Healthcare Systems Strengthening in Smaller Cities in Bangladesh: Geospatial Insights From the Municipality of Dinajpur

Factors associated with essential newborn care practices among non-institutional births in urban Bangladesh: evidence from Bangladesh Urban Health Survey 2021

BACKGROUND

Non-institutional births remain prevalent in low- and middle-income countries, associated with a majority of adverse maternal and child health outcomes, including maternal and child mortality. Ensuring essential newborn care (ENC) practices for these non-institutional births is crucial for reducing these adverse outcomes. This study aimed to identify the prevalence, and factors associated with the adoption of ENC practices among non-institutional births in urban Bangladesh.

METHODS

A total of 2,165 children's data were analyzed, extracted from the 35,186 ever-married women interviewed in the 2021 Bangladesh Urban Health Survey. Six ENC components and their level (lowest/none, moderate, and highest) were considered as the outcome variables. Several socio-demographic factors were considered as the explanatory variables. Multivariate binary and multinomial logistic regression model were used to explore the association between outcome and explanatory variables.

RESULTS

Approximately 49% of all mothers reported practicing the highest level of ENC. Among the individual components, the highest adherence was observed for the use of a disinfected instrument to cut the umbilical cord (90%). The likelihood of adopting the highest level of ENC practices was higher among mothers with relatively higher education and wealth quintiles and lower among those residing in slum and other urban areas of city corporations compared to non-slum areas. Mothers living in the Khulna and Sylhet divisions had a lower likelihood of adopting the highest level of ENC practices.

CONCLUSION

Awareness building programs are needed to educate the population, particularly mothers, about the importance of practicing ENC for improving maternal and child health outcomes.

Strengthening health service delivery and governance through institutionalizing 'Urban Health Atlas'-A geo-referenced Information Communication and Technology tool: Lessons learned from an implementation research in three cities in Bangladesh

INTRODUCTION

Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake.

METHODS

This implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Thirty in-depth and twelve key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA.

RESULTS

Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Findings from the IDIs and KIIs suggest that UHA uptake was challenged by inadequate ICT infrastructure, shortage of human resources and lack of ICT skill among managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from its inception helped the institutionalization process.

CONCLUSION

While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.