School of Health Medical and Allied Sciences, CQUniversity Sydney, Sydney, New South Wales, Australia
Health Systems Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
BMJ Open. 2019 Oct 7;9(10):e029562. doi: 10.1136/bmjopen-2019-029562.
To explore healthcare providers' perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level.
We used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners' service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted.
Twelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions.
Participants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters.
Participants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments' initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems.
The initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country.
探索卫生保健提供者对孟加拉国通过非传染性疾病（NCD）角提供的 NCD 预防和管理服务的看法，并研究加强初级保健水平 NCD 服务提供的挑战和机遇。
我们使用扎根理论方法，对卫生保健提供者进行了深入的定性访谈。我们还使用了健康设施观察清单来评估 NCD 角的服务准备情况。此外，还与政府、非政府组织（NGO）、私营部门、大学和新闻媒体的利益相关者举行了会议。
四个行政区的 12 个分区卫生设施，当地称为县卫生综合中心（UHC）。
深度定性访谈的参与者是卫生服务提供者，包括县卫生和计划生育官员（n=4）、住院医师（n=6）、医生（n=4）和外科医生（n=1）。利益相关者会议的参与者包括卫生政策制定者、卫生方案管理人员、研究人员、学者、非政府组织工作人员、私营医疗从业者和新闻媒体记者。
参与者报告说，糖尿病、高血压和慢性阻塞性肺疾病是主要的 NCD 相关问题。所有参与者都承认政府主动设立 NCD 角以支持 NCD 服务提供。参与者认为 NCD 角在提高 NCD 意识、提供 NCD 护理和提供转介服务方面做出了重大贡献。然而，参与者指出了一些挑战，包括缺乏具体的指导方针和标准操作程序、缺乏培训有素的人力资源、实验室设施、后勤和药物不足、以及记录和报告系统不佳。
孟加拉国政府在初级保健层面采取主动设立 NCD 角的举措值得赞赏。然而，NCD 角仍处于起步阶段，无法为常见的 NCD 提供预防和管理服务。在全国其他 UHC 扩大 NCD 角时，需要考虑到这些发现。
