Are Urban Primary Health Care Centres in Bangladesh Prepared to Manage Non-communicable Diseases? A Mixed Methods Study

Introduction With the dual challenges of rapid urbanization and increasing prevalence of non-communicable diseases (NCDs), urban health primary health care (PHC) system in Bangladesh, like many other developing countries, is facing challenges to respond to the health needs of their populations. The objectives of the study were to: (1) assess the readiness of the urban PHC centres in managing NCDs (focusing on diabetes, hypertension and cardiovascular diseases); (2) assess the gaps in provision of NCD diagnosis, prevention and treatment within primary care in urban areas; and (3) understand the extent to which NCDs are integrated into the urban PHC system. Methods A convergent mixed methods study design was adopted. We analysed secondary data of Bangladesh Health Facility Survey, 2017, a national survey, to assess the readiness of the urban primary health-care centres to manage diabetes and cardiovascular diseases. In addition, we collected primary data through semi-structured interviews with policy makers and urban PHC centre staff in Dhaka to identify gaps in the urban primary health-care system in managing these diseases. Data was collected between March and November 2022. Results Although the urban PHC centres are required to provide all types of PHC services including NCDs, they mainly prioritise maternal and child health (MCH) and sexual and reproductive health (SRH) services, hence, male patients seldom come to these centres to seek healthcare services. NCD care has not been prioritised in the urban PHC centres. The health workforce in the urban PHC centres lacked training in NCD management. Due to lack of a strong follow-up system, it is often hard to track patients, therefore making it difficult to identify and treat patients who are at risk of developing or have already developed NCDs. The centres follow a paper-based recording system, which records particulars of patients attending the centres, however, NCD-related reporting is absent. One of the major challenges is the non- coordination of the two ministries – health and local government – for providing urban PHC including NCDs. Conclusion Integrating NCD care within urban PHC facilities needs to be prioritized by the MOHFW and MOLGRD. This would require restructuring of PHC service delivery modalities and investment in human resources, information systems and equipment, and strong leadership across ministries to mitigate the existing barriers to deliver NCD cares at PHC level.