How prepared are urban primary care facilities to manage hypertension and type 2 diabetes in Dhaka, Bangladesh? A cross-sectional descriptive study of government urban dispensaries and NGO clinics

Background

In urban Bangladesh, rapid urbanisation is increasing the prevalence of hypertension (HTN) and type 2 diabetes (T2D). The plurality of providers, often with minimal public provision, adds complexity. We aimed to evaluate how well two categories of primary health care (PHC) facilities for poor urban residents – NGO-run clinics under the Ministry of Local Government, Rural Development and Cooperation and Urban Dispensaries (UDs) under the Ministry of Health and Family Welfare – are prepared to manage these two conditions.

Methods

We performed a cross-sectional survey of all 19 UDs and 32 NGO clinics in Dhaka between 1st July, 2022 and 25th February, 2023. We developed a bespoke tool to assess how prepared facilities were to manage patients with HTN and T2D based on the essential requirements in Bangladesh’s National Protocol for Management of Diabetes and Hypertension (2019, 2nd edition). Trained researchers observed practices in facilities and consulted facility staff to complete the checklist to assess whether the components in the checklist were adequately in place or not. The components were grouped into domains covering training, guidelines, equipment, diagnostic tests, and drugs. We also developed a separate tool to assess facility preparedness in relation to information systems. We then created an overall preparedness outcome based on the total number of components adequately in place across all domains (excluding the information system tool) and outcomes looking at whether each separate component (including those from the information systems tool) was adequately in place or not. We analysed data using generalised linear models and marginal effects approaches to estimate percentage preparedness levels within facility and disease groups and percentage point differences in preparedness levels between facility and disease groups, along with associated 95% confidence intervals.

Results

Overall levels of preparedness were lacking for both HTN and T2D conditions in both facility types. For HTN management, overall preparedness was 46.8% (95% CI: 41.6%, 52%) for UDs and 32.5% (95% CI: 30.5%, 34.5%) for NGO clinics. For diabetes management, overall preparedness was 31.6% (95% CI: 27.5%, 35.6%) for UDs and 34.9% (95% CI: 33.2%, 36.6%) for NGO clinics. Training and guidelines were absent for NGO clinics for both conditions, with varying levels of preparedness related to diagnostics and drugs in both facility types for the two conditions, although basic equipment levels were high across facility types for both conditions. Only UDs recorded diagnosis and prescriptions that can be recognised and retrieved, and neither had digital records or a designated person for data management. Patient feedback mechanisms were absent for UDs but present at a high level in NGO clinics.

Conclusion

Urban PHC facilities in Dhaka have considerable gaps in preparedness to treat HTN and T2D. National and city-level governments must prioritise ensuring diagnosis, care, and treatment across all providers.