Assessing service availability and readiness to manage cervical cancer in Bangladesh

Abstract

Background The second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. In order to provide accurate information to policymakers in Bangladesh and other low and middle income countries, it is vital to assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh. Methods An interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13. Results There were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services. Conclusion The health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. Given that cervical cancer accounts for more than one-fourth of all female cancers in Bangladesh, management of cervical cancer needs to be available at all levels of health facilities, with primary level facilities focusing on early diagnosis. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals.

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.…”

“…Considering the number of components available, scores for each domain were obtained before computing the composite mean of the scores of the five domains for the aggregate GSR index. [29] Based on previous studies, [31,32] the general service readiness scores were compared with the benchmark of 70%, where facilities/areas scoring above were considered to be ready to provide the services.…”

“…For most of those who accessed services only in PPP-supported health facilities, 38.5% (81) perceived the quality of health services delivery to be moderate. However, those who accessed services only in the government health facilities and those who accessed both PPP-supported & government health facilities 42.5% (40) and 40% (32) respectively, perceived the quality of health services delivery to be good. Considering the respondent households' perceptions, there was no significant association (χ2 = 5.445, p > 0.05) between health services delivery quality and services being accessed in only PPP-supported or government health facilities and services.…”

Assessing service availability and readiness of healthcare facilities to manage diabetes mellitus in Bangladesh: Findings from a nationwide survey

“…The interviews were conducted in-person and were recorded for further analysis. The details of the data collection method have been fully described in studies by Paromita and Rakhshanda [ 18 , 19 ].…”

“…Indices were stratified by facility level and compared to a RI cutoff score of 70%. This cutoff was based upon a study conducted by Wilbroad Mutale et al in Zambia utilizing the SARA tool, which considered a facility to be ‘ready’ to manage diabetes care if it scored above 70% [ 18 , 19 , 21 ]. All data were analyzed using SPSS version 21 (SPSS, Chicago, IL).…”