DOI QR코드

DOI QR Code

The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers' Perspectives

  • Sharmin Parveen (Department of Health Informatics, Bangladesh University of Health Sciences) ;
  • Md. Shahriar Mahbub (Department of Reproductive and Child Health, Bangladesh University of Health Sciences) ;
  • Nasreen Nahar (Department of Reproductive and Child Health, Bangladesh University of Health Sciences) ;
  • K. A. M. Morshed (Advocacy, Innovation and Migration, BRAC) ;
  • Nourin Rahman (Advocacy for Social Change, BRAC) ;
  • Ezzat Tanzila Evana (Advocacy for Social Change, BRAC) ;
  • Nazia Islam (Advocacy for Social Change, BRAC) ;
  • Abu Said Md. Juel Miah (Advocacy for Social Change, BRAC)
  • 투고 : 2024.02.16
  • 심사 : 2024.05.22
  • 발행 : 2024.07.31

초록

Objectives: The objective of this study was to explore healthcare providers' experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services. Methods: A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically. Results: Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives. Conclusions: The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.

키워드

과제정보

The authors wish to thank all participants in this study.

참고문헌

  1. World Health Organization. WHO COVID-19 dashboard [cited 2024 Apr 20]. Available from: https://data.who.int/dashboards/covid19/cases 
  2. Paul R. Bangladesh confirms its first three cases of coronavirus. Reuters; 2020 Mar 8 [cited 2024 Apr 20]. Available from: https://www.reuters.com/article/idUSKBN20V0G9/ 
  3. Government of Bangladesh. Latest status in Bangladesh [cited 2024 Feb 10]. Available from: https://corona.gov.bd/ (Bengali). 
  4. UNICEF Bangladesh. As COVID-19 devastates already fragile health systems, over 6,000 additional children under five could die a day, without urgent action; 2020 [cited 2023 Dec 22]. Available from: https://www.unicef.org/bangladesh/en/press-releases/covid-19-devastates-already-fragile-health-systems 
  5. Lassi ZS, Naseem R, Salam RA, Siddiqui F, Das JK. The impact of the COVID-19 pandemic on immunization campaigns and programs: a systematic review. Int J Environ Res Public Health 2021;18(3):988. https://doi.org/10.3390/ijerph18030988 
  6. Life expectancy declines for first time in 4yrs. The Daily Star; 2023 Apr 18 [cited 2024 Apr 20]. Available from: https://www.thedailystar.net/news/bangladesh/news/life-expectancy-declines-first-time-4yrs-3299446 
  7. GBD 2021 Demographics Collaborators. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024;403(10440):1989-2056. https://doi.org/10.1016/S0140-6736(24)00476-8 
  8. World Health Organization. Bangladesh health system review; 2015 [cited 2024 Apr 20]. Available from: https://iris.who.int/handle/10665/208214 
  9. Ahmed SA, Ajisola M, Azeem K, Bakibinga P, Chen YF, Choudhury NN, et al. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health 2020;5(8):e003042. https://doi.org/10.1136/bmjgh-2020-003042 
  10. Chauhan AS, Singh K, Bhatia R, Khetrapal S, Naskar A. The health system's response to and the impact of COVID-19 on health services, providers, and seekers: a rapid review in the wake of the pandemic. COVID 2023;3(8):1106-1157. https://doi.org/10.3390/covid3080081 
  11. Nguyen PH, Kachwaha S, Pant A, Tran LM, Walia M, Ghosh S, et al. COVID-19 disrupted provision and utilization of health and nutrition services in Uttar Pradesh, India: insights from service providers, household phone surveys, and administrative data. J Nutr 2021;151(8):2305-2316. https://doi.org/10.1093/jn/nxab135 
  12. Basu D, Srivastava P. COVID-19 in South Asia: health, economics and politics. Invest Econ 2021;81(319):117-140. https://doi.org/10.22201/fe.01851667p.2022.319.79762 
  13. Mahmood SS, Hasan MZ, Hasan AM, Rabbani MG, Begum F, Yousuf TB, et al. Health system impact of COVID-19 on urban slum population of Bangladesh: a mixed-method rapid assessment study. BMJ Open 2022;12(2):e057402. https://doi.org/10.1136/bmjopen-2021-057402 
  14. Institute of Epidemiology, Disease Control and Research (IEDCR). Covid-19 update flash; 2020 [cited 2024 Feb 10]. Available from: https://www.iedcr.gov.bd/site/page/6065cfeb-ffbf-400d-847f-4e4daf700763/- (Bengali). 
  15. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa 
  16. Manyazewal T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Arch Public Health 2017;75:50. https://doi.org/10.1186/s13690-017-0221-9 
  17. British Medical Association (BMA). COVID-19: impact of the pandemic on healthcare delivery; 2023 [cited 2024 Feb 9]. Available from: https://www.bma.org.uk/advice-and-support/covid-19/what-the-bma-is-doing/covid-19-impact-of-the-pandemic-on-healthcare-delivery 
  18. Haileamlak A. The impact of COVID-19 on health and health systems. Ethiop J Health Sci 2021;31(6):1073-1074. https://doi.org/10.4314/ejhs.v31i6.1 
  19. Shrestha N, Mishra SR, Ghimire S, Gyawali B, Marahatta SB, Maskey S, et al. Health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal: a qualitative study among frontline health-care workers and policymakers. Disaster Med Public Health Prep 2022;16(6):2560-2568. https://doi.org/10.1017/dmp.2021.204 
  20. Boussarsar M, Meddeb K, Toumi R, Ennouri E, Ayed S, Jarraya F, et al. Resource utilization and preparedness within the COVID-19 pandemic in Tunisian medical intensive care units: a nationwide retrospective multicentre observational study. J Infect Public Health 2023;16(5):727-735. https://doi.org/10.1016/j.jiph.2023.02.022 
  21. Kim Y, Shin JM, Yoo SH, Keam B. Challenges in care for non-COVID-19 patients with severe chronic illnesses during COVID-19 pandemic: a qualitative study of healthcare providers working around acute care hospitals in South Korea. Healthcare (Basel) 2023;11(4):611. https://doi.org/10.3390/healthcare11040611 
  22. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health 2020;20(1):1193. https://doi.org/10.1186/s12889-020-09301-4 
  23. Exemplars in Global Health. Health-system resiliency in Bangladesh during the first year of COVID [cited 2014 Apr 20]. Available from: https://www.exemplars.health/topics/underfive-mortality/covid-19/bangladesh/health-system-resiliency-in-bangladesh 
  24. Uddin Quadery SE, Hasan M, Khan MM. Consumer side economic perception of telemedicine during COVID-19 era: a survey on Bangladesh's perspective. Inform Med Unlocked 2021;27:100797. https://doi.org/10.1016/j.imu.2021.100797 
  25. Chirico F, Nucera G, Magnavita N. COVID-19: protecting healthcare workers is a priority. Infect Control Hosp Epidemiol 2020;41(9):1117. https://doi.org/10.1017/ice.2020.148 
  26. Hassan MZ, Monjur MR, Styczynski AR, Rahman M, Banu S. Protecting frontline healthcare workers should be the top priority in low-resource health systems: Bangladesh and COVID19. Infect Control Hosp Epidemiol 2021;42(1):121-122. https://doi.org/10.1017/ice.2020.208 
  27. Baldwin S, George J. Qualitative study of UK health professionals' experiences of working at the point of care during the COVID-19 pandemic. BMJ Open 2021;11(9):e054377. https://doi.org/10.1136/bmjopen-2021-054377 
  28. Silubonde-Moyana TM, Draper CE, Norris SA. Effectiveness of behavioural interventions to influence COVID-19 outcomes: a scoping review. Prev Med 2023;172:107499. https://doi.org/10.1016/j.ypmed.2023.107499 
  29. World Health Organization. Health workforce [cited 2024 Feb 9]. Available from: https://www.who.int/data/gho/data/themes/health-workforce 
  30. Ahmed SM, Hossain MA, Rajachowdhury AM, Bhuiya AU. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Hum Resour Health 2011;9:3. https://doi.org/10.1186/1478-4491-9-3 
  31. Johnson KJ, Goss CW, Thompson JJ, Trolard AM, Maricque BB, Anwuri V, et al. Assessment of the impact of the COVID-19 pandemic on health services use. Public Health Pract (Oxf) 2022;3:100254. https://doi.org/10.1016/j.puhip.2022.100254 
  32. Garcia-Zamora S, Pulido L, Miranda-Arboleda AF, Garcia DE, Perez G, Priotti M, et al. Aggression, micro-aggression, and abuse against health care providers during the COVID-19 pandemic. A Latin American survey. Curr Probl Cardiol 2022;47(10):101296. https://doi.org/10.1016/j.cpcardiol.2022.101296 
  33. Yin M, Zhang W, Evans R, Zhu C, Wang L, Song J. Violence on the front line: a qualitative comparative analysis of the causes of patient violence towards medical staff in China during the COVID-19 pandemic. Curr Psychol 2023:1-21. https://doi.org/10.1007/s12144-023-04456-w 
  34. Hasan MJ, Sarkar TY, Ahmed M, Banik A, Islam S, Zaman MS, et al. Violence against physicians working in public tertiary care hospital of Bangladesh: a facility-based cross-sectional study. BMJ Open 2024;14(3):e080244. https://doi.org/10.1136/bmjopen-2023-080244 
  35. Das Pooja S, Nandonik AJ, Ahmed T, Kabir ZN. "Working in the dark": experiences of frontline health workers in Bangladesh during COVID-19 pandemic. J Multidiscip Healthc 2022;15:869-881. https://doi.org/10.2147/JMDH.S357815 
  36. Batista C, Hotez P, Amor YB, Kim JH, Kaslow D, Lall B, et al. The silent and dangerous inequity around access to COVID-19 testing: a call to action. EClinicalMedicine 2022;43:101230. https://doi.org/10.1016/j.eclinm.2021.101230 
  37. Mahase E. Covid-19: oxygen shortages two years into pandemic highlight pre-covid failures, says WHO. BMJ 2022;376:o829. https://doi.org/10.1136/bmj.o829 
  38. Daodu O, Gurses A, Osei P, Nosakhare E, Perry S, Sultan M, et al. Work system barriers to & resilience strategies for COVID-19 PPE use in the emergency department: a qualitative interview study. Antimicrob Steward Healthc Epidemiol 2022;2(Suppl 1):s10. https://doi.org/10.1017/ash.2022.71 
  39. Shahrin L, Parvin I, Sarmin M, Abbassi NA, Ackhter MM, Alam T, et al. In-person training on COVID-19 case management and infection prevention and control: evaluation of healthcare professionals in Bangladesh. PLoS One 2022;17(10):e0273809. https://doi.org/10.1371/journal.pone.0273809