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nlpeer/F1000-22/10-170_101 | On this, a doctor that has been on COVID-19 duty since the pandemic outbreak said: | |
nlpeer/F1000-22/10-170_102 | According to the FGDs with the clinicians (FGD 2, 6 and 7), these issues resulted in a very high number of deaths among Bangladeshi doctors, which further undermined healthcare providers' trust in the health system. | |
nlpeer/F1000-22/10-170_103 | Despite their sacrifices, they were not granted prioritized testing or healthcare, while also experiencing delays in salary payments. | |
nlpeer/F1000-22/10-170_104 | As a result, many doctors lacked motivation, as explained by one participant: "Government did not clarify direction regarding who would get the motivation package. | |
nlpeer/F1000-22/10-170_105 | Some doctors did not even receive their regular salary. | |
nlpeer/F1000-22/10-170_106 | This demoralized the doctors. | |
nlpeer/F1000-22/10-170_107 | … I know several young doctors who are saying that, if they are assigned COVID-19 duty, they will simply resign." [FGD-6, renowned public health experts, clinical background] Several doctors from FGD 2, 6 and 7 expressed concerns over workplace security, as Bangladeshi people take out their dissatisfaction over the hea... | |
nlpeer/F1000-22/10-170_108 | To highlight the growing violence which resulted in a death of a colleague, many doctors stopped telemedicine services which they were previously offering benevolently to combat the COVID-19 crisis. | |
nlpeer/F1000-22/10-170_109 | A physician engaged in COVID-19 response said: | |
nlpeer/F1000-22/10-170_110 | The findings yielded by this qualitative study indicate that several problems emerged as a consequence of failure to engage the right kind of experts in managing the pandemic. | |
nlpeer/F1000-22/10-170_111 | As a result of poor decision-making, the Bangladeshi health system was inadequately prepared to respond to the COVID-19 outbreak, as evident in the negative perception of our participants regarding the service providers especially in terms of quality of care they provided, and misinformation some of them shared in the ... | |
nlpeer/F1000-22/10-170_112 | Service providers also complained about lack of training, PPE, equipment, motivational packages, and workplace security. | |
nlpeer/F1000-22/10-170_113 | The finding that the Bangladeshi health system failed to engage the right experts in the right positions is supported by several news articles and reports covering this topic. | |
nlpeer/F1000-22/10-170_114 | The Government of Bangladesh formed a 17-member National Technical Advisory Committee (NTAC) on 19 April 2020, more than a month after the first COVID-19 case was detected in the country. | |
nlpeer/F1000-22/10-170_115 | In the interim, most of the pandemic control efforts were entrusted to bureaucrats or administrators, many of whom lacked expertise or experience in health, let alone pandemic management. | |
nlpeer/F1000-22/10-170_116 | It is also worth noting that only three members of the NTAC had a public health career track 37 . | |
nlpeer/F1000-22/10-170_117 | This issue was further compounded on 21 April, when the government assigned 64 top bureaucrats to supervise and coordinate relief distribution activities in 64 districts of Bangladesh 38 without seeking input or technical leadership from public health professionals. | |
nlpeer/F1000-22/10-170_118 | A policy analysis on the human resources for health in Bangladesh revealed that the DGHS is principally managed by the clinicians at the expense of public health experts. | |
nlpeer/F1000-22/10-170_119 | The same applies to the Ministry of Health and Family Welfare level, which comprises of members drawn from other ministries often unrelated to the health sector 39 . | |
nlpeer/F1000-22/10-170_120 | Given that such administrative approach is not conductive to pandemic management, lessons can be learned from Switzerland, Georgia, and New Zealand and other countries where science-based public health strategies have been proven highly effective 40 . | |
nlpeer/F1000-22/10-170_121 | Since doctors are often seen as the face of a health system, people blame them for any inadequacies in care delivery despite considerable sacrifices most doctors have made throughout the pandemic. | |
nlpeer/F1000-22/10-170_122 | So far, around 3,000 doctors in Bangladesh have contracted the virus and more than 100 have died due to COVID-19 41 . | |
nlpeer/F1000-22/10-170_123 | The negative perceptions regarding the service providers have been widely reported in Bangladeshi media 42 , which were attributed to poor communication skills and inadequate responsiveness (i.e., addressing the social needs of the patients such as being treated with friendliness, respect, information, trust, and sensi... | |
nlpeer/F1000-22/10-170_124 | Service providers' claims that inadequate training, PPE and equipment shortages are the main cause of their grievances have also been documented in other studies from Bangladesh. | |
nlpeer/F1000-22/10-170_125 | In a study conducted from 9 to 14 April 2020, Islam and colleagues examined the frontline health workers' perceptions and opinions on their personal safety while attending COVID-19 patients. | |
nlpeer/F1000-22/10-170_126 | Their findings show that 29% of the participating doctors lacked training on PPE use, 18% lacked training on COVID-19 case management, and 11% of the respondents did not receive any PPE 46 . | |
nlpeer/F1000-22/10-170_127 | Several news reports also highlighted the logistics issues related to food, lodging and transport provision for doctors working in COVID-19 dedicated hospitals 47 . | |
nlpeer/F1000-22/10-170_128 | We found that Bangladeshi health systems suffered from preexisting constraints such as budget shortages, low-quality services, high out-of-pocket payments, unregulated private sector, and a highly centralized secondary or tertiary care. | |
nlpeer/F1000-22/10-170_129 | We recommend increased budgetary allocation and efficiency, along with targeted policy approaches to address these constraints. | |
nlpeer/F1000-22/10-170_130 | Public health professionals were not engaged in scientific decision-making regarding the COVID-19 pandemic, and this spawned multitudes of problems, including inadequate pandemic preparedness, mismanagement, and incoordination. | |
nlpeer/F1000-22/10-170_131 | We recommend a science-based professional response involving relevant experts such as public health professionals, infectious disease epidemiologists, health policy and systems experts, medical anthropologists, health economists, health communication experts, laboratory scientists, and relevant clinicians. | |
nlpeer/F1000-22/10-170_132 | In the long run, a dedicated public health career track, which is currently absent in the Bangladeshi health sector, must be implemented 39 . | |
nlpeer/F1000-22/10-170_133 | We learned about various manifestations of vertical and horizontal incoordination among different government departments and between government and non-governmental actors. | |
nlpeer/F1000-22/10-170_134 | We believe, involving the right kind of professionals will solve most of the incoordination, but special attention and consideration should be given in favor of multisectoral collaboration. | |
nlpeer/F1000-22/10-170_135 | The collaboration and coordination should be extended to the religious leaders, cultural activists, for-profit private sector, non-governmental organizations, political parties, and the most important, the community groups and individuals. | |
nlpeer/F1000-22/10-170_136 | Participants cited instances of miscommunication. | |
nlpeer/F1000-22/10-170_137 | These should be corrected by ensuring data and decision transparency, correct information availability, and contextually and culturally appropriate messaging by trusted messengers in the community. | |
nlpeer/F1000-22/10-170_138 | The information and messages should be tailored by scientifically oriented social and behavior change communication experts and delivered through appropriate channels spread out through the community. | |
nlpeer/F1000-22/10-170_139 | The study participants voiced allegations of poor regulation and corruption. | |
nlpeer/F1000-22/10-170_140 | These need to be curbed by ensuring punitive actions against the wrongdoers, dissolving unholy syndicates in the health sector, ensuring accountability in health system governance, regulating the private sector for cost and quality. | |
nlpeer/F1000-22/10-170_141 | Some doctors were blamed for lack of responsiveness during service provision. | |
nlpeer/F1000-22/10-170_142 | Service providers should be trained and directed to provide high-quality and efficient services with good quality and responsiveness 48,49 . | |
nlpeer/F1000-22/10-170_143 | Some service providers allegedly spread misinformation about which evidence-based treatment protocol should be promoted, and a media guideline (for both traditional and social media) for service providers should be introduced. | |
nlpeer/F1000-22/10-170_144 | Service providers themselves were reportedly neglected, humiliated, and left insecure. | |
nlpeer/F1000-22/10-170_145 | We recommend that their legitimate demands should also be duly addressed; for example, they should be engaged in decision-making; provided with training, PPE, adequate medical equipment, and workplace security. | |
nlpeer/F1000-22/10-170_146 | Above all, such a devastating pandemic cannot be managed without political will, good governance, and an evidence-based scientific approach. | |
nlpeer/F1000-22/10-170_147 | Since this study did not capture the perspectives of health decision-makers, it would be beneficial to conduct further investigations into health system governance incorporating their perspectives. | |
nlpeer/F1000-22/10-170_148 | Quantitative research should also be conducted to explore patients' views on the responsiveness of the service providers, as well as service providers' perspectives on their own safety and experiences during the COVID-19 pandemic. | |
nlpeer/F1000-22/10-170_149 | The main limitation of this study stems from the use of online FGDs, which resulted in a sample that might not reflect the socioeconomic and demographic characteristics of the Bangladeshi population (as those without internet connectivity, or lower educational and socioeconomic status would be unable to respond to the ... | |
nlpeer/F1000-22/10-170_150 | Undergraduate students represent a major portion of the non-clinician participants. | |
nlpeer/F1000-22/10-170_151 | This particular group does bring a special perspective, since university students tend to be younger and of higher socio-economic status than the population at large. | |
nlpeer/F1000-22/10-170_152 | Consequently, the findings reported here cannot be generalized beyond the specific context in which the study was conducted. | |
nlpeer/F1000-22/10-170_153 | Second, it is worth noting that the first author was a COVID-19 patient at the time this study was conducted, which could potentially bias the qualitative analysis. | |
nlpeer/F1000-22/10-170_154 | However, every effort was made to reduce this risk through data triangulation 50 , and by engaging multiple research team members in data coding and interpretation. | |
nlpeer/F1000-22/10-170_155 | Bangladesh experienced several local disease outbreaks over the past several years [51][52][53][54] as well as a dengue epidemic in 2019 55 , but due to their lower magnitude compared to the COVID-19 pandemic, the need for a comprehensive overhauling of the health systems has not been felt so deeply before. | |
nlpeer/F1000-22/10-170_156 | Low-and middle-income countries like Bangladesh are particularly vulnerable to pandemics due to their week governance and limited health system preparedness 56 . | |
nlpeer/F1000-22/10-170_157 | This article focused on the public perceptions of the pandemic management efforts by the health system actors, as the aim was to help the decision-makers and service providers in implementing more effective public health protection measures. | |
nlpeer/F1000-22/10-170_158 | The main contribution of this investigation stems from highlighting the need to engage the right kind of experts in the right places at the outset of pandemic management efforts. | |
nlpeer/F1000-22/10-170_159 | It is further noted that public trust can be improved by being more transparent in official communications, while addressing the needs of service providers. | |
nlpeer/F1000-22/10-170_160 | These findings can help decisionmakers revise their policies in order to prevent a longer-term loss of life and economic downturn. | |
nlpeer/F1000-22/10-170_161 | In addressing the COVID-19 pandemic or any future public health crisis, a science-based professional response is indispensable. | |
nlpeer/F1000-22/10-170_162 | World Bank Group, Washington, DC, USA Thank you for inviting me to review this insightful manuscript. | |
nlpeer/F1000-22/10-170_163 | It comes at a very important time when discussions on lessons learned will help strengthen the health system in the short and medium term. | |
nlpeer/F1000-22/10-170_164 | The article is well written and presents results clearly and adequately. I only have three comments that could help strengthen the manuscript: | |
nlpeer/F1000-22/10-170_165 | The participants in the focus groups are primarily students, health workers or health system experts. | |
nlpeer/F1000-22/10-170_166 | I suggest the results and title of the manuscript are framed more clearly to ensure the reader understands that the views presented are not actually representative of the general public but are rather the views of the health community in Bangladesh. | |
nlpeer/F1000-22/10-170_167 | Presenting and discussing the findings in light of the representation that the participants provide of a public health and medical population is also extremely valuable and better targeted for use in system strengthening activities to come: trust and coordination with and among medical professionals probably ought to h... | |
nlpeer/F1000-22/10-170_168 | 1. | |
nlpeer/F1000-22/10-170_169 | I am not sure I understand why you have two sections in the results where you outline issues related to decision-makers. | |
nlpeer/F1000-22/10-170_170 | I suggest creating a joint section for those two subsections where you can highlight the role they played and allow the reader to foresee areas of improvement at the decision-maker level. | |
nlpeer/F1000-22/10-170_171 | I am particularly interested by policy recommendations and would encourage the authors to strengthen that section further by outlining recommendations in line with the results that are presented: what recommendations stem from the views on coordination, preparation, decision-makers, etc? | |
nlpeer/F1000-22/10-170_172 | 3. | |
nlpeer/F1000-22/10-170_173 | Is the study design appropriate and is the work technically sound? Yes | |
nlpeer/F1000-22/10-170_174 | If applicable, is the statistical analysis and its interpretation appropriate? | |
nlpeer/F1000-22/10-170_175 | Are all the source data underlying the results available to ensure full reproducibility? Yes | |
nlpeer/F1000-22/10-170_176 | Competing Interests: No competing interests were disclosed. | |
nlpeer/F1000-22/10-170_177 | Reviewer Expertise: Public health, Primary Health Care, Measurement of Quality of Care, Health Policy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined abov... | |
nlpeer/F1000-22/10-170_178 | reads as follows: "Urban educated groups' perceptions of the COVID-19 pandemic management in Bangladesh: a qualitative exploration." We have now also edited the results such that the readers can understand whose views were presented and how prevalent the sentiment was across the FGDs. | |
nlpeer/F1000-22/10-170_179 | I am not sure I understand why you have two sections in the results where you outline issues related to decision-makers. | |
nlpeer/F1000-22/10-170_180 | I suggest creating a joint section for those two subsections where you can highlight the role they played and allow the reader to foresee areas of improvement at the decision-maker level. | |
nlpeer/F1000-22/10-170_181 | Response: This study was motivated by the work of Bigdeli et al. (2020) [1]. | |
nlpeer/F1000-22/10-170_182 | In this article, the authors proposed the Health Systems Governance Framework, adapted from the World Development Report 2004. | |
nlpeer/F1000-22/10-170_183 | This framework discusses relationships between three different spheres: 1) Between the Policymakers and Providers, 2) Between Providers and the People, and 3) Between the People and the Policy-Makers. | |
nlpeer/F1000-22/10-170_184 | We mentioned this in the last paragraph of the Background section. | |
nlpeer/F1000-22/10-170_185 | We explored the public perceptions of COVID-19 pandemic management in Bangladesh by focusing on the relationships between (1) people and the decision-makers (or the larger health system governance), (2) people, and the service providers (only physicians were covered in this study), and (3) service providers and decisio... | |
nlpeer/F1000-22/10-170_186 | Aligned with the objective of the article, the three sub-sections under the Result section have been organized. | |
nlpeer/F1000-22/10-170_187 | Creating the joint section will undermine the alignment with the research objectives. | |
nlpeer/F1000-22/10-170_188 | [1] Bigdeli M, Rouffy B, Lane BD, Schmets G, Soucat A. Health systems governance: the missing links. | |
nlpeer/F1000-22/10-170_189 | BMJ Global Health. 2020 Aug 1;5(8):e002533. | |
nlpeer/F1000-22/10-170_190 | I am particularly interested by policy recommendations and would encourage the authors to strengthen that section further by outlining recommendations in line with the results that are presented: what recommendations stem from the views on coordination, preparation, decision-makers, etc? | |
nlpeer/F1000-22/10-170_191 | Response: Thank you for this suggestion. | |
nlpeer/F1000-22/10-170_192 | While reviewing the manuscript, we clearly saw the weaknesses in the Recommendations section. | |
nlpeer/F1000-22/10-170_193 | We have now revised the entire section according to the advice of the reviewer. | |
nlpeer/F1000-22/10-170_194 | Figure 1. | |
nlpeer/F1000-22/10-170_195 | COVID-19 timeline in Bangladesh. | |
nlpeer/F1000-22/10-170_196 | lockdown was terminated due to the upcoming major Muslim religious holiday-the Eid-even though the outbreak was not showing any signs of abating. | |
nlpeer/F1000-22/10-170_197 | This decision was reached despite objections from the leading public health experts. | |
nlpeer/F1000-22/10-637_0 | Pre-Notification And Personalisation Of Text Messages To Increase Questionnaire Completion In A Smoking Cessation Pregnancy Rct: An Embedded Randomised Factorial Trial [Version 2; Peer Review: 2 Approved] | |
nlpeer/F1000-22/10-637_1 | Abstract | |
nlpeer/F1000-22/10-637_2 | Background: Low completion rates of questionnaires in randomised controlled trials can compromise the reliability of the results, so ways to boost questionnaire completion are often implemented. | Abstract |
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