Due to COVID-19

7.1 Infrastructural Adaptations

The policies implemented included changes in lifestyle, using face masks, movement restriction, social distancing and changes in hygiene practices
Creating awareness among the people by using local media in order to strengthen personal hygiene practices
The GoB increased number of ICUs, recruited and trained 2000 doctors and 5000 nurses
GoB ensured supply of medical equipment, PPE and other medical aids for COVID-19 patients and health care providers
However, serious drawbacks were found in hospitals regarding the availability of ventilator support facilities to treat severe acute respiratory syndrome
The situation report of WHO states that as of 26 October 2020 there were 11,730 general beds and 564 ICUs for treating COVID-19 patients all over the country. Among which 3519 (30.0%) general beds and 314 (55.7%) ICUs are occupied by the patients only in Dhaka city

Mask Wearing

According to a report, 63% of people in Bangladesh wear masks. The report also showed that around 53% of people in Dhaka division wear masks to control the transmission of infections.

Social Distancing

In Bangladesh, social distancing is being adapted as the principal strategy to prevent and to slow down the transmission of COVID-19 infection.
According to World Bank data, over 55% of the urban population of Bangladesh live in slums. Access to individual living quarters in slums is usually through narrow lanes barely passable for two individuals.
Adherence to social distancing may have been a problem also because of lack of access to appropriate information, and public awareness.

Testing for Covid-19

Initially the testing facilities were inadequate, however, with time the facilities improved as the number of cases increased.
After three months of coronavirus epidemic in Bangladesh, the GoB decided to charge 200 taka (£1·80) for the COVID-19 test in Government facilities, whereas the private sectors charge 3500 taka (£32). As a result, the rates of testing have reduced to 0.8 tests per 1000 people in one day.

7.2 Health Service Disruptions

Supply Side

The COVID-19 pandemic has had an unprecedented impact on essential health services in Bangladesh, leading to a drastic reduction in utilisation of the major essential health services across all levels of health systems due to multiple factors such as the shortening of outpatient visiting hours, redistribution, re-assignment, and task shifting of frontline health workers towards COVID-19 pandemic response.
The most affected areas were essential maternal and newborn health services and supply chain of essential medicines for non-communicable diseases (NCD) like hypertension, diabetes, mental health, and other chronic diseases and cancers.

Demand Side

The change in health-seeking behavior of communities triggered by travel restrictions, fear of getting the infection from health facilities, loss of routine earnings of vulnerable sections of society have also affected the utilisation rate and access to routine health services.
Additionally, infections among frontline health workers have also contributed to the reduction in demand and in health systems capacity to deliver essential health services.

7.3 Health Service Adaptations

m-Health

In Bangladesh uptake of mobile phones is increasing sharply and more than 20 mHealth services are available around the country
The national helpline ‘333’ (operated by a2i) is a service that has been serving Bangladeshis for since 2018, and it has stepped up to address issues ranging from relief assistance to telemedicine services. As the pandemic hit Bangladesh, the helpline has adapted to the current times, and has been providing information on precautions, health guidelines, and directives on suspected Covid-19 infections.

By January 2021, the national helpline has provided more than 700,000 telehealth, telemedicine services to over 300,000 Covid-19 patients.

Case Study of 333 helpline user

Mizanur, like many, had Covid-19 symptoms but was not sure how he would get to the end of it. Hospitals were crowded, doctors were unavailable and going to a hospital posed further risk of contagion. He found out that the national helpline 333 was providing telemedicine service, and he did not wait to call the number.
“Some people had said it would be difficult to get connected with an agent and required multiple attempts, but to my surprise, my call went through in the first attempt,” said Mizanur. The call centre agent forwarded his call to a registered physician from the helpline’s Doctors’ Pool, who closely listened to Mizanur’s symptoms. He came to the conclusion that it was unlikely that Mizanur had Covid-19, and prescribed him medicine for the fever.
“The doctor told me to dial 333 again if I faced further complications, and messaged me the prescription,” said Mizanur, “My condition then improved within a week.” “The service was very helpful amid this shutdown. I would definitely recommend others to avail this if they’re in need of medical consultation,” Mizanur added.

Resurgence of services post-lockdown

Starting June 2020, Bangladesh gradually overcame the situation through the deployment of additional 2500 doctors and 5000 nurses, enhanced telemedicine services, and increased consultations for patients requiring routine and, emergency services. Additionally, health workers from COVID hospitals have been re-deployed to re-start the delivery of the essential health services to the full potential.
All divisional level health administrators prioritized the timely restoration of essential services by adopting innovative local level strategies such as regular monitoring of essential services delivery through physical visit and virtual meetings with the field health care providers.
Additionally, increased monitoring activities have been conducted for routine immunization, family planning, outpatient consultancy, emergency management in community clinics and Upazila Health Complexes.

7.4 Covid-19 vaccination rollout

Bangladesh began inoculating people against Covid-19 from the first week of February. In November 2020 it signed a deal with the Serum Institute of India to buy 30 million doses of the vaccine developed by British drugmaker AstraZeneca.

Bangladesh drug regulator Directorate General of Drug Administration (DGDA) has authorised Beximco Pharmaceuticals Limited to import and distribute the COVID-19 vaccine from India. In the initial six months of the first phase, Beximco will procure five million vaccine doses per month, reported Dhaka Tribune.

Bangladesh will also get 68 million doses of vaccine from the GAVI vaccine alliance (COVAX), the global health partnership set up in 2000 to increase access to immunisation in poor countries.

Immunisation perspectives in Bangladesh

Bangladesh has had one of the most positive immunization programs in the world. It has used community engagement, reaching all areas of the country. What was of key importance was working with trusting community members and others who were providing information and advice.
The campaigns have emphasized protecting children from disease; at one point the emblem was an umbrella covering everyone. Now it is a circle with a baby inside, even featured on postage stamps! And the public has seen a dramatic impact, with many fewer children suffering and dying of disease.