Pandemic lessons on essential healthcare services for the urban poor: a qualitative perspective of users and providers in Bangladesh

Objective: The COVID-19 pandemic imposed unprecedented challenges to health systems globally. This study explored slum dwellers' experience of receiving essential health services during the pandemic and the challenges faced by healthcare providers in urban areas of Bangladesh.

Design: The study followed a cross-sectional study design using qualitative methods.

Setting: The study was conducted in Dhaka and Gazipur City Corporations during November 2020-February 2021.

Participants: 17 key informant interviews were carried out with healthcare providers and policy-makers and 22 in-depth interviews were carried out with slum dwellers. Thematic analysis was performed.

Results: The study identified challenges to the provision of essential healthcare in selected areas of Dhaka and Gazipur City Corporations during the COVID-19 pandemic. The lack of information on the availability of functional healthcare facilities, fear of contracting COVID-19 and restrictions on movement and transportation, resulted in delays in seeking essential healthcare during a pandemic. Access to healthcare facilities was further hindered by various hospitals' decision to refuse care to general patients without valid, negative COVID-19 test results. Healthcare providers identified patients' tendency to hide COVID-19 symptoms as a barrier to providing healthcare services to general patients. Conversely, patients concealed their symptoms to avoid COVID-19 tests and gain access to required treatment. In addition, the reallocation of human resources for COVID-19 treatment disrupted the delivery of essential health services.

Conclusion: The pandemic affected the accessibility of the slum population to essential healthcare and disrupted health service delivery. The findings of the study have highlighted gaps in the health system during an emergency response period like COVID-19. The study will assist the government and other stakeholders in designing tailored interventions and allocating resources in a more efficient manner to ensure universal health coverage in the face of health emergencies.