Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh

Abstract

BackgroundIn 2011, the Bangladesh Government introduced the National Nutrition Services (NNS) by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC) and management of sick children younger than five years.MethodsService delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 541 mothers/caregivers of sick children.ResultsStructural readiness to provide nutrition services was higher for ANC compared to management of sick children; 73% of ANC rooms had >5 of the 13 essential items while only 13% of the designated areas for management of sick children had >5 of the 13 essential items. One in five (19%) healthcare providers had received nutrition training through the NNS. Delivery of the nutrition services was poor: <30% of women received all four key antenatal nutrition services, 25% of sick children had their weight checked against a growth-chart and <1% had their height measured. Nevertheless, most mothers/caregivers rated their satisfaction of the service above average.ConclusionsStrengthening the provision of equipment and increasing the coverage of training are imperative to improve nutrition services. Inherent barriers to implementing nutrition services in primary health care, especially high caseloads during the management of sick under-five children, should be considered to identify alternative and appropriate service delivery platforms before nationwide scale up.

Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh

“…Studies suggest that inaccessibility to public health care facilities, poor availability of medicines and equipment, and perceptions of lower quality diagnosis and treatment drive people away from low cost public facilities. This either increases the use of expensive private sector care where families end up incurring higher out of pocket payment or increase use of untrained informal care providers [ 47 – 52 ]. Our findings also interestingly suggests that households are faced with worse financial conditions when choosing a private health care provider.…”

Stagnating trends in complementary feeding practices in Bangladesh: An analysis of national surveys from 2004‐2014

“…Because of the critical role of IYCF, several major nutrition programmes and policies in Bangladesh that aim to reduce child undernutrition have emphasized IYCF as a key component. These include the National Nutrition Programme (2006–2011), the National Nutrition Services (2011–2016), and the National Strategy on Prevention and Control of Micronutrient Deficiencies (2015–2024; Billah et al, ; Government of the People's Republic of Bangladesh, ; International Food Policy Research Institute, ).…”

Our son is ‘our asset, future, and bank’: exploring gender-related factors influencing adherence to advice and treatment-seeking guidance following hospital discharge among infants and young children in Bangladesh

“…Interviewees reported that concerns about interactions between men and women led to mothersespecially rural mothers and those living in conservative Muslim homes -being uncomfortable in seeking care from male medical practitioners, contributing to delays in seeking care for their children, including post-hospital discharge. A mixed-method study conducted in 12 rural sub-districts of Bangladesh reported that most healthcare providers (60%) managing under-ve year old sick children are male [16]. Another survey conducted in four rural sub-districts noted that many women are only allowed to meet an unknown male health provider to seek care for their children in a dire emergency [40].…”

“…Gender related factors at the facility/health system level Fewer female medical practitioners being available in healthcare facilities, particularly in rural areas There was widespread recognition across participants (household members, community representatives and health care providers) that there are fewer female than male medical practitioners available in healthcare facilities, particularly in rural areas; a sex difference documented in national databases [16].…”