What can we learn from Bangladesh’s experience?

Other countries aiming to prevent or respond to a drop in EBI delivery (and particularly EBIs delivered through health systems for the reduction of U5M) in the face of any major threat to the health sector can learn from Bangladesh’s experience – but very few of these lessons emerged solely from the country’s experience during the early months of the COVID-19 pandemic. Instead, most originated in Bangladesh’s earlier work to reduce U5M between 2000–2015, which built resilient systems that could also mitigate COVID-19–related EBI disruptions.

Before the next health system shock, countries can take the following actions:

Use data for decision-making at all levels of the health system and work to invest in and build an information system that ensures the availability of quality data. Ensure that data from all sectors of care delivery (facility, community, and private and faith-based sectors) are available and integrated for identifying subnational challenges.

Officials at the Ministry of Health and Family Welfare have access to high-quality, readily-available public data and a strong data monitoring system via the public management information system (MIS) at the Directorate General of Health Services (DGHS) and the Directorate General of Family Planning (DGFP). Because of this, they have been able to track trends in the coverage and delivery of essential services and adjust their interventions accordingly. However, key informants (KIs) recommend that countries analyze this kind of data and present it scientifically.

KIs also emphasize the need to continuously monitor the quality of the data officials use for decision-making.

However, despite the availability of a strong DHIS2 data system, the lack of integration between public and private data prevented officials from drawing an accurate picture of service coverage nationally: according to one WHO report, “some private health facilities limited their services at the early stage of the pandemic,” and public data did not capture these disruptions in the private sector.¹

Much work is still needed to incorporate private-sector data in countries like Bangladesh, where these providers deliver a significant percentage of care. More and better data will improve officials’ ability to track disruptions from health system shocks to all care delivery channels, enabling a more informed response.

Encourage a culture of collaboration and a strong system of coordination between partners and across sectors. Engage all relevant stakeholders, both local and global, in the implementation of interventions and use their knowledge, expertise and resources to improve health outcomes.

Strong, collaborative, multisectoral systems of coordination between the Ministry of Health and Family Welfare, donors, and implementing partners supported the delivery of key services and mitigated EBI disruption in Bangladesh during the first months of the COVID-19 pandemic.

Proactively invest in health systems and quality at all levels of care – particularly in primary care. Ensure clear organizational structure and open lines of communication between the community and the health system, as well as among the different levels of the health system.

Most KIs pointed to the importance of strong health system structures, diverse inputs, and high-quality care, from the central and district level to community clinics and outreach centers, to mitigate EBI disruptions even during emergencies like the COVID-19 pandemic.

Engage communities and civil society by ensuring that all stakeholders within the health system are aligned with the government’s plan and supporting their activities, in order to maximize positive outcomes and avoid duplication of efforts.

KIs emphasized the significance of engaging the community and civil society to mitigate the drop in the delivery of key health services during the early months of the pandemic emergency.

Empower leadership at all levels through a combination of incentives such as rewards, public recognition, and support structures (such as training and performance feedback & evaluation).

Even before the COVID-19 pandemic began, KIs say, the Government of Bangladesh was committed to delivering evidence-based interventions and mitigating disruptions in access to those services.

Create systems that foster public trust and ownership in the health care system, as well as accountability, support, and care delivery. Actively engage with communities through health education campaigns and social communication activities that reinforce the importance of health interventions. Continue the delivery of ordinary health services during health crises.

KIs emphasized the role of public trust and the importance of social support in the maintenance of evidence-based interventions for child health.

Develop and implement strong guidelines and procedures and communicate them broadly. Leverage global guidelines and recommendations, and adapt them to the local context where they should be accompanied by clear orientations on implementation.

KIs pointed to the development of strong guidelines and procedures – as well as effective and timely communication of those guidelines across all the levels of the health system – as a key to EBI maintenance during the first months of the COVID-19 pandemic in Bangladesh. For instance, guidelines to providers at all levels provided clear strategies for delivering key health services to children under five.

Leverage emergency response to strengthen the broader health system. Ensure that new initiatives to respond to COVID-19 are designed to be sustainable, thus strengthening the health system for future crises.

In the early response to COVID-19, Bangladesh leveraged it to establish and build oxygen-production capacity that can help both non-COVID patients, especially those with pneumonia, and COVID patients alike.

These lessons will help countries prepare for and respond to health-system shocks and emergency-response situations including and beyond the COVID-19 pandemic. They are also critical building blocks for regular health system functioning.

By the end of 2020, data show that Bangladesh’s public health sector had resolved many of the EBI disruptions it experienced in the early months of the COVID-19 pandemic. However, the country was hit hard by subsequent waves of the pandemic. Case counts and deaths peaked in April 2021² and then surged again a few months later; by July 2021, daily case counts were almost double those recorded during the April peak.³ Officials re-imposed COVID response measures such as lockdowns and movement restrictions (and implemented a mass COVID vaccination campaign⁴ ), and some EBI disruptions likely returned. In the face of these challenges, officials in Bangladesh continue to draw on the aforementioned strategies to mitigate the ongoing effects of the COVID-19 pandemic on key EBIs for child health.