Studying the impact of Covid-19 on essential health and nutrition services

The Covid-19 pandemic may have had an indirect effect on essential health and nutrition services (EHNS) in Bangladesh, in terms of provision, coverage, utilisation and care-seeking behaviour; particularly for reproductive, maternal, neonatal, child and adolescent health (RMNCAH), tuberculosis (TB), and non-communicable diseases (NCD). 

Through this study, we sought to understand the indirect effects of the Covid-19 on EHNS in Bangladesh. There was specific focus on RMNCAH, together with TB and NCD for provision, coverage, utilisation and care-seeking. Research methods included the review of published and unpublished reports and secondary data analysis, and qualitative primary data collection covering both supply and demand side assessments.

The objective was to propose relevant recommendations arising from the analysis, e.g. options for the demand-side adoption of key measures and supply-side responses and initiatives that could be relevant for the government in EHNS and RMNCAH policy making. We also supported dissemination of findings and recommendations to selective audience from the ministry, World Bank and other development partners.

Our approach

We proposed to better understand these impacts through:

  1. review of published and unpublished reports and secondary data analysis; and
  2. primary data collection covering both supply and demand side assessments.

Data collection tools included in-depth interviews, key informant interviews and focus group discussions with service providers, service managers, service recipients, and community people.

To understand the supply side effects, our team conducted in-depth interviews with different types of service providers like government health and family planning fieldworkers, facility-based workers, facility managers in addition to informal sector service providers and health workers in private/non-government health facilities. For conducting focus group discussions, Health Assistants, EPI technologists, Family Welfare Assistant, Family Welfare Visitor, Brac’s Shebika (DOTS providers) were approached. To assess the demand side effects, focus groups were conducted with pregnant women, recent mothers, mothers of under-five, and patients with TB, diabetes, hypertension and COPD at village, union, upazila, district and Dhaka North City Corporation levels along with interviews of community leaders.

At the national level, key informant interviews were conducted with senior government officials from directorate general of health and family planning services, Bangladesh chemists and druggist association, private clinic and diagnostic centre’s owner’s association, prominent health personalities, academics and development partners. 

The study was focused on Dhaka division, Narayanganj district, given that there had been a higher number of confirmed Covid-19 cases than elsewhere. Each remaining level of administrative unit was selected randomly from this district (Rupganj upazila, Bhalaboo union) along with ward-4 (Mirpur) of Dhaka North City Corporation. As a result, both urban and rural settings were covered.

We implemented this project together with Development Research Initiative.

Area of expertise