Bottleneck analysis of maternal and newborn health services in hard-to-reach areas of Bangladesh using ‘TANAHASHI’ framework’: An explanatory mixed-method study

Abstract

Maternal and Newborn Health (MNH) is of paramount importance in the realm of attaining sustainable development goals that also focuses on universal health coverage (UHC). The study aimed at identifying and exploring the bottlenecks in MNH services in Hard-to-reach (HtR) areas of Bangladesh using the Tanahashi framework exploring the possible remedial approaches. The study was conducted in four different types of HtR areas (hilly, coastal, lowlands, and river islands) by utilizing a sequential explanatory mixed-method design. Overall, we collected information from 20 health facilities and 2,989 households by interviewing 2,768 recently delivered women (RDW) with a structured questionnaire and qualitative interviews (n = 55) of facility managers, local stakeholders, RDWs, and health care providers (HCP). The quantitative data were analyzed principally for descriptive statistics and the qualitative data was analyzed by utilizing the thematic approach. Antenatal care, under-5 care, and family planning services were available in almost all the facilities. However, Normal vaginal deliveries were performed in 55.6% of the union-level facilities. Only 40% of sub-district level facilities had provision for C-sections. Blood transfusion services were available in only 20.1% of facilities, whereas laboratory services were obtainable in 51.7% of facilities. Overall, the bottlenecks were identified in cases of availability of drugs, human resources, transportation, lack of knowledge regarding different essential services and health components, out of pocket expenditure etc. There have been several remedial approaches suggested from both the demand and supply side that included incentives for care providers for staying in these areas, a coordinated transport/referral system, and health education campaigns. More research works are warranted in HtR areas, especially to test the proposed interventions. Meanwhile, the government should take the necessary steps to overcome the bottlenecks identified.

Natural disasters, livelihood, and healthcare challenges of the people of a riverine island in Bangladesh: A mixed-method exploration

“…Our study found that the percentage of home deliveries was alarmingly high in the community which is congruent to the study findings conducted by a study in the hard-to-reach areas of Bangladesh [ 33 , 34 ]. The high rate of home deliveries is concerning, as home deliveries are associated with a number of risks, including increased risk of complications and in turn increased risk of maternal and infant deaths [ 33 , 35 ]. The high rate of miscarriages and deaths among home deliveries is also troublesome.…”

Reaching the Unreachable: A mixed-method evaluation of multidimensional healthcare model addressing the healthcare service gaps in hard-to-reach Northern Riverine Bangladesh

“…A previous study on these populations revealed that 50% of the rich people traveled 30 minutes to receive services, while the corresponding percentage for the poorest was 23%. [25] However, through this 3-tier health care model, they have received health care services in their community for no to minimal cost. With Friendship's addressing transportation and cost barriers, the willingness to seek health care among Char people ultimately increased, as revealed in our exploration.…”

Investigating factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea

“…Additionally, eld notes were taken throughout interviews to summarise the main points and to capture information emphasised by participants. 30 Member checking of synthesised data was undertaken by emailing participants to con rm the results resonated with their views. 31…”