Assessing service availability and readiness of healthcare facilities to manage diabetes mellitus in Bangladesh: Findings from a nationwide survey

Hasina Akhter Chowdhury, Progga Paromita, Cinderella Akbar Mayaboti, Shagoofa Rakhshanda, Farah Naz Rahman, Minhazul Abedin, A K M Fazlur Rahman, Saidur Rahman Mashreky, Hasina Akhter Chowdhury, Progga Paromita, Cinderella Akbar Mayaboti, Shagoofa Rakhshanda, Farah Naz Rahman, Minhazul Abedin, A K M Fazlur Rahman, Saidur Rahman Mashreky

Abstract

Introduction: Diabetes Mellitus (DM) is one of the most prevalent non-communicable diseases (NCDs)as well as a major cause of morbidity and mortality worldwide. Around 80% diabetic patients live in low- and middle-income countries. In Bangladesh, there is a scarcity of data on the quality of DM management within health facilities. This study aims to describe service availability and readiness for DM at all tiers of health facilities using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) standard tool.

Methods: This cross-sectional survey was conducted in 266 health facilities all across Bangladesh using the WHO SARA standard tool. Descriptive analyses for the availability of DM services was carried out. Composite scores for facility readiness index (RI) were calculated in four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. Indices were stratified by facility level and a cut off value of 70% was considered as 'ready' to manage diabetes at each facility level.

Results: The mean RI score of tertiary and specialized hospitals was above the cutoff value of 70% (RI: 79%), whereas for District Hospitals (DHs), Upazila Health Complexes (UHCs) and NGO and Private hospitals the RI scores were other levels of 65%, 51% and 62% respectively. This indicating that only the tertiary level of health facilities was ready to manage DM. However, it has been observed that the RI scores of the essential medicine domain was low at all levels of health facilities including tertiary-level.

Conclusions: The study revealed only tertiary level facilities were ready to manage DM. However, like other facilities, they require an adequate supply of essential medicines. Alongside the inadequate supply of medicines, shortage of trained staff and unavailability of guidelines on the diagnosis and treatment of DM also contributed to the low RI score for rest of the facilities.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Sampling and study inclusion flow…
Fig 1. Sampling and study inclusion flow chart.
[UHC: Upazila Health Complex, NGO: Non-Government Organization.*rest of the district hospitals had been converted to medical college hospital (tertiary facilities)].
Fig 2. Domain specific DM service readiness…
Fig 2. Domain specific DM service readiness index stratified by facility level (the red line indicates the cut off value 70%, above which a hospital is considered to be ’ready’ to provide DM services).
Fig 3. Mean DM service readiness index…
Fig 3. Mean DM service readiness index score for each facility level (the red line indicates the cut off value 70%, above which a facility is considered to be ’ready’ to provide DM services).

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