Capacity and service readiness of facilities for non-communicable diseases in Bangladesh: a health system perspective from two selected districts

BACKGROUND: Non-communicable diseases (NCDs) are a growing health crisis in Bangladesh and a leading cause of morbidity and mortality. This study assessed the capacity and service readiness of healthcare facilities for the management of NCDs, including hypertension (HTN), diabetes mellitus (DM), and chronic respiratory diseases (CRDs), in two selected districts of Bangladesh. METHODS: A cross-sectional study was conducted in 328 public and private health facilities utilising the World Health Organisation's Service Availability and Readiness Assessment manual. The study assessed the facilities' readiness to manage NCDs across four domains: trained staff & guidelines, basic equipment, diagnostics, and essential medicines. A composite mean readiness index (RI) score was calculated using these domains. A facility with a composite RI score of 70% or higher was considered ready to manage NCDs. RESULTS: A total of 84% (n = 277) of facilities belong to the public sector. District hospitals (DH) and Upazila Health Complexes (UHCs) demonstrated high readiness for HTN (83% and 78%, respectively) and DM (78% and 71%, respectively), surpassing the 70% cutoff. However, no facilities met this criterion for CRDs. The highest RI scores were found for equipment for HTN and DM, and in staff & guidelines for CRDs. In contrast, the lowest RI scores were: medicines for HTN (8% in Union-level Facilities and 3% in Community Clinics (CCs)) and diagnostics for DM (4% and 2% respectively). CONCLUSION: PHC-level health facilities, particularly Union-level Health Facilities and CCs in Bangladesh, are critically underprepared for NCD management, with key deficiencies in staffing, diagnostics, and medicine supply. This necessitates an effective, equity-driven approach to equip both public and private healthcare facilities and improve overall NCD care in the country.