“Challenges and Opportunities in Strengthening the Non-communicable Diseases in the Rural Upazila Health Complexes, Chattogram: A situational Analysis”

Abstract

Introduction: Management of non-communicable diseases (NCDs) is an important part of service delivery at the sub-district level hospitals in Bangladesh. The study aimed to assess the challenges faced by the service providers in providing noncommunicable disease (NCDs) management efficiently in the NCD corner of primary health care and identifying the opportunities in strengthening the service. Method: This study adopted a cross-sectional study design. An Exploratory Qual-Quan method was used for data collection. A semi-structured Key Informant Interview (n=4) and an in-depth interview (n=12) were conducted for qualitative data collection. For quantitative data collection, an NCD facility service checklist adopted from WHO SARA guidelines (n=4) was utilized. Setting: The study survey was conducted in the purposively chosen 4 Upazila Health Complexes of Chattogram Division which are Hathazari, Boalkhali, Anowara, and Patiya. Findings: Diabetes Mellitus and COPD were the major NCDs in the Upazila Health complexes. In addition to this, none of the UHCs had management for Cancer and Mental health; thus the patients are referred to government tertiary care hospitals. All of the UHCs had the supply of basic equipment such as BP machines, weight and height machines as well as basic laboratory test facilities; however, concerns were reported on inadequacy in the supply of medicine and NCD book compared to the demand and due to the lack of necessary materials like cartridge and reagents some of the lab tests cannot be performed. The supply of free medicines incentivized the patients to visit for follow-up. Due to the lack of ICU management, and diagnosis facilities of some NCDs, patients are referred to tertiary care for further treatment and investigations. There are no designated positions for Medical officers and nurses. Except for a few, all participants received training on NCD, and the training components were mainly on how to approach patients. Conclusion: There was an inadequate supply of medicine and other NCD-related logistics compared to the demand in the NCD corners. The establishment of the NCD corner still needs some improvements for strengthening the services for the NCDs due to the high prevalence of the disease.