Readiness of public health facilities to provide ischemic heart disease and stroke management for the growing elderly population in Bangladesh

The number of older people is increasing in Bangladesh, accompanied by a rise in cardiovascular diseases such as ischemic heart disease (IHD) and stroke. Consequently, the existing health system will face major challenges yet to date, no research has been conducted to assess the capacity of the health facilities to provide IHD and stroke management for the growing elderly population. This study aimed to evaluate the readiness of the healthcare system in Bangladesh to provide IHD and stroke management for the growing elderly population.

In this cross-sectional mixed-methods research, the World Health Organization’s (WHO) service availability and readiness assessment (SARA) tool was followed to assess IHD and stroke readiness of eleven selected hospitals in Bangladesh. The health system dynamics framework was used to explore service users’ and providers’ perspectives regarding IHD and stroke services. Data sets were generated by 24 in-depth interviews, four focus group discussion and 150 questionnaires. Quantitative data was analysed using descriptive and inferential statistics, while reflexive thematic analysis was used to generate themes from the qualitative components. SPSS version 28.0. and NVivo 12 software were used in the data analysis process.

Only tertiary hospitals had a readiness index (RI) score (79.18%) that exceeded cutoff value. Independent samples t test was statistically significant, t (2.30)=9 , p <.047 (two-tailed). RI score of urban hospitals was 1.44 standard deviation higher than the RI score of rural hospitals. Barriers to providing services in most of the surveyed hospitals were shortage of specialized staff, diagnostics and essential medicines. Findings from the qualitative components confirmed these outcomes while generating some important additional insights, namely that financial solvency and geriatric care, currently lacking, would support better outcome for IHD and stroke patients.

These results will inform future health care practice with regards to improving IHD and stroke services for this vulnerable population group.