Urban educated group's perceptions of the COVID-19 pandemic management in Bangladesh: a qualitative exploration

COVID-19 pandemic in Bangladesh: A scoping review of governance issues affecting response in public sector

Background

On January 30, 2020, WHO declared COVID-19 as a Global Public Health Emergency. The first three COVID-19 cases in Bangladesh were confirmed on March 8, 2020. Thus, Bangladesh got substantial time to prepare the people and the health systems to respond to the outbreak However, neither the health ministry nor the government was found to rise to the occasion and provide the necessary stewardship for a coordinated and comprehensive response.

Objective

The importance of governance to mount an evidence-based pandemic response cannot be overemphasised. This study presents critical reflections on the Bangladesh government's COVID-19 response through a review of selected papers, with expert deliberations on the review findings to consolidate emerging lessons for future pandemic preparedness.

Study design

A scoping review approach was taken for this study.

Methods

Documents focusing on COVID-19 governance were selected from a repository of peer-reviewed articles published by researchers using data from Bangladesh (n = 11).

Results

Findings reveal Bangladesh's COVID-19 response to be delayed, slow, and ambiguous, reflecting poorly on its governance. Lack of governance capability in screening for COVID-19, instituting quarantine and lockdown measures in the early weeks, safety and security of frontline healthcare providers, timely and equitable COVID-19 testing, and logistics and procurement were phenomenal. The pandemic unmasked the weaknesses of the health system in this regard and "created new opportunities for corruption." The failure to harmonise coordination among the government's different agencies for the COVID-19 response, along with poor risk communication, which was not culture-sensitive and context-specific. Over time, the government initiated necessary actions to mitigate the pandemic's impact on the lives and livelihoods of the people. Diagnostic and case management services gained strength after some initial faltering; however, the stewardship functions were not seamless.

Conclusions

Shortage of healthcare workers, incapability of health facilities to cater to COVID-19 suspects and cases, absence of health system resilience, and corruption in procurement and purchases were limited the government's COVID-19 response. These need urgent attention from policymakers to better prepare for the next epidemic/pandemic.

Validation of Responsiveness of Physicians Scale (ROP-Scale) for hospitalised COVID-19 patients in Bangladesh

Background

Responsiveness of Physicians (ROP) is defined as the social actions by physicians aimed at meeting the legitimate expectations of healthcare users. Even though patients’ expectations regarding ROP have increased during the COVID-19 pandemic, the psychometrically-validated ROP-Scale is difficult to apply in hospital settings. The goal of this study is to validate the existing ROP-Scale to measure the responsiveness of hospital physicians during the ongoing COVID-19 pandemic in Bangladesh.

Methods

We conducted a cross-sectional phone survey involving 213 COVID-19 hospital patients, randomly selected from the government database. We applied the Delphi method for content validity, exploratory and confirmatory factor analyses for construct validity, Cronbach’s alpha and corrected item-total correlation for internal consistency reliability, and Pearson’s correlation between the scale and overall patient satisfaction for concurrent validity.

Results

After removing survey items based on data sufficiency, collinearity, factor loading derived through exploratory factor analysis, and internal consistency, the final version of the COVID-19 ROP-Scale consisted of 7 items, grouped under Informativeness, Trustworthiness and Courteousness domains. The confirmatory factor analysis supported the three domains with acceptable model fit [Root mean squared error of approximation (RMSEA) = 0.028, Comparative fit index (CFI) = 0.997, Tucker-Lewis index (TLI) = 0.994)]. The corrected item-total correlation ranged between 0.45 and 0.71. Concurrent validity was ascertained by the high correlation (0.84) between patient satisfaction and the COVID-19 ROP-Scale. Based on the mean domain score, the highest- and the lowest-scoring responsiveness domains were ‘Trustworthiness’ (7.85) and ‘Informativeness’ (7.28), respectively, whereas the highest- and the lowest-scoring items were ‘Not being involved in illegal activities’ (7.97), and ‘Service-oriented, not business-like attitude’ (6.63), respectively.

Conclusions

The 7-item COVID-19 ROP-Scale was demonstrated to be feasible, valid, and internally consistent. Therefore, its application can help amend past mistakes in health service provision and improve care for the hospitalised COVID-19 patients or other patients suffering from similar conditions. This study can contribute to the national decision-making regarding hospital care, open up further avenues in the health policy and system research, and eventually improve the quality of care provided to Bangladeshi patients seeking hospital services. Moreover, findings yielded by this study can be incorporated into doctors’ medical education and in-service training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08413-4.

Prevention and control of COVID-19 by primary health care facilities in China: a field-survey-based qualitative study in three typical cities

Background

During the coronavirus disease 2019 (COVID-19) containment, primary health care (PHC) facilities inChina played an important role in providing both healthcare and public care services to community populations. The tasks of COVID-19 containment facilitated by PHC facilities were different among different regions and during different periods of COVID-19 pandemic. We sought to investigate the gaps on task participation, explore existing problems and provide corresponding solutions.

Methods

Semi-structured face-to-face interviews with COVID-19 prevention and control management teams of PHC facilities were conducted. Purposive stratified sampling was used and 32 team members of 22 PHC facilities were selected from Wuhan (as high-risk city), Shanghai (as medium-risk city) and Zunyi (as low-risk city). Framework analysis was employed to analyze the transcribed recordings.

Results

The main tasks of PHC facilities during the early period of the pandemic included assisting in contact tracing and epidemiological investigation, screening of populations at high-risk at travel centers/internals, house-by-house, or pre-examination/triage within PHC facilities; at-home/ centralized quarantine management; the work of fever sentinel clinics.

Further analyses revealed the existing problems and suggestions for improvement or resolutions. Regular medical supply reserves were recommended because of the medical supply shortage during the pre-outbreak period. Temporarily converted quarantine wards and centralized quarantine centers could be used to deal with pressures on patients’ treatment and management of the febrile patients. Only after strict evaluation of nucleic acid testing (NAT) results and housing conditions, decision on quarantine at-home or centralized quarantine centers could be made. Settings of fever sentinel clinics at PHC facilities allowed fever patients with no COVID-19 infection risks for treatment without being transferred to fever clinics of the designed secondary hospitals. Psychological intervention was sometimes in need and really helped in addressing individuals’ mental pressures.

Conclusions

During the COVID-19 containment, PHC facilities in China were responsible for different tasks and several problems were encountered in the working process. Accordingly, specific and feasible suggestions were put forward for different problems. Our findings are highly beneficial for healthcare teams and governments in handling similar situations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07770-4.