Capacity, Key Accomplishments and Situational Analysis for NCDs in South Asian Countries(cont...)

The public sector primary care system offers an essential services package. However, NCD prevention and treatment services are not included and health workers are not trained in NCD treatment. Most people, including the poor, use private practitioners for first-line clinical care.

Clinical treatment is also sought from the informal sector and through pharmacies, both licensed and unlicensed. Diabetes, stroke, heart diseases, and their symptoms are routinely considered appropriate for treatment outside the formal health care system.NCD treatment mostly
comes at the tertiary level where there is a long tradition of specialty hospital and foundations in both public and private/NGO sectors that provide individual-based clinical treatment for NCDs, with less focus on preventive clinical care.

A public–private Health Care Development Project is being undertaken by the Diabetic Association of Bangladesh to test a model of integrated care service delivery for NCDs in urban and rural areas. The integrated care in this project is the spectrum of services—not just diabetes care—and includes primary, secondary and, through referrals, tertiary care.

There is a low supply of health workers and few are trained in NCD prevention and management. The Diabetic Association of Bangladesh and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) opened the Bangladesh Institute for Health Sciences Academy to produce adequate qualified human resources for all medical institutions in the country.

The National Institute of Cardiovascular Disease offers postgraduate courses on cardiology and training of nurses and paramedics for CVD. The National Institute of Diseases of Chest & Hospital offers postgraduate training on chest disease (medical and surgical).

Bangladesh has a national essential drugs policy and a list of essential drugs to be procured and

used in the public health services system. Most of the essential drugs are generics. At present,

drugs for treating NCDs are not included in the essential drug list.