Journal Article

Assessing the role of the for-profit private healthcare sector in malaria elimination efforts in Bangladesh: a cross-sectional study of challenges and opportunities

Adnan, Sheikh Daud, Alam, Mohammad Shafiul, Matin, Mohammad Abdul, Hasan, Anamul, Rahaman, Md Mosiqure, Hossain, Mohammad Sharif, Das, Shyamol Kumer, Hazarika, Anupama, Rahman, Md Mushfiqur, Islam, Md Nazrul, Alam, Md. Jahangir, Aktaruzzaman, M. M., Islam, Md. Nazmul, Phru, Ching Swe

2024

Overview

Background Among 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh’s malaria burden. Despite the private sector’s prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030. Methods This mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission. Results Among the 104 representative participants, majority were male ( n  = 92, 88.5%), had a diploma in their respective fields ( n  = 53, 51%) and were involved either in laboratory work ( n  = 49, 47.1%) or as owners/managers of health centers ( n  = 41, 39.4%). The selected health facilities were close to the corresponding Upazila Health Complexes (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%). Conclusions This study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh’s malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Antimalarial agents / Bangladesh / Bangladesh - epidemiology / Biostatistics / Capacity development / Case management / Cross-Sectional Studies / Data collection / Disease Eradication / Disease transmission / Environmental Health / Epidemiology / Female / Focus Groups / For-profit / Health care / Health care facilities / Health facilities / Health services / Hospital facilities / Hospitals / Humans / International organizations / Malaria / Malaria - epidemiology / Malaria - prevention & control / Malaria elimination / Male / Medical diagnosis / Medicine / Medicine & Public Health / Middle Aged / Polls & surveys / Prevention / Private Sector / Public Health / Qualitative analysis / Qualitative research / Questionnaires / Risk factors / Surveys and Questionnaires / Underserved populations / Vaccine / Vector-borne diseases