key: cord-0829380-mxzvvy7b authors: Islam, Sufia; Islam, Rizwanul; Mannan, Fouzia; Rahman, Sabera; Islam, Tahiya title: COVID-19 pandemic: An analysis of the healthcare, social and economic challenges in Bangladesh. date: 2020-11-17 journal: Progress in disaster science DOI: 10.1016/j.pdisas.2020.100135 sha: 61d8bd7cfabf050fff0bda5d58bc197f02621db1 doc_id: 829380 cord_uid: mxzvvy7b Bangladesh is one of the worst hit countries in South Asia for COVID-19 outbreak. The objective of this article is to analyse healthcare, social and economic challenges faced by the country. Quantitative data and qualitative information from different sources have been used. Our analysis indicates that limited well-equipped hospitals, inadequate testing facilities, lack of awareness, improper knowledge, attitude to and practice of rules, poverty and precarious employment are the factors dominant in spreading COVID-19. Strict enforcement measures and ensuring people's adherence to rules may help reduce spread of infections. Adequate healthcare services are essential for establishing proper medical care. Both quantitative and qualitative research methodologies have been used in this article. Data from secondary sources, authors' own estimates/projections, information from newspaper articles, websites of WHO, Worldometer, Institute of Epidemiology Disease Control and Research (IEDCR), Government of Bangladesh (GoB), and relevant research organizations were used. Estimates have been made of the vulnerable population by using data from official sources. They have been supplemented by data from other surveys and studies. Personal observations of societal behaviour and qualitative information were obtained from a variety of sources. PubMed, Google scholars were searched for original research articles on COVID-19 pandemic. The search was performed from March to November 7, 2020 to collect data related to healthcare, social and economic perspective of Bangladesh. A series of key search terms was used in the process, such as, "COVID-19," "Coronavirus," "COVID-19 Outbreak". Bangladesh has adopted some policies in order to minimize the transmission of COVID-19 in accordance with the WHO guidelines. The policies include changes in lifestyle, using face masks, movement restriction, social distancing and changes in hygiene practices. In addition, the government and private sector are working on creating awareness amongst the people by using local media in order to strengthen personal hygiene practices. A study conducted by Farhana et al. [3] concluded that a significant proportion of the people in Bangladesh had poor knowledge about the transmission, signs and symptoms and incubation period of COVID-19. Bangladesh healthcare facilities encountered huge difficulties for treating patients since the outbreak of COVID-19. Serious drawbacks were found in hospitals regarding the availability of J o u r n a l P r e -p r o o f Journal Pre-proof ventilator support facilities to treat severe acute respiratory syndrome. With a size of population of 163,046,173, hospital beds per 1000 population is 0.8 and Intensive Care Unit (ICU) beds per 100,000 population is 0.7 [4] . The situation report of WHO states that as of 26 October, 2020 there are 11,730 general beds and 564 ICUs for treatingCOVID-19 patients all over the country. Among which 3519 (30.0%) general beds and 314 (55.7%) ICUs are occupied by the patients only in Dhaka city [5] . The beds in the hospital were not being fully occupied as many infected people are taking treatment at home [6] . Initially the testing facilities were inadequate, however, with time the facilities improved as the number of cases increased. Over the time all the government and some private health care facilities across the country have started COVID-19 testing [6] . However, the testing coverage for COVID-19 in Bangladesh is 1485.6/1 million which is still modest when compared with the countries in the region [7] . WHO continuously supported Ministry of Health and Family Welfare (MOHFW), Bangladesh to expand testing capacity and the plans for further expansion are underway. WHO also undertook a vast operation of samples transportation from the entire 64 districts of Bangladesh. As of September 2020, over 400,000 laboratory samples have been transported with WHO support, representing nearly half of the samples transported all over the country [8] . After three months of coronavirus epidemic in Bangladesh, The GoB decided to charge 200 taka (£1·80) for the COVID-19 test in Government facilities, whereas the private sectors charge 3,500 taka (£32). As a result, the rates of testing have reduced to 0.8 tests per 1000 people in one day [6] . This pandemic has seen doctors on the COVID-19 front-line make personal sacrifices by helping and treating patients with minimal support, even though they do have the ethical responsibility J o u r n a l P r e -p r o o f Journal Pre-proof for their own protection [9] . Front-line doctors and other healthcare professionals struggled to treat COVID-19 patients efficiently due to shortage of appropriate equipment, inadequate number healthcare facilities providing COVID-19 support and unpreparedness of the Government to deal with the crisis [10] . Coronavirus has taken lots of lives including that of healthcare professionals since its first outbreak in Wuhan, China. Bangladesh is not an exception where physicians and health workers are highly vulnerable to get infected by this deadly disease [11] . Shutting down of public services and daily activities resulted in an economic crisis alongside the health crisis. About one-fifth of the country's population live below the poverty line and a significant proportion of the workforce is dependent on casual jobs. The shutdown created a dilemma between saving lives and livelihoods [12] . In Bangladesh, out of the employed population of around 63 million, around 25 million are in wage/salaried employment, over 10 million of whom are in casual employment based on daily wages. Approximately 4.5 million casual labourers are engaged on a daily basis in construction, transport, trade and food and accommodation who were seriously affected [12] . The country's major manufacturing industry of readymade garments (RMG) employs about 4 million people [13] , whose jobs are also of a precarious nature. When COVID-19 spread to developed countries that are major importers of the products of RMG industry, buyers started to cancel their ordersthus jeopardising the livelihoods of workers engaged in the industry [14] [15] [16] . The rest of the manufacturing sector employs another 5 million workers of whom 85% are informally employed [2] . Their conditions of employment are no better than the casual workers. Additionally, among the large proportion of self-employed working people, around 5.19 million self-employed people in the urban informal sector, live precariously [12] . Thus, the livelihood of approximately 18 million people was facing uncertainty during the shutdown period. Taking into account the average size of a family is 4, it would seem that about 72 million are now facing the challenges of livelihood [2] . The government came up with a policy package for economic recovery amounting to Tk 103,117 crore that included credit to export-oriented industries for payment of wage, credit to other enterprises of different sizes, credit for unemployed youth, migrant workers returning from abroad and other micro enterprises, as well as allocations for safety net for the poorin cash as well as kind [17] . But the implementation record of the various schemes varies considerably, with the items for larger enterprises doing much better than those meant for micro, cottage and small enterprises. As for safety net measures, the cash transfer meant for the poor was small in amount, and the process of implementation was marred by errors in selection and delay. So, it is not surprising that the incidence of poverty increased substantially during the crisisas can be seen from the findings of various research studies [18] [19] [20] . Social distancing is being adapted as the principal strategy to prevent and to slow down the transmission of COVID-19 infection [21] . . Due to the unavailability of any established treatment, mankind has to maintain social distancing for mitigating the morbidity and fatality consequence. However, Bangladesh lags behind the ratio of patients and their doctors and nurses compared to other neighbouring countries [33] . Inadequate COVID-19 testing facilities as well as limited clinical and health care services are the serious problems to treat COVID-19 infected people in Bangladesh. Therefore, adequate testing facilities and health care services should be provided by the GoB to combat this deadly virus. For many people in Bangladesh who struggle at precarious levels of living, the stark choice during the period of shutdown was to face a deadly virus or hunger because of inability to access work and earnings. Many preferred to accept the former in order to prevent hunger; for them remaining shut was not a practical option. And when shutdown was imposed upon them, the result for many was inability to go to work and a loss of income. The assistance from the government was too little and too late. Consequently, many who were not poor became poor and those who were already poor became poorer. The economic, physical and cultural environment in which people of Bangladesh live, the practice of social distancing is often a big challenge. Furthermore, lack of awareness about COVID-19, inadequate knowledge of, attitudes to and practice of social distancing are factors that make the COVID-19 epidemic a huge threat to the nation. At the same time, issues such as the Government to influence people and make them aware about this contagious nature of the virus. In order to do that, strict measures may be taken to ensure compliance with social distancing and wearing of mask in public places during this pandemic period. Domestic violence increases during such restrictive times when families spend more time together [29] . This situation exists across all social classes and women see their self-esteem being crushed and shattered on a daily basis within the confinement of their homes. It is a wellknown fact that violence against women and children in Bangladesh is a serious social, economic and cultural problem. According to the Bangladesh Bureau of Statistics 54.4% of married women face domestic violence by their partners [35] . Despite legislation and awareness this is still a huge problem faced by women. The Bangladesh government needs to provide leadership and guidance in this area and implement safeguards and services for women facing such abuse. Based on the experience with regard to the management of the COVID-pandemic, a number of conclusions can be drawn. First, a well-thought out strategy is important in addressing such a big challenge. Rather than assuming that the challenge may not be serious, it is important to err on the more cautious side. Second, stricter measures and more effective enforcement are essential in preventing or slowing down the spread of such a disease. Third, taking into account the weaknesses of the healthcare system that have been exposed by this experience, concrete measures need to be undertaken to bring about improvements in the area of public health. Appropriate preparations including better equipping the healthcare facilities and training of personnel are key in this regard. Measures should be taken to establish strict control on cross infections in hospitals in order to prevent further spreading of COVID-19 infections. J o u r n a l P r e -p r o o f Journal Pre-proof In order to contain the spread of infections, the government's health and social policies need strengthening. Following recommendations are being made in that context: (i) Health care services and testing facilities should be increased. (ii) There must be good coordination between policy makers and local health care providers. (iii) Firm steps should be taken by the local authorities to ensure compliance with social distancing and wearing of mask in public places. (iv) The government's economic recovery programmes for the poor and lower income people should be given greater priority in implementation. (v) Government and Non-Governmental organizations should come forward to implement some safety measures for women who are facing violence and abuse. 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