Trust in the Bangladeshi health system during the COVID-19 pandemic: A mixed-methods exploration

Main Article Content

Taufique Joarder
Muhammad Nahian Bin Khaled
Md. Shamsul Arefin
Shahaduz Zaman

Abstract

Lack of trust in public health institutions hinders pandemic management. Our aim was to determine levels of impersonal and interpersonal trust in the context of coronavirus disease 2019 (COVID-19) pandemic response in Bangladesh. As this mixed-methods research was conducted during the pandemic, data was gathered via an online survey involving 508 respondents, along with seven online focus group discussions with 50 purposively selected participants. Survey respondents have less trust in the health system than in the service providers. The lowest level of trust was observed in the Fairness content area of trust. While some non-clinical participants blamed doctors for shying away from caregiving during the pandemic, most praised them for providing care, risking their lives, and even sacrificing their lives in the process. Several participants also cited a lack of fairness in pandemic management, such as visible attempts by the decision-makers to protect the business interests without consideration for the safety of the poor. However, both clinicians and non-clinicians concurred on the need for the service providers to improve communication related to COVID-19 management. Health sector stewards in Bangladesh should take a science-based, equity-focused pandemic response to gain both impersonal and interpersonal trust and build a resilient health system in the long run.

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Article Details

Section
Original Articles
Author Biographies

Taufique Joarder, Public Health Foundation, Bangladesh, Dhaka, Bangladesh

Public Health Foundation, Bangladesh, Dhaka, Bangladesh

Muhammad Nahian Bin Khaled, International Food Policy Research Institute, Dhaka, Bangladesh

International Food Policy Research Institute, Dhaka, Bangladesh

Md. Shamsul Arefin, Patiya Upazila Health Complex, Ministry of Health and Family Welfare, Government of Bangladesh

Patiya Upazila Health Complex, Ministry of Health and Family Welfare, Government of Bangladesh

Shahaduz Zaman, Brighton and Sussex Medical School, University of Sussex, Sussex, UK

Brighton and Sussex Medical School, University of Sussex, Sussex, UK

References

Alexopoulos AN, Buckley F. What Trust Matters When: The Temporal Value of Professional and Personal Trust for Effective Knowledge Transfer. Group & Organization Management 2013;38(3): 361-91.

Ye M, Lyu Z. Trust, risk perception, and COVID-19 infections: Evidence from multilevel analyses of combined original dataset in China. Soc Sci Med 2020;265: 113517.

Siegrist M. Trust and risk perception: A critical review of the literature. Risk Anal. 2021;41(3): 480-90.

Inglehart R. Modernization and postmodernization: Cultural, economic, and political change in 43 societies: Princeton university press; 2020.

Putnam RD. Bowling Alone: America's Declining Social Capital. J Democr. 1995;6(1): 65-78.

Earle TC, Cvetkovich G. Social trust: Toward a cosmopolitan society: Greenwood Publishing Group; 1995.

Mechanic D. Changing medical organization and the erosion of trust. Milbank Q. 1996: 171-89.

Coleman JS. Foundations of social theory. Cambridge, MA: Harvard university press; 1994.

Fukuyama F. Trust: The social virtues and the creation of prosperity: Free press New York; 1995.

Calnan M, Rowe R. Trust Matters In Health Care: McGraw. Hill Education; 2008.

Kane S, Calnan M, Radkar A. Trust and trust relations from the providers’ perspective: the case of the healthcare system in India. Indian J Med Ethics. 2015;12(3):157-68.

Kittelsen SK, Keating VC. Rational trust in resilient health systems. Health Policy Plan. 2019;34(7): 553-7.

Gilson L. Trust and the development of health care as a social institution. Soc Sci Med. 2003;56: 1453-68.

Robertson D. The Routledge Dictionary of Politics: Taylor & Francis 2004.

Abelson J, Miller FA, Giacomini M. What does it mean to trust a health system? A qualitative study of Canadian health care values. Health Policy. 2009;91(1): 63-70.

Gilson L. Trust in health care: theoretical perspectives and research needs. J Health Organ Manag. 2006;20: 359-75.

Platt JE, Jacobson PD, Kardia SLR. Public Trust in Health Information Sharing: A Measure of System Trust. BioMed Central. 2018;53: 824-45.

Ozawa S, Sripad P. How do you measure trust in the health system? A systematic review of the literature. Soc Sci Med. 2013;91: 10-4.

Sripad P, Ozawa S, Merritt MW, Jennings L, Kerrigan D, Ndwiga C, et al. Exploring Meaning and Types of Trust in Maternity Care in Peri-Urban Kenya: A Qualitative Cross-Perspective Analysis. Qual Health Res. 2018;28: 305-20.

Huq S, Biswas RK. COVID-19 in Bangladesh: Data deficiency to delayed decision. J Glob Health. 2020;10:1-3.

Rockers PC, Kruk ME, Laugesen MJ. Perceptions of the Health System and Public Trust in Government in Low- and Middle- Income Countries: Evidence from the World Health Surveys. Psychol. Public Policy, Law. 2012;38: 406-37.

Department for International Development. Principles of Health Systems Resilience in the Context of Covid-19 Response. UK: Department for International Development; 2020.

The Joint United Nations Programme on HIV and AIDS. Rights in the time of COVID-19: Lessons from HIV for an effective, community-led response. 2020.

Biswas RKH, Samin, Aman A. Relaxed Lockdown in Bangladesh During COVID-19: Should Economy Outweigh Health?. J. Health Policy Manag. 2020.

Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. LancetGlob Health. 2020: 1-8.

Ramalingam B, Wild L, Ferrari M. Adaptive leadership in the coronavirus response: Bridging science, policy and practice. London: ODI; 2020.

Joarder T, Osman FA. Bangladesh’s Health Improvement Strategy as an Example of the Alma-Ata Declaration in Action. In: Bishai D, Schleiff M, editors. Achieving Health for All: Primary Health Care in Action. 1st ed. Baltimore, Maryland: Johns Hopkins University Press; 2020. p. 153-79.

Koehlmoos TP, Islam Z, Anwar S, Hossain SAS, Gazi R, Streatfield PK, et al. Health transcends poverty: the Bangladesh experience. "Good health at low cost” 25 years on: What makes a successful health system? London: London School of Hygiene and Tropical Medicine; 2011. p. 47-81.

The World Bank. World Bank Open Data [Internet]. 2021 [cited 2021 6 April]. Available from: https://data.worldbank.org/.

Chowdhury AM, Bhuiya A, Chowdhury ME, Rasheed S, Hussain Z, Chen LC. The Bangladesh paradox: exceptional health achievement despite economic poverty. Lancet 2013;382(9906): 1734-45.

Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Macdonald B, et al. Coronavirus (COVID-19) Testing [Internet]. 2021 [cited 2021 6 April]. Available from: https://ourworldindata. org/coronavirus-testing.

Worldometers.info. Worldometers Dover, Delaware, U.S.A.: Worldometers [Internet]. 2021 [updated 6 April 2021; cited 2021 6 April]. Available from: https://www.worldometers.info/coronavirus/.

Kavanagh MM, Singh R. Democracy, Capacity, and Coercion in Pandemic Response: COVID-19 in Comparative Political Perspective. J Health Polit Policy Law. 2020;45(6): 997-1012.

Shamasunder S, Holmes SM, Goronga T, Carrasco H, Katz E, Frankfurter R, et al. COVID-19 reveals weak health systems by design: why we must re-make global health in this historic moment. Glob Public Health. 2020;15(7): 1083-9.

Ibrahim MD, Binofai FA, MM Alshamsi R. Pandemic response management framework based on efficiency of COVID-19 control and treatment. Future Virol. 2020;15(12): 801-16.

Mechanic D. Changing Medical Organization and the Erosion of Trust. The Milbank Quarterly 1996;74:171-89.

Creswell JW, Clark VLP. Designing and Conducting Mixed Methods Research. 2nd ed: SAGE; 2011.

Schonlau M. Stata Software Package, Hotdeckvar.pkg, for Hotdeck Imputation [Internet]. 2006 Available from: http://www.schonlau.net/stata.

Hsieh H, Shannon S. Three approaches to qualitative content analysis. Qual Health Research. 2005;15: 1277-88.

Taber KS. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res. Sci. Technol. Educ. 2018;48(6): 1273-96.

Shorey S, Ang E, Yamina A, Tam C. Perceptions of public on the COVID-19 outbreak in Singapore: a qualitative content analysis. J Public Health. 2020.

Elgar FJ, Stefaniak A, Wohl MJ. The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries. Soc Sci Med. 2020;263: 113365.

Bollyky TJ, Crosby S, Kiernan S. Fighting a Pandemic Requires Trust: Governments Have to Earn It. Foreign Affairs; 2020.

Han Q, Zheng B, Cristea M, Agostini M, Belanger JJ, Gutzkow B, et al. Trust in government regarding COVID-19 and its associations with preventive health behaviour and prosocial behaviour during the pandemic: a cross-sectional and longitudinal study. Psychol Med. 2021: 1-32.

Rohwerder B. Social impacts and responses related to COVID-19 in low- and middle-income countries. Brighton, UK: Institute of Development Studies; 2020.

Winskill P, Whittaker C, Walker PG, Watson O, Laydon D, editors. Report 22: Equity in response to the COVID-19 pandemic: an assessment of the direct and indirect impacts on disadvantaged and vulnerable populations in low-and lower middle-income countries. Imperial College London; 2020: Imperial College London.

Bangladesh sees 100th death of doctors from Covid-19. Dhaka Tribune; 2020 48.

Joarder T. How can our doctors be more responsive in the time of Covid-19 pandemic?. The Business Standard; 2020.

Joarder T, George A, Sarker M, Ahmed S, Peters DH. Who are more responsive? Mixed-methods comparison of public and private sector physicians in rural Bangladesh. Health Policy and Planning; 2017.

Zaman S. Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh. Soc Sci Med. 2004;59(10): 2025-36.

Andaleeb SS, Siddiqui N, Khandakar S. Patient satisfaction with health services in Bangladesh. Health policy and planning 2007;22(4):263-73.

Hasan MI, Hassan MZ, Bulbul MMI, Joarder T, Chisti MJ. Iceberg of workplace violence in health sector of Bangladesh. BMC Res Notes. 2018;11(1): 702.

Sakthivel P, Rajeshwari M, Malhotra N, Ish P. Violence against doctors: an emerging epidemic amidst COVID-19 pandemic in India. Postgrad Med J. 2020;2020-138925.

Lewis J, Ritchie J, Ormston R, Morrell G. Generalizing from qualitative research. In: Richie J, Lewis J, Nicholls CM, Ormston R, editors. Qualitative Research Practice: A Guide for Social Science Students and Researchers. 2 ed: SAGE Publications; 2013. p. 347.

Rajan D, Koch K, Rohrer K, Bajnoczki C, Socha A, Voss M, et al. Governance of the Covid-19 response: a call for more inclusive and transparent decision-making. BMJ Glob Health. 2020;5(5): e002655.

Weible CM, Nohrstedt D, Cairney P, Carter DP, Crow DA, Durnová AP, et al. COVID-19 and the policy sciences: initial reactions and perspectives. Policy Sci. 2020;53(2): 225-41.

Baum F, Freeman T, Musolino C, Abramovitz M, De Ceukelaire W, Flavel J, et al. Explaining covid-19 performance: what factors might predict national responses?. BMJ 2021; 372.

Saechang O, Yu J, Li Y. Public Trust and Policy Compliance during the COVID-19 Pandemic: The Role of Professional Trust. Healthcare 2021;9(2):151.

Helliwell JF, Huang H, Wang S, Norton M. World Happiness, Trust and Deaths under COVID-19. In: Helliwell JF, Layard R, Sachs JD, De Neve J-E, Aknin L, Wang S, et al., editors. World Happiness Report 2021. New York: Sustainable Development Solutions Network; 2021. p. 13-56.

Henderson J, Ward PR, Tonkin E, Meyer SB, Pillen H, McCullum D, et al. Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares? Public Health Front. 2020;8(369).

Falcone R, Colì E, Felletti S, Sapienza A, Castelfranchi C, Paglieri F. All We Need Is Trust: How the COVID-19 Outbreak Reconfigured Trust in Italian Front. Psychol. 2020;11(2585).

Gopichandran V, Subramaniam S, Kalsingh MJ. COVID-19 pandemic: a litmus test of trust in the health system. Asian Bioeth Rev. 2020;12: 213-21.

Kye B, Hwang S-J. Social trust in the midst of pandemic crisis: Implications from COVID-19 of South Korea. Res Soc Stratif Mobil. 2020;68: 100523.

Min J. Does social trust slow down or speed up the transmission of COVID-19?. PLOS ONE 2020;15(12):e0244273.

Collins T, Akselrod S, Bloomfield A, Gamkrelidze A, Jakab Z, Placella E. Rethinking the COVID-19 Pandemic: Back to Public Health. Ann Glob Health 2020;86(1).

Loewenson R, Accoe K, Bajpai N, Buse K, Abi Deivanayagam T, London L, et al. Reclaiming comprehensive public health. BMJ Glob Health. 2020;5(9): e003886.

Joarder T, Rawal LB, Ahmed SM, Uddin A, Evans TG. Retaining doctors in rural Bangladesh: A policy analysis. Int J Health Policy Manag. 2018;7: 847-58.

Strict lockdown from April 14. The Daily Star; 2021.

Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. 2020;74(11): 964-8.

Ismail SJ, Tunis MC, Zhao L, Quach C. Navigating inequities: a roadmap out of the pandemic. BMJ Globg Health. 2021;6(1):e004087.

Franchini AF, Auxilia F, Galimberti PM, Piga MA, Castaldi S, Porro A. Covid 19 and spanish flu pandemics: All it changes, nothing changes. Acta Biomedica 2020;91:245-50.

Morens DM, Daszak P, Markel H, Taubenberger JK. Pandemic covid-19 joins history’s pandemic legion. mBio 2020;11:1-9.

Liu Y-c, Kuo R-l, Shih S-r. The first documented coronavirus pandemic in history. Biomedical J. 2020:1-6.

Maude RR, Ghose A, Samad R, Jong HKD, Fukushima M, Wijedoru L, et al. A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital , Bangladesh. BMC Infect. Dis. 2016:1-8.

Rahim MA, Uddin KN. Chikungunya: an emerging viral infection with varied clinical presentations in Bangladesh: Reports of seven cases. BMC Res Notes. 2017;1:1-5.

Rahman M, Hossain M, Sultana S, Homaira N, Khan SU, Rahman M, et al. Date palm sap linked to Nipah virus outbreak in Bangladesh 2008. Vector Borne Zoonotic Dis. 2012;12: 65-72.

Sharmin S, Viennet E, Glass K, Harley D. The emergence of dengue in Bangladesh: epidemiology, challenges and future disease risk. Trans R Soc Trop Med Hyg. 2015;109: 619-27.

Mutsuddy P, Jhora ST, Shamsuzzaman AKM, Kaisar SMG, Khan MNA. Dengue Situation in Bangladesh: An Epidemiological Shift in terms of Morbidity and Mortality. Can J Infect Dis Med Microbiol. 2019;2019: 3516284.

Sriram V, Sheikh K, Soucat A. Addressing Governance Challenges and Capacities in Ministries of Health. Geneva: World Health Organization, UHC Partnership, Alliance for Health Policy and Systems Research, Collaborative HSG; Report No.: 9789240005419; 2020.