Malaria Endgame: Can engagement of the for-profit private sector help the country reach the last mile of malaria elimination in Bangladesh?

Author:

Alam Mohammad Shafiul1,Alam Md Jahangir2,Hossain Mohammad Sharif1,Matin Mohammad Abdul1,Phru Ching Swe1,Hasan Anamul1,Rahman Md Mushfiqur3,Rahaman Md Mosiqure3,Islam Md Nazrul3,Das Shyamol Kumer3,Aktaruzzaman M. M.4,Adnan Sheikh Daud4,Islam Md Nazmul4,Hazarika Anupama2

Affiliation:

1. International Centre for Diarrhoeal Disease Research

2. World Health Organization, Country Office for Bangladesh

3. National Malaria Elimination Program

4. Directorate General of Health Services

Abstract

Abstract

Background Among 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh's malaria burden. Despite the private sector's prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030. Methods This mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission. Results Among the 104 representative participants, majority were male (n=92, 88.5%), had a diploma in their respective fields (n=53, 51%) and were involved either in laboratory work (n=49, 47.1%) or as owners/managers of health centers (n=41, 39.4%). The selected health facilities were close to the corresponding UHC (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%). Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis. Conclusions This study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh's malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.

Publisher

Springer Science and Business Media LLC

Reference35 articles.

1. WHO. World malaria report 2023. Geneva: World Health Organization; 2023.

2. Bangladesh in the era of malaria elimination;Haldar K;Trends Parasitol,2023

3. World Health Organization. Global Technical Strategy for Malaria 2016–2030. Swizerland: Geneva; 2015.

4. National Malarial Elimination Programme. National Strategic Plan for Malaria Elimination in Bangladesh: 2021–2025. (Directorate General of Health Services ed. Bangladesh: Dhaka; 2021.

5. Bangladesh. Improving Capacity to Meet Growing Needs [https://www.worldbank.org/en/results/2016/10/07/bangladesh-health-nutrition-population-improving-capacity-meet-growing-needs].

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