Resource allocation and system efficiency in dengue management: a mixed methods study at Savar Upazila Health Complex

Abstract

Introduction: Dengue fever, a mosquito-borne disease, is a significant public health issue in Bangladesh, with outbreaks exacerbated by urban density, inadequate resources, and seasonal patterns. The country reported over 203,000 cases and 989 deaths in 2023, with rising hospitalizations and fatalities in 2024. Challenges include ICU shortages, insufficient diagnostic tools, and economic impacts. Despite national protocols for dengue management, gaps in adherence at primary healthcare facilities hinder effective response, necessitating focused research and interventions. Method: This study utilized a concurrent mixed-method design at the Savar Upazila Health Complex, combining an observation checklist, supply chain mapping, and qualitative interviews with 12 healthcare providers. The checklist assessed facility resources and dengue management practices, while supply chain mapping identified bottlenecks in resource flow. Interviews explored challenges in protocol adherence, resource limitations, and patient care. Data analysis integrated thematic and quantitative methods, revealing critical deficiencies. Ethical considerations ensured confidentiality, informed consent, and minimal disruption at the UHC. Findings: The health complex has 50 beds but struggles to accommodate dengue patients during peak seasons, often using floor spaces due to overcrowding. Inadequate isolation facilities increase cross-contamination risks. Staff shortages, particularly nurses and health assistants, compromise care quality, though training on dengue protocols exists. Essential supplies, such as diagnostic kits and PPE, face frequent shortages due to inefficiencies in the government-led supply chain. While IV fluids and medicines are generally available, mosquito repellents and equipment are inconsistent. Proactive measures, like sanitation and mosquito control, are limited by resource constraints. Improved infrastructure, staffing, training, and supply chain management are critical for effective dengue care. Conclusion: Resource constraints, staffing shortages, and inefficient procurement hinder dengue management at Savar Upazila Health Complex, compromising patient care. Addressing these challenges requires a comprehensive national policy, intersectoral coordination, and increased funding. Integrating dengue management into broader public health frameworks is essential to improve system capacity and ensure sustained preparedness.