Disability-friendly healthcare at public health facilities in Bangladesh: a mixed-method study to explore the existing situation.

BACKGROUND: Several strategies and policies are being implemented in Bangladesh to address the healthcare needs of people with disabilities, who comprise about 10% of the country's total population. However, these measures are not adequate to provide accessible or friendly healthcare to the people with disabilities. This study aimed to explore the disability-friendliness of healthcare facilities, and the challenges of people with disabilities in terms of access to 1) information and communication, 2) access to infrastructure, and 3) providers' capacity in Bangladesh. METHODS: An explanatory sequential mixed-method study was conducted, including a cross-sectional survey of healthcare facilities, followed by structured-interview with people with disabilities and healthcare managers, and qualitative interviews among people with disabilities or their caregivers, healthcare providers (HCPs), policymakers, and community leaders. Data were collected from 150 public healthcare (primary-to-tertiary) facilities and from 300 people with disabilities in 16 districts across Bangladesh between January-December 2019. An observational checklist and structured questionnaires were used to assess the situation of healthcare facilities, and literature-guided guidelines were used for qualitative interviews. During analysis, the disability-friendliness of healthcare facilities were quantified through a scoring system, and thematic analysis of qualitative data was performed to identify the challenges of implementing disability-friendly healthcare (DFHC). RESULTS: The score for providing DFHC was low across all the four objectives in the healthcare facilities. The highest score (mean percentage) was observed in the infrastructure domain: 29.3 ± 20.5, followed by communication: 18.2 ± 4.8, and information: 14.6 ± 6.22, and the lowest (0.93 ± 7.1) score was for capacity of the HCPs to provide DFHC. Mean percentage scores for access to 13 infrastructure points were low, and extremely low scores were found in areas such as access to elevators (5.6 ± 5.0), ticket counters (7.3 ± 17.7) and toilets (10.6 ± 9.3). Furthermore, about 59.1% of people with disabilities expressed dissatisfaction regarding access to information and communication. The majority (98.2%) recommended that training of HCPs can improve the situation. CONCLUSION: This study revealed that most of the public health facilities in Bangladesh were not disability-friendly. Findings can inform development of a national disability-friendly policy with implementation guidelines.

Impact of a rural drowning reduction programme in Bangladesh on gender equity, norms and behaviour: a mixed-method analysis.

OBJECTIVES: Community-based health programmes implemented in low-income and middle-income countries impact community gender norms and roles and relationships, which in turn affect individuals' health outcomes. Programmes should measure their effects on gender norms, roles and relationships in the communities in which they operate to respond to unexpected health consequences. We conducted a gender analysis on a drowning reduction programme in rural Bangladesh to identify its impacts on gendered roles and behaviours in the community. DESIGN: A mixed-method approach was used. Quantitative programme monitoring data were analysed to assess gender differences in participation and engagement. A qualitative approach using interviews, focus group discussions and observations with purposively selected programme implementing staff and participants aimed at finding explanations for quantitative findings and additional impacts of the programme on gender in the community. The analysis was conducted using Family Health International 360's Gender Integration Framework, which identifies both internal (norms) and external (behaviours) effects. RESULTS: Fewer girls (n=5030) participated in swimming classes than boys (n=6425) due to cultural restrictions and involvement in domestic work. Women were not hired in leadership roles in the implementing organisation due to lower transportation access and their perceived ability to conduct labour-intensive activities. However, communities become more accepting of local women's mobility and employment due to their engagement as swim instructors. Women swim instructors were more satisfied with the pay and part-time nature of the work as men were able to earn more elsewhere. Menstruation management was ignored as all supervisory staff were men. CONCLUSIONS: Systematised strategies are required to ensure equal participation of girls and enable equitable prevention outcomes. Within the implementing organisation, programmatic changes will support gender transformation, such as ensuring women's mobility and engagement in leadership roles. Strategies to combat perceptions that lower paying part time work is more suitable for women than men may be considered.

Impact of community-based first responder development for the management of drowning casualties in rural areas of Bangladesh.

BACKGROUND: Drowning is the leading cause of childhood death in Bangladesh. In order to minimize the number of casualties Centre for Injury Prevention and Research, Bangladesh (CIPRB) incorporated a 'first responder' program which includes Cardio Pulmonary Resuscitation (CPR), in community based drowning prevention program, SwimSafe. Along with swimming lessons, swimming instructors provide first responder services in the community. The objective of this study was to describe the results of the volunteer based first responder services for the management of drowned casualties between 2012 and 2015 in the rural communities of Bangladesh. METHODS: Adolescents and youths who volunteered as community swimming instructors were trained as first responders to provide first aid and resuscitation in the community. Trainers from the International Drowning Research Centre Bangladesh (IDRC-B) of CIPRB delivered the training. The first responders were also trained on the documentation of the first responder services they provided in the community. The documented records were collected from the volunteers on a regular basis; when drowning cases were reported CIPRB management followed up with an in depth data collection, using a structured form. RESULTS: 2,305 community volunteers were trained between 2012 and 2015. Of them 1,461 reported providing first responder services among 6,773 casualties, including 184 drowning casualties. Of the drowning casualties, volunteers treated 31 casualties with Cardiopulmonary Resuscitation (CPR), 51 casualties by putting into the recovery position and 102 casualties were treated for the shock on site. Of those given CPR, 22 (71%) survived and 9 (29%) died. After receiving treatment from the first responder 104 (56.5%) of the drowning casualties were referred to health facilities for further treatment. CONCLUSIONS: The training of community first responders seems to be an effective way of managing and reducing drowning causalities in countries like Bangladesh, where drowning is a significant public health hazard.