Syed Masud Ahmed

• MBBS, MPH, PhD
• Managing Director at BRAC University

This series, "Primary health care in South Asia", is an effort to provide region-specific, evidence-based insights for reorienting health systems towards PHC. Led by regional thinkers, this series draws lessons from five countries in South Asia: Bangladesh, India, Nepal, Pakistan, and Sri Lanka. This is the last paper in the series that outlines po...

In the south Asian region, delivering non-communicable disease (NCD) prevention and control services through existing primary health-care (PHC) facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, y...

Absenteeism by doctors in public healthcare facilities in rural Bangladesh is a form of chronic rule-breaking and is recognised as a critical problem by the government. We explored the factors underlying this phenomenon from doctors’ perspectives. We conducted a facility-based cross-sectional survey in four government hospitals in Dhaka, Bangladesh...

Background On January 30, 2020, WHO declared COVID-19 as a Global Public Health Emergency. The first three COVID-19 cases in Bangladesh were confirmed on March 8, 2020. Thus, Bangladesh got substantial time to prepare the people and the health systems to respond to the outbreak However, neither the health ministry nor the government was found to ri...

Background There is growing interest in pharmaceutical innovation in low- and middle-income countries (LMICs), but information on existing activities, capacities, and outcomes is scarce. We mapped available data at the global level, and studied the national pharmaceutical innovation systems of Bangladesh and Colombia to shed light on pharmaceutical...

Background: Bangladesh has made substantial progress in improving socioeconomic and health indicators over the past 50 years, but data on national disease burden are scarce. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to estimate the burden of diseases and risk factors in Bangladesh from 1990 to 2019...

Objective Bangladesh is currently undergoing an epidemic of road traffic crashes (RTCs). In addition to morbidity and mortality, the economic loss from RTC as per cent of gross domestic product is comparatively higher than in countries with similar socioeconomic conditions. However, trauma care remained poorly developed as a specialty and service d...

Objective This paper aimed to identify and explore the major areas of health-sector corruption during COVID-19 pandemic as revealed in the print media. Findings are expected to mitigate health sector corruption in the country and contribute to strengthening the health systems. Method 2588 news articles on health topics were identified through scan...

Introduction: We conducted a scoping review of the trauma care situation following road traffic crashes (RTCs) in Bangladesh to inform the design of a comprehensive program for mitigating associated morbidity and mortality. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis approach to select relevant article...

Universal Health Coverage (UHC) and Global Health Security (GHS) activities encompass mitigation of risks to health and well-being rights posed by infectious disease outbreaks and facilitated by health promotion (HP) activities. This case study investigated Bangladesh's readiness and capacity to ‘prevent, detect and respond’ to such outbreaks of an...

This study explored the current situation of the National Action Plan (NAP) on Antimicrobial Resistance (AMR) implementation in Bangladesh and examined how different sectors (human, animal, and environment) addressed the AMR problem in policy and practice, as well as associated challenges and barriers to identifying policy lessons and practices. In...

Despite considerable investment by the Bangladesh government in measures to strengthen accountability and transparency, absenteeism among doctors remains a barrier to the achievement of Universal Health Coverage. Recent innovations in anti-corruption theory point to the importance of acting on the structural drivers of absenteeism and argue for app...

Introduction Responsiveness of Health Service Provider (HSP) and quality of services when provided resembles basic professional and social duties of HSP towards their clients. Because of poor responsiveness and quality of services when provided, clients lose their trust towards HSP. These factors are very important to improve relationship between H...

Objective This study explored Frontline Health Workers’ (FLWs) knowledge, attitude and practice (KAP) on COVID-19 and their lived experiences, in both their personal and work lives, at the early stage of the pandemic in Bangladesh. Design, setting and participants This was a qualitative study conducted through telephone interviews in May 2020. A t...

Background The news media play a critical role in disseminating accurate and reliable information during an outbreak like COVID-19, especially in LMICs. Studying how people react and reflect on the information provided and how it affects their trust in health systems is essential for effective risk communication. This study was undertaken to explor...

Objective: Doctor absenteeism is widespread in Bangladesh, and the perspectives of the actors involved are insufficiently understood. This paper sought to elicit preferences of doctors over aspects of jobs in rural areas in Bangladesh that can help to inform the development of packages of policy interventions that may persuade them to stay at thei...

Background: Successful epidemic preparedness and response require an understanding of social behaviour: social values, priorities and practices fundamentally shape human engagements with measures to prepare for and to prevent epidemics and antimicrobial resistance. Because of its capacity to document and evaluate health-seeking behaviors, local und...

Background: Front-line health workers (FLWs) are always at a very high risk of being infected by COVID 19 due to their close contact with patients; thus, proper protection is critical. Concerning the FLWs' safety, Bangladesh's haphazard health system preparedness response on the eve of the pandemic triggered an uncoordinated management crisis, maki...

Objective: To elicit preferences of doctors over interventions to address doctor absenteeism in rural facilities in Bangladesh, a pervasive form of corruption across the country. Methods: We conducted a discrete choice experiment with 308 doctors across four tertiary hospitals in Dhaka, Bangladesh. Four attributes of rural postings were included ba...

Nurses, short in production and inequitable in the distribution in Bangladesh, require the government’s efforts to increase enrolment in nursing education and a smooth career progression. Given the importance of an assessment of the current nursing scenario to inform the decision makers and practitioners to implement the new policies successfully,...

Infectious threats, including pandemics, require a careful understanding of local contexts and global processes. Here, the social sciences can offer important contributions.

The integration of the fields of traditional infectious diseases and social science provide a promising approach for the productive utilisation of community engagement as it relates to the mitigation of particularly situated vulnerabilities, including unequal access to vital resources. We examine here four elements surrounding these issues within e...

In 2008, Vian reported an increasing interest in understanding how corruption affects healthcare outcomes and asked what could be done to combat corruption in the health sector. Eleven years later, corruption is seen as a heterogeneous mix of activity, extensive and expensive in terms of loss of productivity, increasing inequity and costs, but with...

This study has been conducted to support the development of a new approach to anticorruption that takes the socio-economic and political context into account in the construction of novel interventions. It is a qualitative study that seeks to explore the realities of working in the Bangladesh health system, with a particular focus on the factors tha...

Objective: This study explored the illness experiences and healthcare-seeking behaviour of a cross-section of street dwellers of Dhaka City for designing a customised intervention. Design: A qualitative exploratory study of a sample of street dwellers of Dhaka City. Setting: Samples were taken from three purposively selected spots of Dhaka Cit...

Governance failures undermine efforts to achieve universal health coverage and improve health in low-and middle-income countries by decreasing efficiency and equity. Punitive measures to improve governance are largely ineffective. Social accountability strategies are perceived to enhance transparency and accountability through bottom-up approaches,...

An amendment to this paper has been published and can be accessed via the original article.

Background: The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for ‘corruption’ in the LMICs of south and south-east Asia region. ‘Corruption’ works to undermine the UHC goals of achieving equity, quality, and responsiveness including financial protecti...

Background Antimicrobial resistance (AMR) has become an emerging issue in the developing countries as well as in Bangladesh. AMR is aggravated by irrational use of antimicrobials in a largely unregulated pluralistic health system. This review presents a ‘snap shot’ of the current situation including existing policies and practices to address AMR, a...

Objective To explore healthcare providers’ perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level. Design We used a grounded theory approach involving in-depth...

Objective This study was conducted to explore how and whether, the strategic grants made by the Rockefeller Foundation (RF) in different sectors of health systems in the inception phase were able to ‘connect the dots’ for ‘generating a momentum for Universal Health Coverage (UHC)’ in the country. Design Cross-sectional descriptive study, using doc...

Background: How the informal providers deliver health services are not well understood in Bangladesh. However, their practices are often considered inappropriate and unsafe. This study attempted to fill-in this knowledge gap by exploring their perceptions about diagnosis and appropriate treatment, as well as identifying existing barriers to provide...

Background Improvement of health workers' performance is vital for the improvement of health-care service delivery, and workload management is an important factor in improving performance. This study aimed to assess the current workload and staffing need for delivering optimum health-care services in the public-sector district health system in Bang...

Introduction Global actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding of the drivers of antibiotic use from the perspective of providers and consumers. In Bangladesh, there is limited r...

Despite substantial improvements in several maternal health indicators, childbearing and birthing remain a dangerous experience for many women in Bangladesh. This study assessed the relative importance of maternal healthcare service characteristics to Bangladeshi women when choosing a health facility to deliver their babies. The study used a mixed-...

Background Bangladesh is currently faced with an emerging scenario of increased number of female physicians in the health workforce which has health system implications. For a health system to attract and retain female physicians, information is needed regarding their motivation to choose medical profession, real-life challenges encountered in home...

To ensure that the true spirit of ‘inclusion’ underlying the SDGs are translated into effective actions, detailed information on different sections of the population is needed to understand ‘who are left behind’ in the context of a particular country, including their needs and priorities for healthcare services. This study aimed to fill-in this kno...

Mental health disorders are increasingly being recognized as an important public health problem in low-income countries of Asia and Africa. For people of low-income countries, poverty is all pervasive and affects physical, as well as mental, health in various ways. Common mental disorders (CMD), such as anxiety and depression, are quite common amon...

Corruption, Provider Practice, Motivation & Health System Performance in Bangladesh,

The research is a systematic approached review. This is a first published working paper of a anti-corruption evidence (ACE) project entitled “Corruption, Provider Practice, Motivation & Health system Performance in Bangladesh".

Background: Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities - in terms of context, contents, actors, and processes. Methods: Series of group discussions between policy-makers and researchers...

Background: Indoor air pollution is a major environmental health problem affecting many developed and developing countries alike. Exposure to high levels of some pollutants, such as carbon monoxide, can even result in immediate death. This study explored the knowledge of women on indoor air pollution (IAP) and its perceived effects on women’s healt...

Responsiveness entails the social actions by health providers to meet the legitimate expectations of patients. It plays a critical role in ensuring continuity and effectiveness of care within people centered health systems. Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and...

This chapter summarizes all the information from the report by highlighting the epidemiology of NCDs in Bangladesh, current policies and programmes around NCD prevention and management while also indicating health systems gaps in addressing NCDs. The chapter recommends further health systems strengthinng around governance, finance, and capacity dev...

Indoor air pollution is a major environmental health problem affecting many developed and developing countries alike. Exposure to high levels of some pollutants, such as carbon monoxide, can even result in immediate death. This study explored the knowledge of women on indoor air pollution (IAP) and its perceived effects on women’s health in rural B...

Background The private retail drug shops market in Bangladesh is largely unregulated and unaccountable, giving rise to irrational use of drugs and high Out-of-pocket expenditure on health. These shops are served by salespersons with meagre or no formal training in dispensing. Method This facility-based cross-sectional study was undertaken to inves...

Examination of the composition of the health workforce in many low and middle-income countries (LMICs) reveals deep-seated heterogeneity that manifests in multiple ways: varying levels of official legitimacy and informality of practice; wide gradation in type of employment and behaviour (public to private) and diverse, sometimes overlapping, system...

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Objective To identify how 10 low- and middle-income countries achieved accelerated progress, ahead of comparable countries, towards meeting millennium development goals 4 and 5A to reduce child and maternal mortality. Methods We synthesized findings from multistakeholder dialogues and country policy reports conducted previously for the Success Fac...

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Methods: We used a mixed method approach using quantitative (questionnaire survey) and qualitative (key informant interviews and roundtable discussion) methods. Altogether, five public schools with 238 students and 30 private schools with 732 students were included. Statistical analyses were performed using STATA v-12. Qualitative data were analyz...

Background: The World Health Organization (WHO) recommended physician to population ratio is 23:10,000. Kenya has a physician to population ratio of 1.8:10,000 and is among 57 countries listed as having a serious shortage of health workers. Approximately 52% of physicians work in urban areas, 6% in rural and 42% in peri-urban locations. This study...

Bangladesh can duly boast of the status of “Development Puzzle”. The country sustained economic growth averaging 6.7 percent per annum over the last decade; also displayed remarkable advancement in social indicators such as reduction in incidence of poverty, infant and maternal mortality, fertility, food insecurity etc. In driving such socio-econom...

Background: The National Tuberculosis (TB) Control Programme (NTP) of Bangladesh succeeded in achieving the dual targets of 70 % case detection and 85 % treatment completion as set by the World Health Organization. However, TB prevention and control in work places remained largely an uncharted area for NTP. There is dearth of information regarding...

Background: The pharmaceutical market in Bangladesh is highly concentrated (top ten control around 70 % of the market). Due to high competition aggressive marketing strategies are adopted for greater market share, which sometimes cross limit. There is lack of data on this aspect in Bangladesh. This exploratory study aimed to fill this gap by inves...

Introduction: Retention of human resources for health (HRH), particularly physicians and nurses in rural and remote areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to develop appropriate rural retention strategies in Bangladesh. Methods: We conducted a document review, thorough search...

Bangladesh is committed to achieving universal health coverage (UHC) by 2032; to this end, the government of Bangladesh is exploring policy options to increase fiscal space for health and expand coverage while improving service quality and availability. Despite Bangladesh’s impressive strides in improving its economic and social development outcome...

There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries wi...

Malaria continues to be a serious public health problem in south and south-east Asia region. Out of 11 countries of the WHO SEARO, 10 countries including Bangladesh are malaria endemic. In 2009, BRAC Research and Evaluation Division had reported that the thirteen eastern districts of Bangladesh are highly endemic with an overall prevalence of 3.1%,...

This chapter examines the program “Challenging the Frontiers of Poverty Reduction” (CFPR) implemented by the Bangladeshi non-governmental organization BRAC. The program aimed to lift participants out of extreme poverty within 2 years and facilitate their entry into mainstream development programs. To achieve this, the program combined interventions...

Background: BRAC (formerly Bangladesh Rural Advancement Committee), in collaboration with the National Tuberculosis Control Programme, provides one full-day training on TB to make informal allopathic providers knowledgeable for managing TB in rural Bangladesh. This study explored the knowledge and practices of the providers receiving the above tra...

Since 2007, BRAC has been implementing malaria prevention and control programme in 13 endemic districts of Bangladesh under the National Malaria Control Programme. This study was done to examine the role of different communication media in bringing about changes in knowledge and awareness which facilitate informed decision-making for managing malar...

How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly plura...

Settings: All sputum microscopy laboratories under the BRAC Tuberculosis Programme in Dhaka City. Objectives: To study the nutritional status of tuberculosis (TB) patients attending microscopy laboratories during convalescence following DOTS. Design: The study included 1068 TB patients registered for treatment at 10 laboratories from May 2010...

A major challenge for the research community is to take knowledge or evidence generated from research to the practitioners for translation into tangible practice. This paper describes how an indigenous Bangladeshi NGO addressed this challenge and made use of research in developing two of its most successful projects - the oral therapy extension pro...

In Bangladesh, the National Drug Policy (NDP) 1982 was instrumental in improving the supply of essential drugs of quality at an affordable price, especially in the early years. However, over time, evidence showed that the situation deteriorated in terms of both availability of essential drugs and their rational use. The study examined the current s...