Primary healthcare system readiness to prevent and manage non-communicable diseases in Bangladesh: a mixed-method study protocol

Abstract

Introduction: The burden of non-communicable diseases (NCDs) is rapidly increasing in Bangladesh. Currently, it contributes to 67% of annual deaths, and accounts for approximately 64% of the disease burden. Since 70% of the Bangladeshi population residing in the rural area rely on the primary healthcare system, assessment of its capacity is crucial for guiding public health decisions to prevent and manage NCDs. This protocol is designed to recognise and assess the Bangladeshi health system's readiness for NCDs at the primary level.

Methods and analysis: The study will use a mixed-method design. Numerical data will be collected using households and health facilities surveys, while qualitative data will be collected by interviewing healthcare providers, policy planners, health administrators and community members. The WHO's Service Availability and Readiness Assessment (SARA) methodology and Package of Essential Non-communicable (PEN) Disease Interventions for Primary Healthcare reference manuals will be used to assess the readiness of the primary healthcare facilities for NCD services. Furthermore, Health System Dynamics Framework will be used to examine health system factors. Using the supportive items outlined in the WHO PEN package, and indicators proposed in WHO SARA methodology, a composite score will be created to analyse facility-level data. Two independent samples t-test, analysis of variance and χ² test methods will be used for bivariate analysis, and multiple regression analysis will be used for multivariable analysis. Complementarily, the thematic analysis approach will be used to analyse qualitative data.

Ethics and dissemination: The project has been approved by the Monash University Human Research Ethics Committee (Project ID: 27112), and Bangladesh Medical Research Council (Ref: BMRC/NREC/2019-2022/270). The research findings will be shared through research articles, conference proceedings or in other scientific media. The reports or publications will not have any information that can be used to identify any of the study participants.

Keywords: human resource management; organisation of health services; public health; qualitative research; quality in health care.

Figure 1

Health service delivery organisational structure in Bangladesh. Adapted from Bangladesh Health System Review. ngo, non-governmental organisation.

Figure 2

Study site map.

Figure 3

Study design with data collection method and analysis. FGD, focus group discussions; IDI, in-depth interviews; KII, key informant interviews; NCD PEN, non-communicable disease package of essential interventions; SARA, Service Availability and Readiness Assessment.

Figure 4

Health system dynamics framework. Source: adapted from van Olmen et al. NCDs, non-communicable diseases.

Figure 5

Sampling strategy. EAs, enumeration areas. HHs, household