Parallel Session A : Health System Strengthening
Chair
Prof. Mahmudur Rahman BIO
Former Director, IEDCR
Co-Chair
Dr. Shams El Arifeen BIO
Senior Scientist, icddr,b
Moderator
Prof. Dr. Md. Iqbal Kabir BIO
Former Professor of Epidemiology, NIPSOM,
Adjunct Faculty, Armed Forces Medical Institute and Department of Disaster Science & Management, Dhaka University
11:37 AM to 11:44 AM
Rafia S. Rasu
Professor, Pharmacotherapy,
University of North Texas, USA
Improving overall health status through a prescription management
Improving overall health status through prescription management
Rafia S. Rasu1,
PhD, Nahid Rianon2, MBBS, DrPH
1Professor, Pharmacotherapy, University of North Texas,
2Associate Professor, McGovern Medical School, Houston, TX
Introduction: Polypharmacy, knowns as consuming 5 or more medications daily on a chronic basis, is associated with many adverse health outcomes. Non-polypharmacy users report a better overall health status than polypharmacy users. Interventions to reduce polypharmacy may improve health status. Methods: We aim todemonstrate the rationale to improve prescribing at the system level and describe a united process that can help improve patients’ overall health through close monitoring of prescribing and medication management by an advanced health system that includes pharmacists and physicians. Medication therapy management, deprescribing, health literacy, adherence, and pharmacovigilance will be described as part of the united process. Results: Polypharmacy is prevalentamong older adults. We have conducted and reviewed several studies and recommend that monitoring and managing chronically used medications through patient-centered care delivery is an effective way to prevent polypharmacy and improve overall health. Patients at risk for polypharmacy are usually older than age 60, have comorbidities, have multiple prescribers, self-treat using over-the-counter medications, have history of hospitalizations, and go to medical practices with poor medication tracking processes. To avoid polypharmacy and the risks of medication-related harm in patients, clinical pharmacistsand primary care physicians need a complementary team approach to medication management practices. These may include applying deprescibing, considering health literacy level, emphasizing medication adherence and compliance with consequences, following up patients after hospitalization, monitoring and reporting pharmacovigilance. Physicians and pharmacists work together in such interventionsand manage medications with an ultimate goal to improve health and yet minimize adverse health outcomes, e.g., adverse drug reactions, inappropriate prescribing, drug-drug interaction. Conclusions/Implication: Preventing inappropriate prescribing is not just educating a physician not to write the prescription; it involves the clinical pharmacist, pharmacy dispensing unit, physician, and the patient working together as an entity to adopt a centralized approach that optimizes therapeutic outcomes.
Key words: Polypharmacy, Prescription management, patient-centered care, health outcomes.
11:45 AM to 11:52 AM
Sohana Shafique
Health Systems and Population Studies Division,
icddr,b, Bangladesh
The production, deployment and retention of physicians as public health workforce in Bangladesh: current situation and future recommendation for government sector
The production, deployment and retention of physicians as public health workforce in Bangladesh: current situation and future recommendation for government sector
Sohana Shafique1, Dipika Shankar Bhattacharyya1, Iffat Nowrin1, Iqbal Anwar2
1Health Systems and Population Studies Division, icddr,b, Bangladesh,
2Obstetric and Gynecological Society of Bangladesh
Background: The Public Health Workforce (PHW) include workforce who are engaged primarily in protecting and promoting the health and are responsible for planning and providing public health services for the whole or specific population groups. The PHW is particularly critical to deal with emergency situation like a pandemic. In Bangladesh, there is a strong infrastructure of health facilities where the physician cadres are leading the public health activities. Purpose: The purpose of this study was to document the current challenges and possible way out regarding production, deployment and retention of physicians in the public health workforce in Bangladesh. Methods: This exploratory research employed a desk review of relevant policies and qualitative data collection methods including 14 Key Informant Interviews (KIIs). Two high level stakeholder consultation workshops were arranged to identify research questions and formulate policy recommendation. Framework analysis was used to synthesize the study findings. Results: In the present medical curriculum, there is a lack of focus on public health, which ultimately hinders the interest of graduate physicians to start their career in public health. Regarding deployment, the current sanctioned posts at the district and sub-district level are inadequate to provide optimal public health services. A clearly designed career pathway for physicians in public health positions is absent in current system for retention. There is an urgent need to revisit the policies and strategies regarding PHW. Appropriate guideline for post-graduation is immediately needed for government doctors. In terms of deployment and retention, plan for clear career path, and financial and non-financial incentives for the public health physicians were strongly recommended. Conclusions: Specific attention is required with regard to production, deployment and distribution of physicians engaged in public health activities, at different tiers of health system, to achieve Universal Health Coverage in Bangladesh.
Key words: Human Resources for Health, Public Health Workforce, Health System, Health Policy, Medical Education.
11:53 AM to 12:00 PM
Nahid Rianon
Associate Professor, McGovern Medical School at UTHealth, TX, USA
Primary Health Care is the ultimate key for health promotion
Primary Health Care is the ultimate key for health promotion
Nahid Rianon1,
MBBS, DrPH, A. J. Faisel2, MBBS, MPH
1Associate Professor, McGovern Medical School at UTHealth, TX, USA,
2Kumudini Women’s Medical College, Tangail, Bangladesh
Introduction: Stopping a disease before it happens and controlling the worsening of the disease with continuous management by a clinician are basis of a primary health care practice. Continuation of care provides a window to the physician to monitor and assess disease progression, risk factors and helps in preventing further worsening of a health condition. Primary care is aimed to improve quality of life and decrease health care burden on the society and health care system. With such an aim, primary health care is designed to serve the public and people need to have easy access to the health service with a continuity of care. The same physician or physicians from the same group practice need to be able to see the patient longitudinally. Culturally sensitive practice setting and current technology to assess and diagnose risks and diseases are also desirable for such practice. For example, a person with a headache can go to a pharmacy and get acetaminophen to relieve headache on a temporary basis. We all know that headache can be a symptom of many underlying diseases. If the headache happens to be due to a new onset hypertension, this person not only needs a diagnosis but also needs long-term monitoring and management of this disease. Health care cost to the person and the society with available primary care service would be a minimal fee for service and medication cost. Whereas, the cost without the health service could be devastating with a consequent stroke, chronic kidney disease and loss of productive work life for the patient who may have been the sole earning member of a family. Bangladesh has the resources with trained physicians and population to serve. Many small organizations have started such practice in isolated manner with a limited scope. It is time to have a strategic planning to start primary health care for all.
Objective:
Methods:
Results:
Conclusion:
Key words: Primary care, continuity of care, public.
12:01 PM to 12:08 PM
Dipika Shankar Bhattacharyya
Research Investigator, UHC, Health Systems and Population Studies Division, icddr,b,
Bangladesh
Challenges of performing key public health functions by the physician cadres in peripheral level government health system in Bangladesh: a qualitative exploration
Challenges of performing key public health functions by the physician cadresin peripheral level government health system in Bangladesh: a qualitative exploration
Dipika Shankar Bhattacharyya1, Sohana Shafique1, Iffat Nowrin1, Iqbal Anwar2
1Health Systems and Population Studies Division, icddr,b, Bangladesh
2Obstetric and Gynecological Society of Bangladesh
Background: To strengthen the health system of a country, identifying and ensuring the public health functions (PHFs) is one of the core agenda of the World Health Organization. The definition of PHFs varies widely considering country needs. In Bangladesh, the physician cadreareat the leadership position for over seeing and maintaining the PHFs attheds trict and sub-district level. However,the reisdearth of contextualin formation regarding the pur view of ssential PHFs in the country. Purpose:The purpose of this study was to document the perception of keystakeholderson what constitute the PHFs for the leadership positions at districtand sub-district level and identifying the challenges they facein providing the services. Method:Aqualitative exploratory research consisting adeskre view of job description of CivilSurgeons(CSs)and Upazila Health and Family Planning Officers(UHFPOs), 15 Key Informant Interviews with relevant professionals and a high level consultation workshopwere conducted. Data were analyzed the matically. Result: Three major categories of public health functions were identified : i)population-wide preventive services; ii)clinical preventive services; and iii)administrative/management activities. Un derall these categories the CSand UHFPOs need to ensure a wide range off unctions for alarge population. Although a specific structure has been established for the community level staff, but at districtandsub-districtlevel, the clinical and public health roles for the leadership position so often get amalgamated. Therefore, ensuring public health functions are hampered. Besides, the sepositions need training and adequate supports afftoper for m the function s effectively. Conclusions: The reisa need for recognizing the essential public health functions in Bangladesh context for differenttier so f health systems. Revisiting the job descriptions and strengthening appropriate public health services at differenttier sin healthsystem in the country should be prioritized to achieve health-related Sustainable Development Goals.
Key words: Human Resources for Health,Public health function, health system, Health Policy.
12:09 PM to 12:16 PM
Koushik Majumder
Chattogram Medical College,
Chattogram
COVID-19 preparedness level among the hospital staffs in a tertiary hospital of Bangladesh: A cross- sectional survey
COVID-19 preparedness level among the hospital staffs in a tertiary hospital of Bangladesh: A cross- sectional survey
Koushik Majumder, Antu Datta, Dr. Susmita Dey Pinky
Chattogram Medical College, Chattogram
Introduction: COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020, with the first case being reported in December 2019 in Wuhan, China while for Bangladesh the date was March 8, 2020. The pandemic has put healthcare professionals at significant risk working in emergency medicine, infectious diseases, respiratory and internal medicine departments straining the flexibility of healthcare systems to respond to the crisis, particularly in low-resource settings.This study was aimed to assess the preparedness level of the physicians and nurses to deal with the sudden outbreak and highlight the insufficiency of the healthcare systems to guide the altering of strategies for a better proceeding with an outbreak. Methods: A cross-sectional survey was conducted among the working doctors and nurses of emergency, outpatient clinic, infectious disease, respiratory and internal medicine departments in Chattogram Medical College Hospital, Chattogram using the simple random sampling technique. This study is a collaborating part of a multicenter multinational survey named “Awareness and preparedness of hospital stuffs against Novel Coronavirus” that was conducted at the same time in 50 countries worldwide. Ethical approval was obtained from CMC ERC. 50 data were collected from March 3 to 12, 2020 administering a self-developed structured questionnaire comprising of 32 questions and later was analyzed using SPSS v26. Result: Among 50 participants, 84% were doctors, 16% were nurses and 44% of the total respondents were aged ≥ 30 years. 76% of the participants had no training course on handling Covid-19 patients by then although 44% participants had experiences of working during an outbreak namely bird flu, dengue in the past. The majority of the respondents (44%) were unsatisfied with the current facilities available in the hospital in order to manage the COVID-19 outbreak. Only 6% of the respondents were highly confident in handling suspected COVID patient, 38% were confident to some extent whereas 22% of them mentioned that they had no confidence at all. Conclusion: Assessing hospital personnel’s preparedness of the crisis and determining how they will respond is crucial to contain this pandemic and prevent further outbreaks in future.
Key words: COVID-19, preparedness, hospital staffs, tertiary, pandemic
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12:17 PM to 12:24 PM
Dr. Taufique Joarder
Public Health Foundation,
Bangladesh
Trust in the Bangladeshi health system during the COVID-19 pandemic: A mixed-methods exploration
Trust in the Bangladeshi health system during the COVID-19 pandemic: A mixed-methods exploration
Taufique Joarder1, Muhammad
Nahian Bin Khaled2, Md. Shamsul Arefin3, Shahaduz Zaman4
1Public Health Foundation, Bangladesh,
2International Food Policy Research Institute,
3Patiya Upazila Health Complex,
4Brighton and Sussex Medical School,
University of Sussex
Introduction: Lack 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. Our aim was to determine levels of impersonal and interpersonal trust in the context of COVID-19 pandemic response in Bangladesh. Methods: In this mixed-methods research, quantitative data were gathered via an online survey (n=508), and seven online focus group discussions (n=50) with purposively selected male and female clinicians and non- clinicians. Results: Survey 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 (3.12/10), followed by Confidence (3.38/10). In the context of interpersonal trust, the lowest level of trust is observed in Fairness (3.81/10), followed by Communication (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. Several participants cited lack of fairness in pandemic management, e.g., imposing lockdown in periphery areas without arranging transport, 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. Conclusions: Health 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.
Key words: COVID-19, Pandemic,Trust, Resilience, Health policy and systems research, Bangladesh
12:25 PM to 12:32 PM
Dr. Sadia Fatema Kabir
District SRHR Officer, Gazipur,
Directorate General of Health Services
Maternal health care service delivery status at the sub-district facilities during COVID-19 pandemic in Bangladesh
Maternal health care service delivery status at the sub-district facilities during COVID-19 pandemic in Bangladesh
Dr. Sadia Fatema Kabir1,
Dr. Animesh Biswas2, Md. Shamsuz Zaman2
1District SRHR Officer, Gazipur,Directorate General of Health Services,
2SRHR, UNFPA Bangladesh
Background: The history of communicable disease outbreaks in low- and middle-income countriesare common. Since 2020, the communicable pandemic crisis COVID-19 has not only affected multiple aspects of day-to-day life but has also affected the healthcare system in our country as many other LMICs. The number of services seeking women in the sub-district facilities are noticeably decreased during the pandemic situation compared to before. Hesitancy as well as reluctance to visit health care facilities are more common among the women during pandemic. Directorate general of health services (DGHS) is giving continuous effort to ensure maternal health care services at the facilities. Objective: To explore the situation of maternalhealth care services during pregnancy, delivery and post-partum period during COVID-19 pandemicat sub-district health care facilities(upazila health complexes). Methodology:a qualitative study was performed in nine upazila health complexes of Sirajganj district in November 2020. A structured checklist was followed to observe antenatal care at antenatal corner, normal vaginal delivery at labor room and postnatal care. Finally, content analysis was done. Result: Antenatal care was available in all facilities during the COVID-19 time. Midwives followed a roster to continue services. However, it was observed that women had to wait for longer to receive the services. All facilities had handwashing facilities, basin, and water at the entrance, while the soap was unavailable in most cases. Infection prevention and control was maintained at ANC corner, and personal protective equipment (masks, gloves, hand sanitizer) were present. Vaginal deliveries were performed only in the daytime, 24/7 was unable to perform due to limited human resources. In contrast, Triage at the entrance was inadequately functional. Conclusion: Despite COVID-19 challenges, upazila health facilities continued routine maternal health care services, however, due to limited providers during COVID-19 still, a challenge to ensure 24/7 services.
Keywords: COVID-19, service delivery, maternal health, sub-district facility
12:33 PM to 12:47 PM
Q/A Session
12:48 PM to 01:00 PM
Sum up by the Chair and Co-Chair
Troubleshooting
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