Assessing service availability and readiness to manage Chronic Respiratory Diseases (CRDs) in Bangladesh

Abstract

Introduction Chronic Respiratory Diseases (CRDs) are some of the most prevailing non-communicable diseases (NCDs) worldwide and cause three times higher morbidity and mortality in low- and middle-income countries (LMIC) than in developed nations. In Bangladesh, there is a dearth of data about the quality of CRD management in health facilities. This study aims to describe CRD service availability and readiness at all tiers of health facilities using the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) tool. Methods A cross-sectional study was conducted from December 2017 to June 2018 in a total of 262 health facilities in Bangladesh using the WHO SARA Standard Tool. Surveys were conducted with facility management personnel by trained data collectors using REDCap software. Descriptive statistics for the availability of CRD services were calculated. Composite scores for facility readiness (Readiness Index ‘RI’) were created which included four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. RI was calculated for each domain as the mean score of items expressed as a percentage. Indices were compared to a cutoff of70% which means that a facility index above 70% is considered ‘ready’ to manage CRDs at that level. Data analysis was conducted using SPSS Vr 21.0. Results It was found, tertiary hospitals were the only hospitals that surpassed the readiness index cutoff of 70%, indicating that they had adequate capacity and were ready to manage CRDs (RI 78.3%). The mean readiness scores for the other hospital tiers in descending order were District Hospitals (DH): 40.6%, Upazila Health Complexes (UHC): 33.3% and Private NGOs: 39.5%). Conclusion Only tertiary care hospitals, constituting 3.1% of sampled health facilities, were found ready to manage CRD. Inadequate and unequal supplies of medicine as well as a lack of trained staff, guidelines on the diagnosis and treatment of CRDs, equipment, and diagnostic facilities contributed to low readiness index scores in all other tiers of health facilities.

Readiness of health facilities and determinants to manage diabetes mellitus: evidence from the nationwide Service Provision Assessment survey of Afghanistan, Bangladesh and Nepal

“…The explanatory variables were chosen based on two criteria: (1) they were available in the SPA survey [29][30][31] and (2) previous research had established them as important determinants of readiness of health facilities to provide DM services. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] The following variables were considered: facility location, managing authority, facility type, external sources of revenue, quality assurance activities, routine management meetings, external supervision, user fees, presence of trained health provider at facility 24 hours with duty schedule or present on-call, feedback on clients' opinions, health facility's' ability to perform diagnosis and/or treatment, and number of trained DM care providers.…”

Public-Private Partnership Supported Health Facilities and Progress towards Attainment of Universal Health Coverage in Kilimanjaro, Tanzania

“…With reference from previous studies assessing health facilities' readiness in services delivery, 70% GSR score was considered to be the cut-off point, where facilities that scored 70% or higher were considered to be ready to offer the expected health services. [31,32,42,43] In this study, the GSR index of 87%, is above the threshold, implying that the health facilities in the study area are generally ready for health services delivery. A report from the Ministry of Health [24] on service availability and readiness assessment conducted in 27 districts of Tanzania found that the private facilities including faith-based ones, had higher scores on the GSR index than the government facilities.…”

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

“…The overall mean GSR score of all SDPs was 83.4%. Facilities with a general readiness score of 70% are generally considered as having good service readiness [ 29 , 30 ]. Comparing this to the average GSR score in this study the present results show that SDPs in Ghana generally have good service readiness.…”