Noncommunicable Disease Prevention and Control Situation in a Primary Health Care Setting of Bangladesh: Design and Baseline Findings of an Intervention

Research Article

Chronic Dis Int. 2016; 3(1): 1021.

Noncommunicable Disease Prevention and Control Situation in a Primary Health Care Setting of Bangladesh: Design and Baseline Findings of an Intervention

Zaman MM¹*, Ullah AKMJ², Bhuiyan MR¹, Karim MN¹, Moniruzzaman¹ and Rahman SMA³

¹World Health Organization, Bangladesh

²Directorate General of Health Services, Bangladesh

³Debhata Upazila Health Complex, Bangladesh

*Corresponding author: M Mostafa Zaman, Research and Publication Unit, World Health Organization, Dhaka, Bangladesh

Received: June 07, 2016; Accepted: July 25, 2016; Published: July 26, 2016


Background: Noncommunicable Diseases (NCDs) have been increasing in Bangladesh. It is necessary to examine the capacity of the Primary Health Care (PHC) system and its response to an intervention to strengthen NCD control measures. Current paper presents the initial finding of the assessment of capacity of PHC system in dealing with NCD prevention and control through a basic minimum intervention in an Upazila of Bangladesh.

Methods: The assessment of the capacity of PHC was done in Debhata upazila of Satkhira district using interviews, record reviews and observations using check lists and questionnaires. A basic minimum intervention was done to see its appropriateness in a view to detect, prevent and manage NCDs, and to generate evidence to substantiate control measures. The intervention included such components as (a) strengthening health system through training and supply of equipment and medicines; (b) promoting medical information system and evidence generation, and (c) creation of public awareness through observance of NCD related days and campaigns.

Results: Doctors, nurses, technologists and filed level workers were present as per approved post and providing services. Relevant medicines, as per WHO essential drug list, were either supplied inadequate quantities or not supplied at all. Newly established NCD corner was not able to function adequately. The attendance of patients with NCDs was also poor (only 427 patients in 2013). Detection and referral of cases from field by the health workers were absent. Training of people and supply of essential equipment/logistics have improved functions substantially. With a short training and provision of equipment, health assistants could conducts NCD risk factor survey with satisfactory quality.

Conclusion: Relevant backbone for NCD prevention and control is already existent at PHC level. Strengthening skills of personnel and provision of essential medicines and technologies can improve capacity of PHC system to deal with NCDs.

Keywords: Bangladesh; Non-communicable disease control; Risk factors; Primary health care system


Proportional mortality rate due to Non-Communicable Diseases (NCDs) has been increasing in Bangladesh [1-5]. As a result NCDs have been identified as one of the important public health problems in Bangladesh. Major NCDs include heart diseases, stroke, diabetes, chronic respiratory diseases and cancers [5,6]. They are caused by the top of genetic predisposition and age, some behavioral risk factors like unhealthy diet, tobacco use, physical inactivity, and excessive use of alcohol over a prolonged period [7]. They gradually mature to metabolic risk factors such as hypertension, impaired glucose tolerance, dyslipidemia, and ultimately develop into full blown NCDs [8].

All the major behavioral risk factors are modifiable, metabolic factors are preventable and the NCDs are treatable to a large extent [9,10]. The best is to prevent NCDs before they develop. It needs health system approach among others. It is necessary to examine how the health system has been implementing programs for prevention and management of NCDs. It is well known that the tertiary and secondary level hospitals are providing curative care and contributing to secondary and tertiary preventions [11-13]. Primary Health Care (PHC) system plays an important role in prevention of diseases through public awareness, early detection, treatment and referral [13]. However, PHC’s readiness and orientation towards prevention and management of NCDs are not systematically known [14].

The World Health Organization (WHO) has devised a Package for Essential NCD (PEN) intervention [15] in low resource settings, which is yet to be field-tested in Bangladesh. We presume that PHC is still far from dealing with the comprehensive PEN package. Therefore NCD interventions should be done in stepwise pattern, starting with a basic minimum, so that the system can absorb it efficiently. Towards this end, we have done an assessment of the capacity of an upazila health complex for prevention and control of NCDs. A basic minimum intervention was also given to examine its readiness to deal with NCDs. Its design and baseline findings are described in this report.


The capacity assessment was done in one of the south-western frontier upazila, Debhata, in Satkhira district in 2012. Debhata is situated on the east bank of the Ichhamoti river that separates West Bengal of India from Bangladesh. Debhata’s total area is about 173 square kilometers. It consists of 5 unions, 59 mauza, and 125 villages. There are total 29,816 households having a population of 1,25,358. Of them 50,418 are adults aged 18 years or older. Its literacy rate (54.8%) is comparable to the national average (51.8%) [16,17] (Figure 1).