Hospitals lack basic amenities, equipment in Bangladesh

A survey has revealed serious lack of basic amenities and equipment for maternal and childcare and family planning services in public and private health centres.

This is despite Bangladesh buying millions of dollars worth of medical equipment.
 
The government survey also found almost 65 percent public facilities at the district level and below - barring community clinics - were ill-equipped to prevent hospital-induced infections.
 
This dismal state preparedness at the health facilities was evident even though Bangladesh’s health sector achievements have earned global kudos for being “striking” and the government is striving to achieve universal health coverage.
 
The National Institute of Population Research and Training (NIPORT) released a raft of findings in its 2014 Bangladesh Health Facility Survey (BHFS) preliminary reports on Sunday before a select group of policymakers and government officials in Dhaka.
 
The survey mainly focused on facilities for quality health services in the areas of child health, maternal and newborn care, family planning, selected non-communicable diseases, and tuberculosis.
 
In its assessment of service readiness the survey adopted the WHO, USAID and the World Bank proposed parameters.
 
It was designed in a way that a survey of 1,596 government, NGO, and private facilities would yield nationally representative results.
 
All seven types of public facilities ranging from district hospitals to community clinics in remote villages were covered.
 
The governments of Bangladesh and US lent the NIPORT survey financial support. The ICF International provided technical support under the DHS Programme.

More than 90 percent of all public facilities surveyed including community clinics lacked at least five of the six basic amenities.

Regular electricity, an improved water source, privacy during consultation, patients’ latrine, phone services, and a computer with Internet access have been identified as basic hospital amenities, which, WHO says, are important for patients’ satisfaction.

At least 60 percent the facilities cannot ensure privacy for clients during consultation.

Patients say this makes it difficult for them to talk freely, says the survey report.

More than 50 percent of the facilities, excluding community clinics, do not have improved women’s toilets.

Not more than a quarter of facilities have all the six basic equipment - stethoscope, thermometer, blood pressure apparatus, adult weighing scale, child or infant scale, and a light source -- a list WHO and USAID propose for basic health services.

About 55 percent public facilities have at least five of those six basic items, while 79 percent private facilities had them, and 90 percent of NGO clinics.

Lack of appropriately trained staff was a common drawback in all facilities. The survey refers to in-service training in individual skill areas.

For the five services the survey considered, except for family planning, approximately around 50 percent facilities lack appropriately trained staff.

“When we are talking about saving lives I don’t think there should not be any half or compromised standard,” Dr Ishtiaque Mannan, Chief of Party of USAID's MCHIP project, said while commenting on the survey.

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Gross disjoint

He found a “gross disjoint” between the needed focus and the levels of preparedness.

For example, he said, to save most of the 6000 mothers dying every year, we need emergency obstetric care, but in reality only 37 percent upazilla and district hospitals were in a position to provide the service whereas all of them were supposed to be ready for this.

He said the detection of pre-eclampsia and eclampsia that account for 20 percent would-be mothers’ death require a simple urine test that can be done using strips that cost Tk 1.9 each – 2 cents.

But the survey showed only six percent of public facilities could conduct basic urine tests for protein or glucose presence, or to check pregnancy.

“Is it a money matter? Certainly not. The fact is those who are responsible are not paying attention,” he said.

Over the past decade, the overall care-seeking had increased with most people approaching private health care facilities.

But the survey, surprisingly, found that readiness in the private sector was abysmal with less than 10 percent of them meeting the bare minimum standards for all the services, and none of the qualified standards for normal delivery and TB care.

“Is the private sector going unsupervised or unregulated?” asked Dr Mannan.

Paradox

Additional secretary for health Biman Kumar Saha highlighted the achievements of the health sector in cutting maternal and child deaths, though he acknowledged the challenges on seeing the survey results.

Director for maternal and child health of the family planning directorate Dr Mohammed Sharif said: “We have to think in the context of Bangladesh. We have to keep giving services to the country’s vast population and gradually improve quality.”

He implied that despite the quality concerns revealed in the survey, the health sector was surging ahead.

But ICDDR,B director for the Centre for Child and Adolescent Health Dr Shams El Arifeen said business as usual would not work.

“We are currently in a situation that has left us with complex problems and we can progress at the same rate only if we are more effective than in the past,” he warned.

Dr Mannan said the effect of bad quality was “subtle”.

For example, he said, 20 percent of newborn deaths are due to birth asphyxia and the right evidence based approach was to resuscitate the newborn in the first minute of life, which means the baby has to cry and breathe in the first golden minute.

“But if he cries in the fifth minute, he will survive, families will be happy, but study shows there are long-term development effects of this delayed resuscitation.”

Dr Kanta Jamil, a Senior Adviser of the USAID’s Office of Population, Health, Nutrition and Education, said the survey was meant “to ensure quality and equitable” healthcare for all Bangladeshi citizens.

She said survey report had come at a time when the next health, nutrition and population programme was being devised in which quality of care would be “a key” element.