| Table of contents |
TABLES AND FIGURES ..........................................................................................................................vii
FOREWORD ............................................................................................................................................ xiii
PREFACE ...................................................................................................................................................xv
CONTRIBUTORS TO THE REPORT ..................................................................................................xvii
ABBREVIATIONS AND ACRONYMS..................................................................................................xix
READING AND UNDERSTANDING TABLES FROM THE 2017 BANGLADESH HFS............ xxiii
MAP OF BANGLADESH........................................................................................................................xxx
1 OVERVIEW OF THE HEALTH SYSTEM IN BANGLADESH...............................................1
1.1 Health Status in Bangladesh ................................................................................................ 1
1.2 Health, Population, and Nutrition Sector Program .............................................................. 1
1.3 Health Service Delivery System of Bangladesh .................................................................. 3
1.3.1 Management Structure and Health Facilities under DGHS ................................... 4
1.3.2 Management Structure and Health Facilities under DGFP .................................... 5
1.3.3 Urban Primary Health Care Services Delivery Project (UPHCSDP) .................... 6
1.3.4 NGO Health Programs ........................................................................................... 6
1.3.5 Private Health Sector ............................................................................................. 6
1.4 Health Financing ................................................................................................................. 7
1.5 Health Stewardship .............................................................................................................. 8
2 METHODOLOGY..........................................................................................................................9
2.1 Overview ............................................................................................................................. 9
2.2 Institutional Framework and Objectives of the 2017 BHFS ................................................ 9
2.2.1 Institutional Framework ......................................................................................... 9
2.2.2 Objectives of the 2017 BHFS .............................................................................. 10
2.3 Data Collection Methods ................................................................................................... 10
2.4 Survey Implementation...................................................................................................... 11
2.4.1 Questionnaire Adaptation .................................................................................... 11
2.4.2 Pre-test ................................................................................................................. 11
2.4.3 Main Training ...................................................................................................... 11
2.4.4 Data Collection .................................................................................................... 12
2.4.5 Data Management and Report Writing ................................................................ 12
2.4.6 Data Analysis and Report Preparation ................................................................. 12
2.5 Sampling ............................................................................................................................ 13
2.5.1 Sampling Methodology ........................................................................................ 13
2.5.2 Sampling Frame ................................................................................................... 13
2.5.3 2017 BHFS Sample Size and Sample Allocation ................................................ 13
2.5.4 Sample of Health Facilities and Outcomes .......................................................... 13
2.5.5 Sample of Health Service Providers .................................................................... 14
3. FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, AND SUPPORT .............19
3.1 Background ........................................................................................................................ 20
3.2 Availability of Services ..................................................................................................... 21
3.2.1 Overall Availability of Specific Client Services .................................................. 21
3.2.2 Availability of Basic Client Services ................................................................... 21
3.2.3 General Service Preparedness .............................................................................. 22
3.3 Basic Management Systems to Support and Maintain Quality Services and Appropriate Client Utilization ........ 33
3.3.1 Supportive Management Practices for Providers ................................................. 33
3.3.2 Quality Assurance ................................................................................................ 34
3.3.3 Client Feedback ................................................................................................... 35
3.4 Availability of Human Resources for Health .................................................................... 35
3.5 Management of Medical Waste in Health Care Facilities ................................................. 37
4 CHILD HEALTH SERVICES.....................................................................................................55
4.1 Background ........................................................................................................................ 55
4.2 Availability of Child Health Services ................................................................................ 56
4.2.1 Provision of Outpatient Curative Care, Child Growth Monitoring, Child Vaccination, and Nutrition Services ............ 56
4.2.2 Vitamin A Supplementation and Deworming ...................................................... 57
4.2.3 Availability of Guidelines, Basic Equipment, and Trained Staff for Child Curative Care .............. 57
4.2.4 Availability of Medicines and Commodities for Sick Child Care ....................... 58
4.2.5 Infection Control in Sick Child Services ............................................................. 59
4.2.6 Laboratory Diagnostic Capacity .......................................................................... 59
4.3 Readiness of Health Facilities to Provide Child Curative Care ......................................... 60
4.4 Basic Management and Administrative Systems ............................................................... 61
4.4.1 Personal Supervision and Training ...................................................................... 61
4.4.2 In-service Training by Topic ............................................................................... 62
5 FAMILY PLANNING SERVICES .............................................................................................71
5.1 Background ........................................................................................................................ 71
5.2 Family Planning Services .................................................................................................. 72
5.2.1 Availability of Family Planning Services ............................................................ 73
5.2.2 Facilities Providing Modern Family Planning Methods and Services ................. 74
5.2.3 Frequency of Availability of Family Planning Services ...................................... 75
5.2.4 Availability of Commodities on the Day of the Assessment ............................... 76
5.2.5 Availability of Service Guidelines, Trained Staff, and Equipment ...................... 76
5.2.6 Infection Control During Provision of Family Planning ...................................... 76
5.2.7 Readiness to Provide Family Planning Services .................................................. 77
5.3 Basic Management and Administrative Systems ............................................................... 80
5.3.1 Training and Supervision ..................................................................................... 80
5.3.2 In-service Training by Topic ............................................................................... 81
6 ANTENATAL CARE SERVICES ..............................................................................................93
6.1 Background ........................................................................................................................ 93
6.2 Availability of ANC Services ............................................................................................ 94
6.2.1 ANC Service Provision ........................................................................................ 94
6.2.2 Availability of ANC Guidelines, Trained Staff, and Equipment ......................... 95
6.2.3 Availability of Laboratory Diagnostic Tests ........................................................ 96
6.2.4 Availability of Medicines for Routine ANC ........................................................ 96
6.2.5 Availability of Infection Control items ................................................................ 97
6.3 Readiness of Health Facilities to Provide ANC Services .................................................. 97
6.4 Basic Management and Administrative Systems ............................................................. 101
6.4.1 Recent In-service Training and Supervision ...................................................... 101
6.4.2 In-service Training by Topic ............................................................................. 101
7 DELIVERY AND NEWBORN CARE......................................................................................111
7.1 Background ...................................................................................................................... 112
7.2 Availability of Maternal Health Services ........................................................................ 113
7.2.1 Service Provision ............................................................................................... 113
7.2.2 Guidelines, Trained Staff, and Equipment for Delivery Services ...................... 115
7.2.3 Medicines and Commodities for Delivery Care ................................................. 116
7.2.4 Items for Infection Control during Provision of Delivery Care ......................... 117
7.3 Signal Functions for Emergency Obstetric and Newborn Care ....................................... 118
7.4 Readiness of Health Facilities to Provide Normal Delivery Services ............................. 119
7.5 Newborn Care Practices .................................................................................................. 121
7.5.1 Routine Newborn Care ...................................................................................... 121
7.5.2 Availability of Essential Medicines for Newborn Care ..................................... 121
7.5.3 Availability of Equipment for Newborn Care Services ..................................... 122
7.6 Basic Management and Administrative Systems ............................................................. 123
7.6.1 Recent In-service Training and Supervision ...................................................... 123
7.6.2 In-service Training in Newborn and Delivery Care by Topic ........................... 123
8 NON-COMMUNICABLE DISEASES......................................................................................137
8.1 Background ...................................................................................................................... 138
8.2 Availability of Services for Diabetes ............................................................................... 141
8.2.1 Service Provision ............................................................................................... 141
8.2.2 Availability of Diagnostic Capacity and Medicines for Diabetes ...................... 143
8.3 Availability of Services for Cardiovascular Diseases ...................................................... 143
8.3.1 Service Provision ............................................................................................... 143
8.3.2 Availability of Medicines and Commodities for Cardiovascular Diseases ........ 145
8.4 Availability of Services for Chronic Respiratory Diseases ............................................. 145
8.4.1 Service Provision ............................................................................................... 145
8.4.2 Availability of Medicines and Commodities for Chronic Respiratory Diseases 147
8.5 Availability of Services for Hypertension ....................................................................... 147
8.5.1 Service Provision ............................................................................................... 147
8.5.2 Availability of Medicines and Commodities for Hypertension ......................... 149
8.6 Availability of Services for Cervical Cancer ................................................................... 149
8.6.1 Availability of Screening Services for Cervical Cancer .................................... 149
8.6.2 Service Guidelines ............................................................................................. 150
8.6.3 Trained Staff ...................................................................................................... 150
8.6.4 Equipment .......................................................................................................... 150
9 TUBERCULOSIS .......................................................................................................................161
9.1 Background ...................................................................................................................... 162
9.2 Availability of TB Services ............................................................................................. 163
9.2.1 Service Provision ............................................................................................... 163
9.2.2 Availability of Diagnostic Capacity and Medicines for TB Treatment ............. 165
9.3 Readiness of Health Facilities to Provide TB Services ................................................... 165
REFERENCES .........................................................................................................................................171
APPENDIX A PERSONS INVOLVED IN THE SURVEY................................................................175
APPENDIX B SUMMARY INDICATORS .........................................................................................179
APPENDIX C QUESTIONNAIRES.....................................................................................................181 |
