The readiness of primary healthcare facilities to address non-communicable diseases in rural Bangladesh
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Introduction: Strengthening the capacity of primary healthcare (PHC) systems is essential to address the rising burden of non-communicable diseases (NCD) in Bangladesh. The study assessed the readiness of rural PHC facilities in addressing the five World Health Organization (WHO) priority NCDs: diabetes, cardiovascular diseases, chronic respiratory diseases, cervical cancer, and mental health disorders.
Methods: Between March and April 2024, a cross-sectional survey was conducted in three subdistricts of Dinajpur District, Bangladesh, as a part of a type-2 hybrid effectiveness implementation trial aimed at evaluating implementation fidelity and examining the process of
intervention delivery pertinent to NCD care. All healthcare facilities (government, non government, and private,) within the study areas were included. Two existing tools, the WHO Service Availability and Readiness Assessment (SARA) and the Harmonized Health Facility Assessment (HHFA), were adapted to evaluate NCD-specific readiness across four domains: clinical services, staff and guidelines; equipment; diagnostic capacity; and essential medicines. Readiness scores were calculated for each domain, with scores ≥70% indicating sufficient
preparedness for NCD management.
Results: Union-level public health facilities (ULPHF) had slightly better overall service readiness (39.6%) than community clinics (CC) (38.7%), while upazila (subdistrict) health complexes (UHC) had the highest overall readiness (82.1%). UHC had the highest readiness for diabetes care (68.2%), particularly in clinical services, staffing, and guidelines (88.9%). The availability of medicines was critically low in CC (0.2%). Equipment for the management of cardiovascular diseases was most available (80.0%), whereas cervical cancer equipment was totally unavailable (0.0%) in ULPHF, CC, and private/NGO facilities. Chronic respiratory disease and cervical cancer diagnostic capacity were totally absent (0.0%) in ULPHF and CC. In mental health service provision, UHC were the most prepared (32.5%), whereas ULPHF were the least prepared (3.3%). None of the facilities achieved the 70% threshold of overall readiness for all five NCDs.
Conclusion: Findings reveal serious gaps in the readiness of PHC facilities in Bangladesh to
respond to NCDs in the four areas. Shortages of trained personnel, absence of standard treatment
guidelines, limited diagnostic services, and irregular availability of essential medicines highlight
important areas requiring urgent strengthening to enhance PHC readiness and ensure equitable
NCD-care provision.
Methods: Between March and April 2024, a cross-sectional survey was conducted in three subdistricts of Dinajpur District, Bangladesh, as a part of a type-2 hybrid effectiveness implementation trial aimed at evaluating implementation fidelity and examining the process of
intervention delivery pertinent to NCD care. All healthcare facilities (government, non government, and private,) within the study areas were included. Two existing tools, the WHO Service Availability and Readiness Assessment (SARA) and the Harmonized Health Facility Assessment (HHFA), were adapted to evaluate NCD-specific readiness across four domains: clinical services, staff and guidelines; equipment; diagnostic capacity; and essential medicines. Readiness scores were calculated for each domain, with scores ≥70% indicating sufficient
preparedness for NCD management.
Results: Union-level public health facilities (ULPHF) had slightly better overall service readiness (39.6%) than community clinics (CC) (38.7%), while upazila (subdistrict) health complexes (UHC) had the highest overall readiness (82.1%). UHC had the highest readiness for diabetes care (68.2%), particularly in clinical services, staffing, and guidelines (88.9%). The availability of medicines was critically low in CC (0.2%). Equipment for the management of cardiovascular diseases was most available (80.0%), whereas cervical cancer equipment was totally unavailable (0.0%) in ULPHF, CC, and private/NGO facilities. Chronic respiratory disease and cervical cancer diagnostic capacity were totally absent (0.0%) in ULPHF and CC. In mental health service provision, UHC were the most prepared (32.5%), whereas ULPHF were the least prepared (3.3%). None of the facilities achieved the 70% threshold of overall readiness for all five NCDs.
Conclusion: Findings reveal serious gaps in the readiness of PHC facilities in Bangladesh to
respond to NCDs in the four areas. Shortages of trained personnel, absence of standard treatment
guidelines, limited diagnostic services, and irregular availability of essential medicines highlight
important areas requiring urgent strengthening to enhance PHC readiness and ensure equitable
NCD-care provision.
Date Issued
2026-12-01
Date Acceptance
2026-05-07
Citation
BMC Health Services Research, 2026, 26 (1)
ISSN
1472-6963
Publisher
BMC
Journal / Book Title
BMC Health Services Research
Volume
26
Issue
1
Copyright Statement
© The Author(s) 2026. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Identifier
10.1186/s12913-026-14719-4
Subjects
Non-communicable diseases
Bangladesh
Service availability
Readiness
Primary healthcare
Publication Status
Published
Article Number
ARTN 1028
Date Publish Online
2026-05-28