The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases.

The rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs). A cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities' readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered 'ready' to manage NCDs. The general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs. All levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.

Kabir A ，Karim MN ，Billah B 《-》

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

Chowdhury HA ，Paromita P ，Mayaboti CA ，Rakhshanda S ，Rahman FN ，Abedin M ，Rahman AKMF ，Mashreky SR ... -  《-》

Availability of Hypertension and Diabetes Mellitus Care Services at Subdistrict Level in Bangladesh.

In Bangladesh, the rapid rise of noncommunicable diseases (NCDs) has become a significant public health concern. This study assesses the readiness of hypertension (HTN)- and diabetes mellitus-related services at primary health-care facilities in Northeast Bangladesh. A cross-sectional survey using a semi-structured interview was conducted between April 2021 and May 2021 among 51 public primary health-care facility staff (upazila health complexes [UHCs]). The NCD-specific service readiness was assessed using an adapted questionnaire from the WHO manual of Service Availability and Readiness Assessment and included four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. For each domain, the mean readiness index score was calculated. Facilities with a readiness score of above 70% were considered to be ready. The diagnostic capacity of the UHCs ranged from 0% to 88.9%, the availability of essential medicine and basic equipment varied between 15.4%-69.2% and 36.4%-100%, respectively, whereas the score in availability of basic amenities was between 57.1% and 100%. The score for the protocol drugs used to manage HTN was 52.9%, whereas for diabetes, it was 88.2%. The average general service readiness score for the facilities was 59.1%. Overall 17.6% of the facilities were assessed to be ready. Currently, primary health-care facilities are not ready to implement the national guidelines for diagnosing and treating diabetes and HTN due to shortages of medications, staff, and diagnostic materials.

Jubayer S ，Hasan MM ，Luna M ，Al Mamun MA ，Bhuiyan MR ，Sayem NN ，Amin MR ，Farrell M ，Moran AE ，Gupta R ，Choudhury SR ... -  《-》

Assessing service availability and readiness to manage Chronic Respiratory Diseases (CRDs) in Bangladesh.

Paromita P ，Chowdhury HA ，Mayaboti CA ，Rakhshanda S ，Rahman AKMF ，Karim MR ，Mashreky SR ... -  《PLoS One》

Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey.

Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya. A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as "ready" to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. Of the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67-74) and CVD (69%; 95% CI: 66-72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45-50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be "ready" to offer NCDs services than public facilities. Similarly, hospitals were more likely "ready" to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide. Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs.

Ammoun R ，Wami WM ，Otieno P ，Schultsz C ，Kyobutungi C ，Asiki G ... -  《-》