Implementation barriers and facilitators to a COVID-19 intervention in Bangladesh: The benefits of engaging the community for the delivery of the programme

The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review

BACKGROUND

Rural community health workers [CHWs] play a critical role in improving health outcomes during non-pandemic times, but evidence on their effectiveness during the COVID-19 pandemic is limited. There is a need to focus on rural CHWs and rural health systems as they have limited material and human resources rendering them more vulnerable than urban health systems to severe disruptions during pandemics.

OBJECTIVES

This systematic review aims to describe and appraise the current evidence on the effectiveness of rural CHWs in improving access to health services and health outcomes during the COVID-19 pandemic in low-and middle-income countries [LMICs].

METHODS

We searched electronic databases for articles published from 2020 to 2023 describing rural CHW interventions during the COVID-19 pandemic in LMICs. We extracted data on study characteristics, interventions, outcome measures, and main results. We conducted a narrative synthesis of key results.

RESULTS

Fifteen studies from 10 countries met our inclusion criteria. Most of the studies were from Asia [10 of 15 studies]. Study designs varied and included descriptive and analytical studies. The evidence suggested that rural CHW interventions led to increased household access to health services and may be effective in improving COVID-19 and non-COVID-19 health outcomes. Overall, however, the quality of evidence was poor due to methodological limitations; 14 of 15 studies had a high risk of bias.

CONCLUSION

Rural CHWs may have improved access to health services and health outcomes during the COVID-19 pandemic in LMICs but more rigorous studies are needed during future pandemics to evaluate their effectiveness in improving health outcomes in different settings and to assess appropriate support required to ensure their impact at scale.

Disparities in COVID-19 vaccine uptake among rural hard-to-reach population and urban high-risk groups of Bangladesh

BACKGROUND

Vaccination has been an indispensable step in controlling the coronavirus disease pandemic. In early 2021, Bangladesh launched a mass vaccination campaign to boost the COVID-19 vaccination rate when doses were available and immunized millions in the country. Although deemed a success, disparities became conspicuous in vaccination coverage across population of different socioeconomic background.

METHODS

The purpose of this cross-sectional study was to assess the vaccination coverage for three doses and detect disparities in uptake of the COVID-19 vaccine among rural population of hard-to-reach areas and urban individuals belonging to the high-risk group -defined in our study as individuals from elusive population such as floating population/street dwellers, transgender, addicts and disabled population. We conducted household survey (n = 12,298) and survey with high risk group of people (2,520). The collected primary data were analysed using descriptive statistical analysis.

RESULTS

Our findings show that coverage for the first dose of COVID-19 vaccination was high among respondents from both rural Hard-to-reach (HTR) (92.9%) and non-HTR (94.6%) areas. However, the coverage for subsequent doses was observed to reduce significantly, especially for third dose (52.2% and 56.4% for HTR and non-HTR, respectively).

CONCLUSION

Vaccination coverage among urbanites of high-risk group was found to be critically low. Vaccine hesitancy was also found to be high among individuals of this group. It is essential that the individuals of urban high-risk group be prioritized. Individuals from this group could be provided incentives (transport for disabled, monetary incentive to transgenders; food and medicine for drug user and floating people) and vaccination centers could be established with flexible schedule (morning/afternoon/evening sessions) so that they receive vaccine at their convenient time. Community engagement can be used for both high-risk group and rural population to enhance the COVID-19 vaccination coverage and lower disparities in uptake of the vaccine doses nationwide.

COVID-19 vaccination success in Bangladesh: Key strategies were prompt response, early drives for vaccines, and effective awareness campaigns

Bangladesh is located in Southeast Asia that has a high population density. It is a lower-middle-income country. The COVID-19 pandemic severely impacted the nation that slowed its economic growth. It halted major industries, crippling the nation's economy. The students were uncertain after the declaration of school closures. Hospitals could not treat other patients properly due to the vast health burden of COVID-19. Bangladesh put up a solid fight during COVID-19 as a lower-middle-income country. Prompt action, early vaccination drives, effective awareness campaigns, and widespread public involvement have enabled Bangladesh to bring more than 90% of its population into COVID-19 vaccination coverage. It was possible by the effective diplomatic and local health strategy implemented by the Bangladeshi government, the country's extensive prior experience, and its long history of achieving a high success rate in other vaccination campaigns. Bangladesh was able to flatten the curve sooner than other developed countries. Therefore, the cogs of everyday social life and the economy begin to turn once more. The strategy Bangladesh used to combat the COVID-19 pandemic through vaccination and diplomatic policy by calling on its prior experience has the potential to serve as a model for other low- and middle-income countries and an example for developed nations.