Community health workers for non-communicable diseases prevention and control in Bangladesh: a qualitative study

Abstract

Background: The increasing burden of Non-Communicable Diseases (NCDs) in Bangladesh underscores the importance of strengthening primary health care systems. In this study, we examined the barriers and facilitators to engaging Community Health Workers (CHWs) for NCDs prevention and control in Bangladesh.Methods: We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders’ consultative meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection from health facilities across three districts in Bangladesh. We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n=4); key informant interviews with central level health policymakers/ managers (n=15) and focus group discussions with CHWs (4 FGDs; total n=29). Participants in a stakeholder consultative meeting included members from the government (n=4), non-government organisations (n=2), private sector (n=1) and universities (n=2). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.Results: The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispensing basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. Yet, the facilitating factors to engaging CHWs included government commitment and program priority, development of NCD related policies and strategies, establishment of NCD corners, community support systems, social recognition of health care staff and their motivation.Conclusion: Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for building capacity of CHWs, maximizing CHWs engagement to NCD services delivery, facilitating systems-level support and strengthening partnerships with non-state sectors would be effective in prevention and control efforts of NCDs in Bangladesh.

Health challenges of the 21st century - Empirical essays on the health and economic burden of non-communicable diseases and climate change in Southeast Asia

“…Long et al (2020) assess the barriers for expanding community health worker services to NCD prevention and care in Vietnam and find that shortages of trained health personnel, limited training provision and imbalanced workload pose substantial challenges. Similar results have been found for community health workers programs in Bangladesh (Rawal et al, 2021), Nepal (Rawal et al, 2020) and Uganda (Musoke et al, 2021).…”

Kiến Thức Về Bệnh Tăng Huyết Áp Và Đái Tháo Đường Tuýp Ii Của Cán Bộ Trạm Y Tế Tỉnh Nam Định

“…Hệ thống y tế cơ sở tại các vùng nông thôn gồm cán bộ trạm y tế và các y tế thôn, trong đó cán bộ trạm y tế là nòng cốt nếu được đào tạo và hướng dẫn thiết lập tốt có thể thực hiện hiệu quả công tác phòng ngừa và quản lý BKLN nói chung, tăng huyết áp (THA) và đái tháo đường (ĐTĐ) nói riêng. Hơn nữa, hệ thống y tế cơ sở có rất nhiều thuận lợi trong việc kiểm soát huyết áp và tuân thủ dùng thuốc vì đã loại bỏ rào cản do sự khác biệt về văn hóa, giáo dục và ngôn ngữ giữa người bệnh và hệ thống chăm sóc sức khỏe [3], [4].…”