Primary Care in Bangladesh can help manage the outbreak now and lay the foundation for a healthier future

As the COVID-19 pandemic continues to unfold in Bangladesh, more confirmed cases and deaths are being reported in recent weeks. Bangladesh is one of the most densely populated countries in the world, with 1,200 people per square kilometer (compare this with China’s 148 people per square kilometer). Combined with the reality that a large portion of the population depends on shared transport, handwashing in public spaces is limited, and many people do not have enough income to stock up on essential commodities for weeks at a time, social distancing measures will be nearly impossible to sustain. 
 
These challenges could lead to an unchecked COVID-19 outbreak in Bangladesh and result in even higher mortality due to high rates of poverty and an insufficient supply of quality health care. Decades of progress to reduce poverty and improve health could be undone in months.
 
The primary care system in Bangladesh is an important way to ensure that people can continue to receive essential health services, such as ensuring women have access to skilled birth attendants and children can continue receiving lifesaving immunizations.
 
Over the last generation, primary health care in the public sector has been very strong for the masses, and is responsible for Bangladesh’s impressive progress on social development indicators, where in fact Bangladesh fares better than any other country in South Asia. Life expectancy has jumped from a mere 45 years in 1960 to almost 73 years now, and the under-five mortality rate is less than a quarter what it was in 1990.
 
Unfortunately, primary care is widely overlooked in the private sector, which is responsible for more than 70% of healthcare spending. Most people go to a hospital when they are sick and there is very little emphasis on prevention. This creates an increasing challenge in a country that already has a shortage of doctors and overcrowded health facilities. When there’s not a health crisis, fewer than 20% of people can access critical care, which means a spike in COVID-19 cases can quickly overwhelm the health system.

Thankfully, many primary care facilities in Bangladesh are pivoting their services to help the government respond directly to the crisis. For example, our group at Praava Health was the first private provider in the country to support the government's efforts with a free “333” hotline and also supporting sample collection for government COVID-19 testing. We have also launched COVID-19 testing for the general public, an important way to increase access to testing -- a critical step to being able to lift lockdowns.

In addition to directly supporting government efforts, below are three ways primary care facilities can help reduce the burden on hospitals during this time so they can focus on treating severe COVID-19 patients.

1. Primary care systems can be an important source of accurate and trusted information for the general public. As we have seen globally, the lack of access to proper information can lead to more panic and uncertainty.  Praava Health has developed several tools to keep patients updated with the right information. We have created a dedicated COVID-19 webpage that contains all updated local and international information on COVID-19, as well as frequently asked questions. For people who still have questions, patients can leave comments on our Facebook page, and our doctors will answer on live videos. We have also launched a self-assessment tool and a coronabot that allows people to answer a few simple questions and receive recommendations about whether they should seek testing or remain home.  During a crisis, people seek security and answers. As a primary care facility, we see it as our role to be a trusted source of information.
2. Primary care facilities can help support COVID-19 patients or suspected and high-risk patients by helping them manage symptoms at home and provide guidance to family members on how to care for their loved ones. Given that 80% of all COVID-19 positive patients do not require hospital care, primary care doctors can provide medical advice to patients who are under lockdown or quarantine to help them and their families manage symptoms from home, and to help them determine if and when going to a hospital is absolutely necessary. In fact, Praava has developed tools to identify patients’ clinical risk profiles, based upon which patients’ biometrics are reported regularly, and doctors check in with patients as needed. These types of measures are crucial to reduce transmission to healthcare workers and other patients and reduce the burden on hospitals which can then focus on cases requiring acute care.
3. Primary care providers can continue to provide care for non-COVID patients, either those who need ongoing disease management, or preventative care for people who still need routine checkups. Internet usage has tripled since 2013 and there are more than 30 million active smartphone users in Bangladesh, which means we can do much of this through telehealth or video consultations to reduce the risk of transmission. For those who need in-person care, we can also provide imaging and outpatient procedures that would otherwise be done at a hospital. Ultimately, keeping these patients healthy will be an important part of reducing stress on hospitals and critical care units. Praava’s home services help patients to avoid leaving their home to reduce spread of COVID-19. For example, Praava is offering telehealth services for remote screening, triage, and treatment of COVID-19 and has already rolled out free COVID-19 telehealth screenings to its 55,000 patients. While our clinic remains open and serving patients, telehealth is key to preventing overload of onsite resources while minimizing transmission to both health workers and patients. Praava has converted the majority of in-clinic appointments to video consultations to prevent patients' and health workers' exposure to the virus.  Our group is also part of a national telemedicine group that collaborates with the government to promote use of telemedicine as an initial triage tool at a time when the health system is so stretched.  These services include video-consultations but also include home sample collection for any testing needs (including COVID-19 testing) or home delivery of drugs. This ensures that those suffering from chronic or other illnesses can maintain continuity of care while staying at home.  Additionally, Praava’s doctors have identified high risk individuals (elderly and those with chronic diseases) empaneled within our patient pools, and are proactively engaging them to help them understand their particular risk profiles and how to protect themselves against the virus, while ensuring that they are continuing to seek the care they need during this time.

The COVID-19 pandemic has shown us the challenge of containing a new pathogen that does not respect international borders. It can quickly overwhelm the strongest of health systems and the effects will likely be felt for years to come. However, this challenge has also shown us why strong primary health care is crucial to stop outbreaks in their tracks – and provide the necessary foundation for a healthier community.

By Sylvana Sinha, Founder and CEO, Praava Health

The views expressed in this blog are those of the author and do not necessarily reflect the views of PHCPI , WONCA, AfroPHC, or their members and partners.