Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence. Methods We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group discussion with stakeholders representing key actors in informal market systems namely: representatives from the government, private sector, not-for-profit sector and membership organizations. Results Barriers to policy compliance among drug shop operators included limited knowledge of government drug policies, or the government-led Bangladesh Pharmacy Model Initiative (BPMI), a national guideline piloted to regulate drug sales. Drug shop operators had no clear knowledge of different antibiotic generations, how and for what diseases antibiotics work contributing to inappropriate antibiotic dispensing. Nonetheless, drug shop operators wanted the right to prescribe antibiotics based on having completed related training. Drug shop customers cited poor healthcare facilities and inadequate numbers of attending physician as a barrier to obtaining prescriptions and they described difficulties differentiating between qualified and unqualified providers. Conclusion Awareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.
In Bangladesh, cities produce huge volumes of solid waste, sewage, and greywater with limited resources to manage it. Waste and sanitation workers, key players in managing waste, are continuously exposed to different health hazards in their work due to lack of occupational safety and basic protections. This vulnerability has been exacerbated by the COVID-19 Pandemic. Focusing on workers’ experiences and everyday working realities, this study sought to assess the organizational capacity, gaps, and challenges of local waste management authorities during COVID-19. It also sought to deepen understanding of job arrangements, occupational safety, hygiene knowledge, and practices of these waste workers at their workplace. A qualitative study was conducted consisting of 61 key informant interviews with seven categories of local officials and 50 in-depth interviews with five categories of waste and sanitation workers in 10 cities of Bangladesh. An inductive content analysis approach was adopted. The results showed that COVID-19 had aggravated the existing waste management challenges and imposed severe health risks on waste workers. Respective conservancy departments lagged behind due to lack of safe cleaning methods and equipment, and limited funds for waste worker training, which ultimately led to poor occupational safety for workers. This vulnerable worker group lacked basic job facilities, received poor payment and insufficient protective equipment, and rarely had any health support from their employers. Also, they were not provided with an adequate understanding of occupational safety and health hygiene; and no appropriate handwashing facilities at their workplace to tackle infectious diseases like COVID-19. The study investigated this countercomplaint and discussed the current arrangements from the prespective of both city authorities and waste workers. The study recommended more automated waste collectors and compositors for the conservancy departments, increased active monitoring, work benefits, safety equipment for waste workers, and tailored training to eradicate work-related health hazards and injuries.
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