Critical gaps in infectious disease prevention and control: insights from IHR-2005 implementation enablers and challenges at key entry points in Bangladesh

The global spread of infectious diseases led World Health Organization (WHO) to establish the International Health Regulations, later revised as IHR-2005. However, implementation remains incomplete and inconsistent in many Low- and Middle-Income Countries (LMICs), including Bangladesh. To our knowledge, no qualitative research on International Health Regulation-2005 (IHR-2005) implementation at designated Points of Entry (PoEs) in Bangladesh has been conducted yet. Therefore, we aimed to explore the enablers and challenges of implementing the IHR-2005 for infectious disease prevention and control at the designated PoEs in Bangladesh after the COVID-19 pandemic. We conducted an exploratory qualitative study from October 2022 to June 2023 at four designated Points of Entry (PoEs) in Bangladesh. A total of 30 interviews were completed, including 20 In-Depth Interviews (IDIs) with service providers and port users and 10 Key Informant Interviews (KIIs) with decision-makers and experienced service providers. All interviews were transcribed, coded, and thematically analyzed using ATLAS.ti software (version 7.5.10). The findings revealed more challenges than enablers on both the regulators and public sides of implementing IHR-2005 at the designated PoEs in Bangladesh. Key challenges included a lack of understanding of IHR-2005 and its role in global infectious disease prevention and control, inadequate training on IHR-2005, a severe shortage of human resources, and uncooperative behavior from travelers. Additionally, there was a limited availability of ambulances for transporting ill travelers, and health offices were often inaccessible or not conveniently located at every PoE. Among the four PoEs, Benapole Ground Crossing (BGC) encountered the most significant obstacles in ensuring effective IHR-2005 implementation. The overall environment at BGC was also found to be suboptimal. Other designated PoEs had good communication and coordination capacities, available medical and technical services, and a good environment. The implementation of IHR-2005 at designated PoEs in Bangladesh faces significant challenges, hindering its effectiveness. Addressing these barriers is essential to strengthen the enforcement of IHR-2005 and enhance the country’s ability to prevent and control the spread of infectious diseases at key entry points.