Bangladesh

Bangladesh: Rapid Assessment Findings on Covid-19 Effects on Urban Health

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Since the initial outbreak of COVID-19 in Bangladesh earlier this March, Bangladesh is at an economic and social standstill due to the government imposed nation-wide lockdown. Although every sector of the country is facing problems, the health sector is currently among the most affected sectors.

The Health Access and Linkage Opportunities for Workers Plus (HALOW+) is directly related to the health sector and is responsible for maintaining the overall health and safety of the people/areas under its intervention. To assess the current situation of the RMG workers of 17 factories and their respective communities under HALOW+ in this pandemic crisis, a small-scale survey study was conducted from 23rd-26th April, 2020. A total of 141 participants from both Community Support Groups (CSG), Urban Lowincome people including RMG Workers, Ward Health Development Committee and GO – NGO Coordination Forum, District Managers of Public, Private and NGO health and Family Planning department, Public Health Specialist from UN bodies, INGO and Academic institutes and RMG Factory owner and senior management were interviewed with a standardized questionnaire. The study revealed that COVID-19 had a significant impact on the overall health system as a total of 322 health workers out of 516 in Gazipur are currently in home/institutional quarantine, telemedicine facilities have dropped to 80% and there’s a 50% reduction in total patient reported in Upazila Health Complexes (UHC)-reasons being absence of doctors and proper medical facilities. Participants also mentioned to have difficulties in their family lives, personal nutrition and hygiene maintenance, such as- 55% reported to have familial issues due to joblessness of them/their spouses, 58% reported ofSince the initial outbreak of COVID-19 in Bangladesh earlier this March, Bangladesh is at an economic and social standstill due to the government imposed nation-wide lockdown. Although every sector of the country is facing problems, the health sector is currently among the most affected sectors.

The Health Access and Linkage Opportunities for Workers Plus (HALOW+) is directly related to the health sector and is responsible for maintaining the overall health and safety of the people/areas under its intervention. To assess the current situation of the RMG workers of 17 factories and their respective communities under HALOW+ in this pandemic crisis, a small-scale survey study was conducted from 23rd-26th April, 2020. A total of 141 participants from both Community Support Groups (CSG), Urban Lowincome people including RMG Workers, Ward Health Development Committee and GO – NGO Coordination Forum, District Managers of Public, Private and NGO health and Family Planning department, Public Health Specialist from UN bodies, INGO and Academic institutes and RMG Factory owner and senior management were interviewed with a standardized questionnaire. The study revealed that COVID-19 had a significant impact on the overall health system as a total of 322 health workers out of 516 in Gazipur are currently in home/institutional quarantine, telemedicine facilities have dropped to 80% and there’s a 50% reduction in total patient reported in Upazila Health Complexes (UHC)-reasons being absence of doctors and proper medical facilities.

Participants also mentioned to have difficulties in their family lives, personal nutrition and hygiene maintenance, such as- 55% reported to have familial issues due to joblessness of them/their spouses, 58% reported of Being deprived of basic human needs as- food, education, income etc. 55% reported their food intake has decreased, they take less protein-rich foods and more leafy foods. 71% of pregnant participants mentioned they have missed their regular ANC check-ups due to unavailability of health services and local transportation facilities. 70% of female participants faced familial issues, 35% participants have reported to have been physically abused by their husbands due to economic instability and all of them reported to have psychological/mental pressures increase during lockdown. To prevent the spread of disease, 88% the low-income population maintain handwashing, 58% maintain social distancing and 48% maintain other healthy habits as cleanliness, vitamin-c intake, nutritious food, fresh juice, fruit intake etc. 77% have stored helpline numbers, 59% have stored essential medicines and 21% have set aside some money as preventative measures in case of an emergency. Of the target population 48% can identify three main COVID-19 symptoms (out of them 59% are female), 11% can name the two main ways of transmission (out of them 80% are females). 94% of them responded they would separate a person with COVID-19 symptoms, 47% would take the person to doctor/hospital and 28% of them would call the IEDCR. 65% of them know the name of the hospitals in their locality assigned for COVID-19 cases. Both collective and individual initiatives are being taken to increase humanitarian (i.e. aid) and social awareness activities at community levels to fight COVID-19. CSG members and members of GONGO platforms are announcing for staying home, establishing hand washing system, marking social distance maintaining spot at markets and shopping places, prepare list of families who are in the most need for relief, distribution of food, soap, mask, and gloves, spraying disinfectant.

Although 86% participants have not received any relief/support, they mentioned cash support and food delivery through close-proximity points to be more effective as relief/support items than safety-materials. The community people, health professionals, management staff and factory owners anticipate long-term impacts of COVID-19 on their communities/factories, such as: economic crisis, limited livelihood opportunities, food crisis, increase social crime, family disharmony. Increased number of communicable diseases among children, increased unwanted pregnancy, increased morbidity and mortality of maternal and child health, increased morbidity/burden of noncommunicable diseases, increased out pocket health expenditure and crisis on capacity building and skilled health professional's crisis in overall health systems.

Some future measures of interventions have also been proposed based on the study. These include: Ensuring food and cash support for the urban low-income communities for a certain period, Interactive awareness raising activities on Risk Messaging for community people, Ensuring consistent supplies of safety materials for the low-income communities, consistent supplies of protective gears for all level of Health Service providers, support public health system for functioning of primary health care services, engaging community for refunctioning of EPI and satellite session through arranging space and maintaining social distance, strengthening capacity of frontline health workers and community on prevention and community-based management of Communicable diseases and mental health, strengthening coordination system among GO-NGO --private sectors for better primary health care and referral services.