Health system impact of COVID-19 on selected urban slum population of Bangladesh: A rapid assessment study to support pandemic preparedness

Background: Worldwide the impact of COVID-19 pandemic has been grave, particularly in countries with a weak health systems like Bangladesh. We rapidly assessed the health-system impact of COVID-19 in the urban slums of Bangladesh that are identified as hotspots for COVID-19. 

Methods: A cross-sectional survey among 476 households was conducted in October-December 2020 in five selected slums of Dhaka city. In-depth interviews with purposively selected 22 slum dwellers and key-informant interviews with 16 local healthcare providers and 4 policymakers were conducted. The study explored the impact of the pandemic on the health system by considering the WHO-defined building blocks. Descriptive and systematic framework approaches were applied to analyse the quantitative and qualitative data, respectively.   

Results: About 12% of members reported suffering from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers during the lockdown period. 39% of the recently delivered women sought healthcare in three months preceding the survey. An overall reduction in healthcare use was reported during the lockdown period compared to pre-pandemic time. Reduced workhour, inadequacy of healthcare providers, and COVID-19 test requirements at health facilities were challenges in accessing healthcare. Mismanagement and inefficient use of resources were reported as challenges to health financing during the pandemic. Health information sharing was inadequate in the urban slums resulting from a lack of community and stakeholder engagement (51% received COVID-19-related information, and 49% of respondents knew about the national hotline number). Acute shortage of human resources was reported during the pandemic resulting from shortage of specialist doctors and uneven distribution of health workforce. COVID-19 test was inadequate due to the lack of adequate test facilities and the stigma associated with COVID-19. Lack of strong leadership and stakeholder engagement was seen as the barriers to effective pandemic management. 

Conclusion: The adverse effect of the pandemic on urban health-system warrants the need for effective planning and sustained investment in building a resilient health-system. Documenting the challenges during the pandemic and the best practices to overcome the challenges can help develop an effective preparedness plan to tackle future health emergencies.