Challenges in dengue referral system at Savar Upazila Health Complex, Dhaka: a mixed method study

Abstract

Background: Dengue-endemic regions are home to up to 3.6 billion individuals, or 40% of the global population (CDC, 2024). In Bangladesh, 327 deaths were attributed to Dengue fever between January and August 2023, resulting in a case fatality rate of 0.47% (WHO, 2023). Bangladesh continues to face challenges in the Healthcare system, which has affected the referral process of patients seeking timely healthcare services in tertiary hospitals. This study aims to identify the barriers in the referral process for dengue management in primary healthcare settings in Bangladesh. Methods: Savar Upazila Health Complex (UHC) was used as the study site. The study employed a mixed method concurrent study design, the qualitative approach was used to identify the barriers affecting the referral system for dengue management by exploring experiences and perceptions shared by healthcare professionals. The quantitative approach was used to assess the level of satisfaction by dengue patients in selected domains including the referral process, communication, and quality of care throughout the referral. Results: The study identified health system barriers that disrupt the referral process for dengue patients in accessing higher medical care in tertiary hospitals. Some health system-related factors that negatively affect the timely referral include a shortage of ambulances, lack of feedback system, shortage of skilled healthcare professionals and inadequate infrastructure. Furthermore, the study found that, of the 36 referred patients (n=36), 13.89% are dissatisfied with the overall referral process, 25.00% are dissatisfied with the overall communication between UHC and the hospital and 16.67% are dissatisfied with the quality of care offered throughout the referral process. What’s more is that 16.67% of the 36 patients reported experiencing form of delay during their referral, solely the main delay is the shortage of ambulances which is a transport-related challenge clearly revealed by the healthcare professionals. Conclusion: It is recommended that the Ministry of Health and Family Welfare (MoHFW) must develop a referral management policy and a standard medical referral guideline for all healthcare facilities in Bangladesh. The MoHFW should also engage with international partners to initiate infrastructure development and increase annual budgetary allocation for address the current resources constraint faced at primary healthcare facilities. All in all, these policy changes and program implementation will strengthen the dengue referral system in Bangladesh.