Community Health Workers for Non-Communicable Diseases Prevention and Control in Bangladesh: A Qualitative Study

Abstract

Abstract

Objective. To examine the barriers and facilitators to engaging Community Health Workers (CHWs) for Non-communicable Diseases (NCDs) prevention and control in Bangladesh.Design: We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders’ meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection, and data were analysed thematically.Setting: Data were collected from health facilities across three districts in Bangladesh, and two stakeholder consultative meetings were conducted at the central level.Participants: We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n=4); key informant interviews with central level health policymakers/ managers (n=15) and focus group discussions with CHWs (4 FGDs; total n=29). Participants in a stakeholder consultative meeting included members from the government (n=4), non-government organisations (n=2), private sector (n=1) and universities (n=2).Results: The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispatching of basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. The facilitating factors to engage CHWs included government commitment and program priority, development of NCD related policies and strategies, the establishment of NCD corners, community support systems, social recognition and staff motivation.Conclusion: Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for capacity building of CHWs, systems-level support and maximizing CHWs engagement to prevention and control of NCDs in Bangladesh.