid qualitative assessment of division-level capacity identified successes and bottlenecks in providing EHNS- and COVID-19-related services during the first months of the pandemic in Bangladesh. Semi-structured interviews were held with the Health and Family Planning Divisional Directors of the Ministry of Health and Family Welfare. The Primary Health Care System Framework guided the content analysis, focusing on (i) service delivery, (ii) communication and community outreach, and (iii) surveillance and service monitoring. Our findings identified low care seeking due to fears of getting infected and unawareness that EHNS were still available. Adaptations to telemedicine were highly heterogeneous between divisions, but collaboration with NGOs were fruitful in reinstating outreach activities. Guidelines were centered on COVID-19 information and less so on EHNS. The inflexibility of spending capacities at divisional and clinic levels hindered service provision. Misinformation and information voids were difficult to handle all around the country. Community health workers were useful for outreach communication. EHNS must be guaranteed during sanitary emergencies, and Bangladesh presented with both significant efforts and areas of opportunity for improvement.

Perinatal care and breastfeeding education during the COVID‐19 pandemic: Perspectives from Kenyan mothers and healthcare workers

“…Notably, not all communities experienced reductions in ANC visits: A study in Nampula Province, Mozambique noted no disruptions and an actual increase in ANC visits, comparing data 2 years before COVID lockdowns to July 2021 (Lydon et al, 2022 ). Telehealth and mobilisation of community health workers were important interventions that improved education and outreach for COVID‐19 across geographically diverse regions of Bangladesh, but they were not optimised to ensure the continuity of essential health and nutrition services (Gaitán‐Rossi et al, 2022 ). In Kenya, national guidelines on Reproductive, Maternal, Newborn and Family Planning were published within 1 month of the first COVID‐19 case in the county Plotkin et al, 2022 ).…”

Adaptation of a community health outreach model during the COVID-19 pandemic: The case of the Mexican Consulates in the United States of America

“…This expansion did not entail additional staff, so it reduced its capacity to provide their regular services. Prior research on emergency response has shown that institutional design can hamper rapid responses (13). However, the VDS were able to quickly adapt their services as they moved along a changing crisis and managed to keep offering their regular services while adding those that were most needed in different stages of the pandemic.…”

“…The COVID-19 pandemic has disrupted health systems worldwide including basic services unrelated with the pandemic (12,13). Hospital conversion has been a challenge for health facilities aiming to provide health care in safe conditions (14).…”

Reimagining gendered community interventions: the case of family planning programs in rural Bangladesh

“…Family planning use decreased by 23% during the pandemic compared to the pre-pandemic level, and the use of oral contraceptives drastically dropped from 62 to 24% during the same period [ 18 ]. Several recent studies have recommended taking on sufficient family planning workers to restore full door-to-door services [ 17 , 18 ]. However, the interplay of such policies with patriarchal structures fails to challenge the structures that inhibit women from exercising their reproductive rights in full.…”

“…The net result has often been a simple shift in dependencies—from one on the family group to one that now includes fieldworkers as advocates, information sources, and bridges to the outside world. Yet this model is called upon in the post-Covid world to reinvigorate the family planning agenda [ 17 ], even though COVID-19 exposed the inability of the patriarchal structures to negotiate any change that would lead to a dramatic drop in contraceptive rates [ 17 , 18 ]. There is still much work to do to change the fundamental power relations in which women are embedded.…”