Child and Maternal Mortality
in Islamic Countries
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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.