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The COVID-19 pandemic has been a major health concern in Bangladesh until very recently. Although the Bangladesh government has employed various infection control strategies, more targeted Non-Pharmaceutical interventions (NPIs), including school closure, mask-wearing, hand washing, and social distancing have gained special attention. Despite significant long-term adverse effects of school closures, authorities have opted to keep schools closed to curb the spread of COVID-19 infection. However, there is limited knowledge about the impact of reopening schools alongside other NPI measures on the course of the epidemic. In this study, we implemented a mathematical modeling framework developed by the CoMo Consortium to explore the impact of NPIs on the dynamics of the COVID-19 outbreak and deaths for Bangladesh. For robustness, the results of prediction models are then validated through model calibration with incidence and mortality data and using external sources. Hypothetical projections are made under alternative NPIs where we compare the impact of current NPIs with school closures versus enhanced NPIs with school openings. Results suggest that enhanced NPIs with schools opened may have lower COVID-19 related prevalence and deaths. This finding indicates that enhanced NPIs and school openings may mitigate the long-term negative impacts of COVID-19 in low- and middle-income countries. Potential shortcomings and ways to improve the research are also discussed. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has highlighted the importance of a well-equipped and supported healthcare workforce, and Bangladesh still faces challenges in providing adequate and well-equipped healthcare services. Therefore, the study aims to assess the level of working conditions of the clinical health workers in Bangladesh and their relative importance in delivering quality healthcare services. Methods: The study followed a cross-sectional study design and collected primary data adopting a quantitative method. A total of 319 clinical workforces from four districts and eight sub-districts were randomly selected using a multi-stage sampling technique. A 26-component questionnaire used to assess various components of working conditions. Descriptive statistics, and bivariate analysis were used to analyze the data. Results: The study found that the working conditions of clinical health workers in primary and secondary healthcare facilities in Bangladesh were quite poor (3.40), with almost two-thirds of respondents showing negative views in 23 out of 26 indicators. The results also showed that working conditions were significantly (p ≤ 0.05) higher in primary compared to secondary level facilities. Moreover, men, younger workforce, and workforce with shorter length of service were more likely to report poor working conditions than their counterparts. Lastly, receiving monthly salary in due time was top-ranked (99.15) in terms of importance for delivering quality healthcare, followed by availability of medicines (98.04), and medical and surgical requisites (97.57), and adequate mentoring and support to perform duties (97.50). Conclusion: The study highlights the poor working conditions of clinical health workers in public health facilities in Bangladesh. It recommends that policymakers should prioritize improving working conditions by addressing the factors that are crucial for delivering quality healthcare. Improving working conditions will have a positive impact on the retention and motivation of workers, which will ultimately lead to better health outcomes for the population. [ABSTRACT FROM AUTHOR]

This study surveys 622 Bangladeshi civil servants of all administrative jurisdictions and elicits their preference for health insurance schemes. The latter vary in the amount of sum assured as well as in terms of premium sharing rules with the government. The paper also explores the financial burden that the premium subsidy may impose on the exchequer and the state's fiscal capacity to shoulder it. We discover a very high willingness to join the scheme. Though all three premium-sharing options posit flat rates common for all employment ranks, respondents appear to prefer premiums proportional to their basic salary. [ABSTRACT FROM AUTHOR]

Introduction: Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-specific impoverishment impact of OOP payments between the regions experiencing different climate change risks, defined as high disaster-prone (HDP) areas and low-disaster-prone (LDP) areas, in Bangladesh. Materials and methods: This paper estimated three poverty measures, such as poverty headcount, poverty intensity and normalized poverty gap for all ailments, catastrophic events, diseases types (communicable, non-communicable (NCDs), and accident and injury), illness conditions (acute and chronic) and hospitalization using 3,791 randomly selected rural households (1,203 from HDP and 2,588 from LDP areas) across the regions. Cost of basic need approach was used for estimating poverty line expenditure. Results: About 13 percent households annually fall into poverty due to OOP outlays for healthcare. Despite having significantly (p-value≤0.01) less OOP payments (HDP areas: BDT 5,117; LDP areas: BDT5,811) the impoverishment impact of OOP payments for healthcare in HDP areas (16.5%) has substantially higher than LDP areas (11.3%). Population in HDP areas, especially char (river island; 19.55 percent) and haor (water submerged; 16.80 percent) are more susceptible to any level of OOP payments due to low level of earnings. Catastrophic healthcare expenditure (61.79%) and NCDs (14.29 percent) are exacerbating the poverty level in Bangladesh. Both absolute and relative average poverty gap are more widen in HDP than LDP areas due to catastrophic OOP outlays for healthcare. Conclusion: The impoverishment effect due to OOP payments for healthcare in both HDP and LDP areas are high, especially for NCDs and catastrophic healthcare expenditure. However, the situation is bit worse in HDP areas. Preventing the escalation of NCDs as well as catastrophic expenditure and hence reducing the level of impoverishment thereof call for restricting tobacco use, increasing physical activity, encouraging to intake healthy diets, ensuring food safety, controlling air pollution, and improving mental health. Moreover, government should give more emphasis, especially in the HDP areas, on making community clinics more functional through providing screening equipment and training to the Community Health Care Providers for early detection of NCDs, and ensuring availability of medicine all the time. Note that other than community clinics, there is little option for providing healthcare in HDP areas due to poor functionality of public facilities as well as lack of private facilities in HDP areas. [ABSTRACT FROM AUTHOR]

This paper analyses inequity in formal health care use in rural Bangladesh using data from a survey conducted of 4010 households drawn from 120 villages. We find that the use of formal health care is incredibly low (40 per cent); about two-thirds of which is private health care, and only one-fourth utilises public sector facilities. Inequity favours the better off, although the level of inequity is modest. Prevailing inequity resides mainly in the utilisation of private health care while non-communicable diseases contribute significantly. Thus, the main public health concern in rural areas of Bangladesh is the low utilisation of formal health care (especially public health care), not inequity. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary: We examine the impact of Micro Health Insurance placement on health awareness, healthcare utilization, and health status of microcredit members in rural Bangladesh, using data from 329 households in the operating areas of Grameen Bank. The results are based on econometric analysis conditioned on placement of the scheme and show that placement has a positive association with all of the outcomes. The results are statistically significant for health awareness and healthcare utilization, but not for health status and these findings are potentially important for the expansion and replication of Micro Health Insurance. [ABSTRACT FROM AUTHOR]

This article examines the impact of micro health insurance on poverty reduction in rural areas of Bangladesh. The research is based on household-level primary data collected from the operating areas of the Grameen Bank during 2006. A number of outcome measures are considered; these include household income, stability of household income via food sufficiency and ownership of nonland assets, and the probability of being above or below the poverty line. The results show that micro health insurance has a positive association with all of these indicators, and this is statistically significant and quantitatively important for food sufficiency. [ABSTRACT FROM AUTHOR]

This study analyses the responsiveness of outpatient care to assess the quality of urban primary health care among all 5 types of health care providers in Bangladesh, namely, the Urban Primary Health Care Services Delivery Project, the NGO Health Services Delivery Project (NHSDP), NGOs, private hospitals, and the Ministry of Health and Family Welfare (MOHFW). Other than some public-private comparisons, there is an absolute knowledge gap regarding responsiveness in urban health systems, particularly in the context of Bangladesh, and this gap motivates this study. The study used primary data collected from 810 randomly selected outpatients. The survey used a structured questionnaire on all 7 domains of responsiveness of outpatient care suggested by the World Health Organization. The estimated mean responsiveness score reveals that overall, approximately 33% of the patients rated the responsiveness of the system as poor. In reported responsiveness, the NHSDP was ranked at the top and the MOHFW at the bottom. The latter is quite expected. Overall, prompt attention and autonomy were the worst-performing domains, and choice of provider, dignity, and clear communication were the better-performing ones. The results suggest the need to improve the degree of responsiveness of all domains, especially those that are more concerned with access to health care, namely, prompt attention, dignity, clear communication, and confidentiality. The Ministry of Health and Family Welfare facilities should give additional consideration to promote prompt attention, autonomy, and quality of basic amenities. Private facilities should also provide additional stress on improving prompt attention and autonomy. The nontherapeutic quality of health care needs to be emphasized in the medical education system. Further research based on household surveys could be worthwhile to measure responsiveness more comprehensively., (© 2018 John Wiley & Sons, Ltd.)

Background: Analysing disease-specific impoverishment impact of out-of-pocket (OOP) payments for health care is crucial for priority setting in any informed policy discussion. Lack of evidence, particularly in the Bangladesh context, motivates our paper., Objective: To examine disease-specific impoverishment impact of OOP payments for health care., Methods: The paper estimates the poverty impact of OOP payments by comparing the difference between the average level of headcount poverty and poverty gap with and without health care payments. We used primary data drawn from 3,941 households, distributed over 120 villages of seven districts in Bangladesh during August-September 2009., Findings: We find that OOP outlays annually push 3.4 % households into poverty. The corresponding figures for those who had non-communicable diseases (NCDs), chronic illness, hospitalization and catastrophic illness were 4.61, 4.65, 14.53 and 17.33 %, respectively. Note that NCDs are the principal reason behind the latter two situations (about 88 % and 85 % of cases, respectively). Looking into individual categories of NCDs we found that major contribution to headcount impoverishment arose out of illnesses such as cholecystectomy, mental disorder, kidney disease, cancer and appendectomy. The intensity of impoverishment is the largest among the hospitalized patients, and more individually among cancer patients., Conclusions: The poverty impact of OOP outlays for health care, in general, is quite high. However, it is especially high for NCDs, particularly for chronic NCDs and those requiring immediate surgical procedures. Hence, these illnesses should be given more priority for policy framing. In addition to suggesting some ex-ante measures (e.g. raising awareness regarding the risk factors causing NCDs), the paper argues for reforms to enhance efficiency in the public health care facilities and increasing the quality of public health care.