Are Bangladeshi healthcare facilities prepared to provide antenatal care services? Evidence from two nationally representative surveys

Abstract

Identifying high-risk pregnancies through antenatal care (ANC) is considered the cornerstone to eliminating child deaths and improving maternal health globally. Understanding the factors that influence a healthcare facility’s (HCF) preparedness to provide ANC service is essential for assisting maternal and newborn health system progress. We aimed to evaluate the preparedness of HCFs to offer ANC services among childbearing women in Bangladesh and investigate the facility characteristics linked to the preparedness. The data for this study came from two waves of the Bangladesh Health Facilities Survey (BHFS), conducted in 2014 and 2017 using a stratified random sample of facilities. The study samples were 1,508 and 1,506 HCFs from the 2014 and 2017 BHFS, respectively. The outcome variable "ANC services preparedness" was calculated as an index score using a group of tracer indicators. Multinomial logistic regression models were used to identify the significant correlates of ANC service preparedness. We found that private hospitals had a lower chance of having high preparedness than district and upazila public facilities in 2014 (RRR = 0.04, 95% CI: 0.01–0.22, p-value = <0.001) and 2017 (RRR = 0.23, 95% CI: 0.07–0.74, p-value = 0.01), respectively. HCFs from the Khulna division had a 2.84 (RRR = 2.84, CI: 1.25–6.43, p-value = 0.01) and 3.51 (RRR = 3.51, CI: 1.49–8.27, p-value = <0.001) higher likelihood of having medium and high preparedness, respectively, for ANC service compared to the facilities in the Dhaka division in 2017. The facilities that had a medium infection prevention score were 3.10 times (RRR = 3.10, 95% CI: 1.65–5.82; p-value = <0.001) and 1.89 times (RRR = 1.89, 95% CI: 1.09–3.26, p-value = 0.02) more likely to have high preparedness compared to those facilities that had a low infection prevention score in 2014 and 2017 respectively. Facilities without visual aids for client education on pregnancy and ANC were less likely to have high (RRR = 0.29, 95% CI: 0.16–0.53, p-value = <0.001) and (RRR = 0.55, 95% CI: 0.30–0.99, p-value = 0.04) preparedness, respectively, than those with visual aids for client education on pregnancy and ANC in both the surveys. At all two survey time points, facilities that did not maintain individual client cards or records for ANC clients were less likely to have high (RRR = 0.53, 95% CI: 0.31-.92, p-value = 0.02) and (RRR = 0.41, 95% CI: 0.25–0.66, p-value = <0.001) preparedness, respectively, compared to their counterparts. We conclude that most facilities lack adequate indicators for ANC service preparedness. To improve the readiness of ANC services, government authorities could focus on union-level facilities, community clinics, private facilities, and administrative divisions. They could also make sure that infection control items are available, maintain individual client cards or records for ANC clients, and also ensure ANC clients have access to visual aids.

The level of utilization and associated factors of WHO recommended antenatal care visits in South Asian countries

“…Implementing targeted interventions to improve education levels among women and their partners could significantly enhance ANC visits. A study conducted in a South Asian country found lack of proper indicators for ANC service preparedness such as staff and guidelines and equipment on union-level facilities, community clinics, private facilities and administrative divisions [ 61 ]. Thus, efforts to increase accessibility to healthcare facilities, particularly in rural areas, and initiatives to alleviate financial barriers for lower-income households are crucial.…”

Availability and readiness of healthcare facilities and their effects on antenatal care services uptake in Bangladesh: analysis of linked data

“…According to a recent study, 54.6% of facilities that provide ANC services have at least one ANCtrained staff, while only 4.3% of facilities are fully prepared to provide ANC services [27]. Although, in total around 18000 community clinics are available across rural areas of the country and only 33% of the facilities have considerably high preparedness for ANC services [27]. By policy, they are the primary provider of ANC services, but their lack of readiness impedes women's access to healthcare.…”

“…Another signi cant barrier to ANC service uptake is healthcare facility readiness to provide ANC, which frequently arises as a result of lower governmental priorities to equip Upazila to community level healthcare facilities with required facilities. According to a recent study, 54.6% of facilities that provide ANC services have at least one ANCtrained staff, while only 4.3% of facilities are fully prepared to provide ANC services [27]. Although, in total around 18000 community clinics are available across rural areas of the country and only 33% of the facilities have considerably high preparedness for ANC services [27].…”

“…Following this, multicollinearity of the available variables was checked. Following these steps, a list of variables was generated where the variables nally chosen were summarised under three headings following the socio-ecological model of health: individual level factors, households level factors, and community level factors [10,[26][27][28][29][30][31][32]. Individual level factors were mother's age at birth at the last child, mother's education status, mother's employment status, and pregnancy intention at conception.…”

Socio-economic status and pregnancy complications and their impact on antenatal care services provided at home and Upazila health complex

“…Culturally unique and economically distinctive areas were selected for this survey [ 21 ]. A recent study in Bangladesh focused on appreciating the preparedness of the health care facility to ensure antenatal care among pregnant women for the welfare of both mothers and newborn children using data from the Bangladesh Health Facilities Survey (BHFS) 2014 and 2017 [ 22 ].…”