Implementation barriers and facilitators to a COVID-19 intervention in Bangladesh: The benefits of engaging the community for the delivery of the programme

Abstract

Background BRAC (Bangladesh Rural Advancement Committee), the largest NGO globally, implemented a community-based comprehensive social behavior communication intervention to increase community resilience through prevention, protection, and care for COVID-19. We conducted implementation research to assess fidelity and explore the barriers and facilitators of this intervention implementation. Methods We adopted a concurrent mixed-method triangulation design. We interviewed 666 members of 60 Community Corona Protection Committees (CCPCs) and 80 members of 60 Community Support Teams (CSTs) through multi-stage cluster sampling using a structured questionnaire. The qualitative components relied on 54 key informant interviews with BRAC implementers and government providers. Results The knowledge about wearing mask, keeping social distance, washing hands and COVID-19 symptoms were high (on average more than 70%) among CCPC and CST members. While 422 (63.4%) CCPC members reported they ‘always’ wear a mask while going out, 69 (86.3%) CST members reported the same practice. Only 247 (37.1%) CCPC members distributed masks, and 229 (34.4%) donated soap to the underprivileged population during the last two weeks preceding the survey. The key facilitators included influential community members in the CCPC, greater acceptability of the front-line health workers, free-of-cost materials, and telemedicine services. The important barriers identified were insufficient training, irregular participation of the CCPC members, favouritism of CCPC members in distributing essential COVID-19 preventive materials, disruption in supply and shortage of the COVID-19 preventative materials, improper use of handwashing station, the non-compliant attitude of the community people, challenges to ensure home quarantine, challenges regarding telemedicine with network interruptions, lack of coordination among stakeholders, the short duration of the project. Conclusions Engaging the community in combination with health services through a Government-NGO partnership is a sustainable strategy for implementing the COVID-19 prevention program. Engaging the community should be promoted as an integral component of any public health intervention for sustainability. Engagement structures should incorporate a systems perspective to facilitate the relationships, ensure the quality of the delivery program, and be mindful of the heterogeneity of different community members concerning capacity building. Finally, reaching out to the underprivileged through community engagement is also an effective mechanism to progress through universal health coverage.

Impact of public health interventions on COVID-19 control in Lahore

“…Several studies have highlighted the significance of various measures in managing the COVID-19 pandemic. For instance, Akter et al (2022) 12 stressed the importance of community participation and capacity building for effective COVID-19 management. Similarly, Lupton and Lewis (2021) 13 , Ha et al (2021) 14 , and Gilmore et al (2020) 15 emphasized the relevance of clear communication, good data management, and regular reviews to ensure that policies and procedures are addressing the pandemic's challenges.…”

Insights from Government Officials on Strategies and Practices for Managing the Covid-19 Pandemic: A Qualitative Study

“…The interviews conducted with key stakeholders revealed five key themes in pandemic management. Akter et al conducted a study in Bangladesh that aligns with the theme of Public Perception and Engagement, emphasizing the importance of community engagement and capacity building for effective COVID-19 management 12 . The study also aligns with the theme of Disease Management and Vaccination by highlighting the potential benefits of telemedicine services in reducing the burden on the healthcare system and improving access to healthcare for underprivileged populations.…”

COVID‐19 vaccination success in Bangladesh: Key strategies were prompt response, early drives for vaccines, and effective awareness campaigns

“…In addition, patients infected with coronavirus were also allowed to use telemedicine services provided by local and national organizations. 38 On February 7, 2021, Bangladesh launched a nationwide immunization campaign against COVID-19, with the primary targets being front-line combatants and anyone aged 40 years or older. 25 On August 10, 2021, the Bangladesh government announced that those 18 or older could receive the vaccines for COVID-19.…”

“…Along with the government, various charities and social welfare groups assisted in detecting COVID‐19 patients and provided financial assistance to those patients so they could remain in quarantine for 14 days. In addition, patients infected with coronavirus were also allowed to use telemedicine services provided by local and national organizations 38 …”