Trust in the Bangladeshi Health System During the COVID-19 Pandemic: A Mixed-Methods Exploration

Abstract

BackgroundLack of trust in public health institutions hinders care-seeking and limits community support for contact tracing, information and communication uptake, and multi-sectoral or multi-stakeholder engagement. In light of these understandings, our aim was to determine levels of impersonal and interpersonal trust in the context of COVID-19 pandemic response in Bangladesh.MethodsAs this mixed-methods research was conducted during the pandemic, data was gathered via an online survey involving 508 respondents, along with seven online focus group discussions in which 50 purposively selected male and female clinicians and non-clinicians took part. Quantitative data was subjected to descriptive and comparative analysis, whereas content analysis was applied to the qualitative data.ResultsSurvey respondents have less trust in the health system (a mean score of 3.77/10) than in the service providers (4.95/10). In the context of impersonal trust, the lowest level of trust is observed in the Fairness domain (3.12/10), followed by the Confidence domain (3.38/10). In the context of interpersonal trust, the lowest level of trust is observed in the Fairness domain (3.81/10), followed by the Communication domain (4.83/10). While some non-clinical participants blamed doctors for shying away from caregiving during the early days of the pandemic, most praised them for providing care, risking their life due to the shortage of PPE, and even sacrificing their life in the process. Several participants also cited lack of fairness in pandemic management, such as imposing lockdown in periphery areas of the country without arranging transport for those requiring medical help to the centrally located modern health facilities, and visible attempts by the political decision-makers to protect the business interests without consideration for the safety of the poor. However, both clinicians and non-clinicians concurred on the need for the service providers to improve communication related to COVID-19 management.ConclusionsHealth sector stewards in Bangladesh should learn the lessons from other countries, ensure multi-sectoral engagement involving the community and political forces, and empower public health experts to organize and consolidate a concerted health system effort in gaining trust in the short term while striving to build a resilient and responsive health system in the long term.

COVID-19 recovery measures and use of medications among COVID-19 patients at home: A cross- sectional study in Bangladesh

“…The country is facing di culty providing treatment facilities for all the patients. Moreover, even though the patients required hospital facilities, they have less trust in health systems for various reasons [11,12]. So, mild and moderate patients who would mostly recover without special treatment may adopt these approaches to suppress the disease from being severe.…”

“…There was no specialized hospital in most divisions, while 34% of the total COVID-19 dedicated general beds were in Dhaka city, and 2,542 out of 3,329 of them are occupied [8]. Therefore, despite the intention of going to hospitals, many infected individuals could not get to the hospital facilities and developed a preference for taking medications at home Studies demonstrated pervasive mistrust of the Bangladeshi people on the health systems and healthcare providers during the COVID-19 pandemic [11,12]. This distrust had made people reluctant to seek medical treatment at the hospital, and as a result, a lot of COVID-19 related deaths occurred outside hospitals; 696 people died outside hospitals, of which 662 have died at home by 22 September 2020 [13].…”

Validation of Responsiveness of Physicians Scale (ROP-Scale) for hospitalised COVID-19 patients in Bangladesh

“…The ongoing COVID-19 pandemic has brought multiple challenges for both healthcare providers and patients, as it has increased anxiety, distrust, and uncertainty [ 5 , 6 ], necessitating greater sensitivity to patient needs. As a result, ROP has gained attention of both policymakers and scholars from various disciplines such as public health, social psychology, social medicine, healthcare communication, and media studies.…”