Assessing readiness of health facilities for hypertension and integration with diabetes care in Bangladesh: Evidence from the National Service Provision Assessment Survey
Year: 2025
Type: article
Abstract: BACKGROUND: Hypertension (HT) and diabetes mellitus (DM) are two major noncommunicable diseases (NCDs) with a high rate of comorbidity that utilize similar health system resources. Limited evidence exists, however, on the level of readiness of health facilities in Bangladesh to manage HT and integrated HT-DM care. The objective of this study was an assessment of facility readiness for HT and integrated HT-DM management and to identify key factors influencing levels of readiness. METHODS: The study involved the analysis of data from 382 health facilities at or above sub-district level from the most recent nationally representative dataset, the 2017 Bangladesh Health Facility Survey (BHFS). Readiness for HT and integrated HT-DM services was assessed based on composite scores as constructed from the WHO-Service Availability and Readiness Assessment (SARA) indicators. Negative binomial regression models were applied to determine the factors associated with facility readiness. RESULTS: Facilities showed low readiness scores for both HT and integrated HT-DM care, with mean scores of 3.72 (out of 8) and 6.71 (out of 16), respectively. Although most facilities have basic equipment like BP apparatuses (98.7%) and stethoscopes (98.8%), a huge gap is observed in the training of staff (20.5%) and availability of guidelines for management (16.6%) of HT, diagnostic tools for DM, and essential medicines including ACE inhibitors (7.3%), thiazide diuretics (12.0%), and metformin (49.4%). Significant determinants of HT readiness included type of facility, client feedback system, and the number of HT care providers, while for integrated HT-DM readiness, important predictors were a type of facility, treatment-only service provision, client feedback mechanism, and structure of user-fees. CONCLUSIONS: In Bangladesh, health facilities are still not adequately ready to deliver integrated HT-DM services, illustrating deficits in human resources, clinical protocols, diagnostics, and availability of medicines at an overall system level. There are several areas that need improvement-the need for strengthening integrated training, free availability of medicines, client feedback systems, and collaboration between the public-private-NGO sectors. The results, though based on 2017 data, remain important in capturing system readiness prior to the reform and serve as a nationally representative baseline to assess the upspring of HT and NCD program improvements in Bangladesh.
Source: PLoS ONE
Authors: Jannat-E-Mim Jisan, Mosiur Rahman, Md. Sarwar Zahan, Prosannajid Sarkar, Md. Rashed Alam, Wazedul Islam, Farhana Akhter Liza, Majharul Islam, Md. Mamunur Rashid, Anika Tabashsum, Chowdhury Mashrur Mahdee, Fahim Sahriar
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,382
OpenAlex ID: W4417535618