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Child and Maternal Mortality

in Islamic Countries

83

services has increased over the years, still the WHO recommended ANC 4+ visits is low and, the

quality of those services is lacking. There was a similar concern for delivery care. One expert

called out the need for a quality of care framework by which to train and measure quality at all

levels.

Acceptability of services was another barrier to accessing healthcare services cited by the Key

Informants. Many Key Informants mentioned that trust between the community and the

healthcare providers was lacking, thereby limiting service acceptability. Most Key Informants

mentioned cultural or religious beliefs as potential barriers for accessing healthcare, MNCH care,

and delivery care. For example, multiple Key Informants mentioned that certain parts of the

population have a fear of going to a facility for delivery because they do not want to have a C-

section delivery.

Physical accessibility did not appear to be an issue in Bangladesh, as infrastructure for

healthcare access is available throughout the country at the district and sub-district levels.

However, while the infrastructure of FWCs and other health centers does exist, and medical

professionals are assigned to them, the challenge is assuring that medical professionals will

actually be present at their post. It is also a challenge to have medical staff available 24/7 in all

of these centers. So, while physical accessibility to the centers may not be a problem, if nobody

is there to staff the center, it presents an issue. The Key Informants related this to an overall

concern with human resource management and distribution.

Also related to human resource management, a concern noted by some Key Informants was the

current ratio of doctors to nurses. According to one expert, there should be about 3 nurses for

every 1 doctor, but currently, in Bangladesh, it is the opposite. The Key Informants expressed a

need for more midlevel nurses, different nurse specialists, and more midwives. They also

mentioned that task distribution needs to be changed and tasks should be shifted so that nurses

are helping according to their skillset to alleviate tasks that are being completed by doctors.

The Key Informants agreed that health information systems in Bangladesh are somewhat

developed but that improvements for full coverage of electronic health records, and data

utilization are needed. A large amount of data needs to be integrated between the bifurcated

health system components and data needs to be analyzed in a timely manner so that results can

be used to inform decision-making for future policies and improvements. The Key Informants

were overall encouraged that more data is being collected but stressed that a cohesive

surveillance system is needed.

Overall, the Key Informants alluded to the fact that Bangladesh has made impressive strides in

MNCH despite a shortage of financial resources. Most of those achievements were lower-

hanging fruit, and now that those have been achieved, they agreed that Bangladesh should be

focusing on the harder-to-achieve indicators and invest adequate funds into those activities.