The Readiness of Primary Healthcare Facilities to Address Noncommunicable Diseases in Rural Bangladesh

Introduction Strengthening the capacity of primary healthcare (PHC) systems is essential to address the rising burden of non-communicable diseases (NCDs) in Bangladesh. The study assessed the readiness of rural PHC facilities in addressing the five World Health Organization (WHO) priority NCDs: diabetes, cardiovascular diseases, chronic respiratory diseases, cervical cancer, and mental health disorders. Methods Between March and April 2024, a cross-sectional survey was conducted in three subdistricts of Dinajpur District, Bangladesh, as a part of a type-2 hybrid effectiveness-implementation trial aimed at evaluating implementation fidelity and examining the process of intervention delivery pertinent to NCD care. All healthcare facilities (government, non-government, and private,) within the study areas were included. Two existing tools, the WHO Service Availability and Readiness Assessment (SARA) and the Harmonized Health Facility Assessment (HHFA), were adapted to evaluate NCD-specific readiness across four domains: clinical services, staff and guidelines; equipment; diagnostic capacity; and essential medicines. Readiness scores were calculated for each domain, with scores ≥ 70% indicating sufficient preparedness for NCD management. Results Union-level public health facilities (ULPHFs) had slightly better overall service readiness (39.6%) than community clinics (CC) (38.7%), while upazila (subdistrict) health complexes (UHCs) had the highest overall readiness (82.1%). UHCs had the highest readiness for diabetes care (68.2%), particularly in clinical services, staffing, and guidelines (88.9%). The availability of medicines was critically low in CC (0.2%). Equipment for the management of cardio-vascular diseases was most available (80.0%), whereas cervical cancer equipment was totally unavailable (0.0%) in ULPHFs, CCs, and private/NGO facilities. Chronic respiratory disease and cervical cancer diagnostic capacity were totally absent (0.0%) in ULPHFs and CCs. In mental health service provision, UHCs were the most prepared (32.5%), whereas ULPHFs were the least prepared (3.3%). None of the facilities achieved the 70% threshold of overall readiness for all five NCDs. Conclusion Findings reveal serious gaps in the readiness of PHC facilities in Bangladesh to respond to NCDs in the four areas. Shortages of trained personnel, absence of standard treatment guidelines, limited diagnostic services, and irregular availability of essential medicines highlight important areas requiring urgent strengthening to enhance PHC readiness and ensure equitable NCD-care provision.