Community Health Services in Pabna, Bangladesh: Assessing Effectiveness and SDG Contributions

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Atiq Zaman, Rafi Hasan Siddique This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4429275/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Achieving the United Nations Sustainable Development Goals (SDGs) requires strengthening community health systems, especially in resource-limited settings. This study evaluates the effectiveness and availability of community health services in Pabna Sadar Upazila, a sub-district in northwest Bangladesh, and analyzes their contributions toward select SDG targets. Using mixed methods including a population-based survey (n=625 households), in-depth interviews with health workers (n=15) and district managers (n=5), and direct observation of community clinics (n=12), we assess service utilization, population coverage, quality of care, and alignment with SDG 3 (Good Health and Well-Being). The study finds relatively high utilization of services targeting maternal and child health, but limited provision of services addressing non-communicable diseases and the needs of the rapidly growing elderly population. Significant inequities exist in service access and quality between urban and rural areas. While making important contributions to SDG targets 3.1 (maternal mortality), 3.2 (neonatal/child mortality) and 3.7 (sexual/reproductive health services), existing community health services only partially support other critical SDG 3 targets. We identify key health systems constraints as well as promising strategies to strengthen community-based health service delivery as a pathway for further progress on the SDGs in Bangladesh and other low-income countries. Introduction The 2030 Agenda for Sustainable Development, launched by the United Nations in 2015, establishes an ambitious set of 17 Sustainable Development Goals (SDGs) for all countries to strive towards, encompassing interlinked economic, social and environmental dimensions (United Nations, 2015 ). The SDGs build upon and expand the earlier Millennium Development Goals (MDGs), with greater emphasis on promoting inclusive social development, environmental sustainability, and multi-sectoral policy coherence. Achieving the health-related SDG 3 ("Ensure healthy lives and promote well-being for all at all ages") requires comprehensive efforts spanning the prevention and control of communicable and non-communicable diseases, reduction of premature mortality, promotion of mental health, achievement of universal health coverage, and increased preparedness for health emergencies ( Nations, 2015 ) Strengthening community health systems represents a core strategy for making progress on SDG 3 and its targets, particularly in resource-limited countries where large segments of the population lack access to facility-based health services Community health workers (CHWs) and local primary care facilities serve as the frontline for healthcare delivery, providing promotive, preventive, and basic curative services while facilitating linkages to higher-level care (Perry, Zullige, & Rogers, 2014) . Investments in community health services have yielded substantial gains in maternal and child health outcomes globally, as well as increased access to family planning, immunization, control of infectious diseases like HIV/AIDS and tuberculosis, and improved health behaviors (Cometto, et al.) . By delivering low-cost, high-impact interventions that are well-accepted by communities, CHWs make important contributions to achieving universal health coverage as envisioned under SDG 3.8 . However, community health programs in many countries continue to face important challenges related to insufficient population coverage, poor integration with facility-based health services, gaps in service quality, health worker shortages and turnover, and lack of long-term sustainable financing (Cometto, et al. ). With mounting burdens of non-communicable diseases and population aging, there are also growing demands to reorient community health services beyond their traditional focus areas of maternal/child health and infectious disease control (Olu, Muneene, Bataringaya, J. E., & A., 2020) . Overcoming these constraints requires context-specific research to evaluate the effectiveness and align community health strategies with evolving population health needs. In Bangladesh, the national community health program overseen by the Ministry of Health and Family Welfare aims to deliver an Essential Service Package (ESP) through community clinics and associated community health workers ( Bangladesh, 2016 ) The ESP targets maternal, neonatal and child health; family planning; nutrition; and control of tuberculosis, malaria, and other infectious diseases. This program helped Bangladesh make substantial progress on most of the MDGs related to maternal/child mortality, immunization, and infectious disease control in the period from 1990–2015 (K. , Streatfield, & Reza, 2017 ). However, with rising life expectancy and an epidemiological transition underway, the scope of the program needs to broaden to more adequately address prevalent non-communicable diseases, mental Methods This study employed a mixed methods design to comprehensively evaluate community health services in Pabna Sadar Upazila, a rural sub-district located in northwest Bangladesh. Quantitative and qualitative data were collected concurrently and integrated during the analysis phase. For the quantitative component, a population-based household survey was conducted using a two-stage cluster sampling design. The sample was first stratified by urban/rural areas, then 30 clusters (villages/mahallas) were selected probability proportional to population size, and finally 625 households were randomly selected from the clusters. The survey collected data on household demographics, healthcare utilization patterns, out-of-pocket expenditures, health status, and satisfaction with local health services. Qualitative data were gathered through in-depth interviews with community health workers (n = 15) and district/upazila health managers (n = 5), as well as direct observation of 12 community clinics using a structured checklist to assess service availability, infrastructure, equipment, and staffing levels. The interviews explored health worker roles, service delivery processes, supervision, monitoring, and perceived facilitators/barriers to effective community healthcare provision. Additionally, we conducted a document review of policies, program guidelines, and monitoring data related to Bangladesh's community health program. Quantitative data were analyzed using descriptive statistics and regression models in Stata 15.0, while qualitative data were analyzed using content analysis methods aided by ATLAS.ti software to identify major themes and patterns. Results The household survey revealed that 77% of pregnant women received at least four antenatal care visits, and 65% of births occurred in facilities or were attended by skilled providers—relatively high coverages but still short of universal access. However, only 39% of children under 5 with acute respiratory infections or diarrhea sought treatment, indicating gaps in care-seeking for childhood illnesses. Coverage of non-communicable disease services was very low, with just 27% of adults with hypertension receiving any treatment. Marked inequities existed in healthcare utilization and effective coverage, with urban households faring substantially better than rural households across most indicators. For example, the percentage of facility-based births was 86% in urban areas versus 52% in rural areas (p < 0.01). Income and education levels were also strong determinants of access to quality care. Qualitative findings pointed to important health system constraints undermining community health service delivery. Supply-side challenges included health worker shortages (only 60% of sanctioned positions filled), high turnover, inadequate supervision, recurrent stockouts of essential medicines, and poor maintenance of water/sanitation facilities. Many community clinics lacked electricity and basic diagnostic equipment. On the demand side, low perceived quality of care and lack of trust in providers—especially informal providers without proper credentials—deterred care-seeking. Out-of-pocket costs were another barrier, as government services have many official and unofficial fees. Geographic access issues also impeded rural residents from obtaining care due to long travel distances and poor road infrastructure. Despite these limitations, the community health program was perceived as an important and trusted service delivery platform, filling critical gaps in accessible care for underserved populations. Health workers reported high levels of job satisfaction stemming from community engagement and their ability to address prevalent health needs like maternal/child health and infectious diseases like tuberculosis. Discussion Our findings indicate that community health services in Pabna make important contributions to achieving SDG targets 3.1 (reducing maternal mortality), 3.2 (ending preventable child deaths), and 3.7 (universal access to sexual/reproductive health services), but are hindered from more fully supporting other SDG 3 targets by health system constraints. Key barriers include gaps in human resources, inadequate financing and infrastructure, poor integration across levels of care, and a service package that remains too narrowly focused on select maternal/child health and infectious disease interventions. The results highlight the need to expand the scope of community-based services to better prevent and manage non-communicable diseases like cardiovascular conditions, diabetes, cancer and respiratory illnesses. With a rapidly growing elderly population, there are also increasing needs for services addressing age-related functional limitations, palliative care, and long-term care supports. Augmenting community health worker training, equipment Our study also revealed stark urban-rural inequities in access and utilization of community health services in Pabna. Such inequities hinder progress towards SDG 3's overarching goal of achieving universal health coverage and leaving no one behind. Tailored strategies are needed to enhance geographic accessibility in hard-to-reach rural areas, such as increasing the number of community clinics, deploying community-based providers for home visits, and leveraging digital health technologies like telemedicine to bridge distances. Demand-side barriers like out-of-pocket costs must also be addressed through health financing reforms that reduce household expenditures. Finally, the critical human resource shortages documented suggest an urgent need for investments in recruitment, training, and retention of community health workers and frontline staff for these facilities. Evidence-based strategies like performance-based incentives, enhanced supervision and mentoring, and creating a established career path may help motivate and sustain this vital workforce. Conclusion Community health services represent a critical yet underutilized platform for accelerating progress on the health-related SDGs in Bangladesh and other low/middle-income countries. The services assessed in Pabna contribute substantially to reproductive, maternal, and child health targets, but an expanded, more comprehensive model of community-based primary healthcare is needed. Key priorities are broadening the scope of services to address non-communicable diseases and the needs of an aging population, redressing urban-rural inequities through improved accessibility and financial protection, strengthening human resources for community health, and better integrating community and facility-based care. With strategic investments and health systems reforms, the community health model has the potential to drive greater progress across multiple SDG 3 targets, from reducing mortality and morbidity to increasing access to quality essential services to attaining universal health coverage. Community engagement, multi-sectoral collaboration, adequate financing mechanisms, and strong governance and accountability will be essential for optimizing the impact of community health services in pursuit of the 2030 Sustainable Development Agenda. Declarations Author Contribution Atiq Zaman Wrote the main manuscript text and Rafi Hasan helped collecting and sorting data Ethics Statement: This study adhered to established ethical guidelines and protocols for social science research involving human participants. Approval for all study procedures and materials was obtained from an independent ethics review (Equity in Health Ethics Committee, PUT) committee prior to data collection activities. The overarching principles of respect for persons, beneficence, and justice were upheld throughout the research process. Participant Consent Statement: For the quantitative household survey component, informed consent procedures ensured voluntary participation without coercion or undue inducement. Respondents received full information about the study's purpose, risks, benefits, confidentiality protections, and their rights as participants. Only those providing affirmative consent were enrolled. The qualitative interviews and community clinic observations followed similar consent protocols. Verbal consent was obtained from all respondents after explaining the research objectives, plans for data management, and provisions to maintain privacy and confidentiality. Participants were made aware of their ability to refuse or withdraw from the study without consequence. Ethical duties of beneficence and non-maleficence guided efforts to maximize potential benefits of the research while minimizing possible harms or risks to participants. No minors or members of other vulnerable groups were involved. Data were carefully de-identified and separated from personal identifiers to safeguard confidentiality. The study procedures and findings will be disseminated in a transparent manner adhering to ethical standards for responsible reporting of research results. No ethical conflicts of interest were present. References Bangladesh, G. o. (2016). Community Clinic Revitalization: Operational Plan. Ministry of Health and Family Welfare. Cometto, G. F., N., P.-Z., J., A., Lehmann, E. A., McPake, U., & Taylor, D. (n.d.). Managing the movement of skilled health care workers in the Pacific Region. . Human Resources for Health . K., A., Streatfield, ,. G., & Reza, M. M. (2017). Institutional readiness to support and sustain MNCH services in Bangladesh. International Journal of Health Policy and Management. Nations, U. (2015). Transforming our world: The 2030 Agenda for Sustainable Development. United Nations. Retrieved from https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf Olu, O., Muneene, D., Bataringaya, J. E., N., & A., &. S. (2020). How can we strengthen the close ties between non-communicable diseases and universal health coverage? AMA Journal of Ethics, . Perry, Zullige, & Rogers. (2014). Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annual Review of Public Health . Retrieved from . https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-032013-182354 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4429275","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308430204,"identity":"258e628e-55d9-4152-b632-48e27344bce4","order_by":0,"name":"Md. Atiq Zaman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYFCCBDACAcYHHyqAFDNzAyEtjA1QLcyGM86AKEYitEBZbNK8bWDb8GvRbU9+/uBBWZ28bvvZAxK882qj+duBWn5UbMOpxezMM8OGhHNshtvO5CUYSG47njvjMGMDY8+Z27i13EgwbEhs42HcdiDHIMFw27HcBqAWZsY2fFrSPwK1SNhvO//G4EDinGO58wlryQHZYpC4DcQ42FCTu4GgljNvCmcknEtI3nbjjTFjw7EDuRuBWg7i9cvx9A0ff5TV2W47n2P++09NXe6884cPPvhRgVsLBLDBWYfB5AEC6lG01BFWPApGwSgYBSMOAAAjSGbjQacgtwAAAABJRU5ErkJggg==","orcid":"","institution":"Pabna University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Md.","middleName":"Atiq","lastName":"Zaman","suffix":""},{"id":308430205,"identity":"ad093811-5e64-4ffd-9941-0515379e6ef9","order_by":1,"name":"Rafi Hasan Siddique","email":"","orcid":"","institution":"Pabna University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Rafi","middleName":"Hasan","lastName":"Siddique","suffix":""}],"badges":[],"createdAt":"2024-05-16 07:44:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4429275/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4429275/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58178793,"identity":"07d48b57-852e-4f0f-8a77-914f07fd863d","added_by":"auto","created_at":"2024-06-12 05:41:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":200995,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4429275/v1/6984b5f4-7405-4163-822d-10eb82442c89.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community Health Services in Pabna, Bangladesh: Assessing Effectiveness and SDG Contributions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe 2030 Agenda for Sustainable Development, launched by the United Nations in 2015, establishes an ambitious set of 17 Sustainable Development Goals (SDGs) for all countries to strive towards, encompassing interlinked economic, social and environmental dimensions (United Nations, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The SDGs build upon and expand the earlier Millennium Development Goals (MDGs), with greater emphasis on promoting inclusive social development, environmental sustainability, and multi-sectoral policy coherence. Achieving the health-related SDG 3 (\"Ensure healthy lives and promote well-being for all at all ages\") requires comprehensive efforts spanning the prevention and control of communicable and non-communicable diseases, reduction of premature mortality, promotion of mental health, achievement of universal health coverage, and increased preparedness for health emergencies \u003cb\u003e(\u003c/b\u003eNations, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eStrengthening community health systems represents a core strategy for making progress on SDG 3 and its targets, particularly in resource-limited countries where large segments of the population lack access to facility-based health services Community health workers (CHWs) and local primary care facilities serve as the frontline for healthcare delivery, providing promotive, preventive, and basic curative services while facilitating linkages to higher-level care \u003cb\u003e(Perry, Zullige, \u0026amp; Rogers, 2014)\u003c/b\u003e. Investments in community health services have yielded substantial gains in maternal and child health outcomes globally, as well as increased access to family planning, immunization, control of infectious diseases like HIV/AIDS and tuberculosis, and improved health behaviors \u003cb\u003e(Cometto, et al.)\u003c/b\u003e. By delivering low-cost, high-impact interventions that are well-accepted by communities, CHWs make important contributions to achieving universal health coverage as envisioned under SDG 3.8 .\u003c/p\u003e \u003cp\u003eHowever, community health programs in many countries continue to face important challenges related to insufficient population coverage, poor integration with facility-based health services, gaps in service quality, health worker shortages and turnover, and lack of long-term sustainable financing \u003cb\u003e(Cometto, et al.\u003c/b\u003e). With mounting burdens of non-communicable diseases and population aging, there are also growing demands to reorient community health services beyond their traditional focus areas of maternal/child health and infectious disease control \u003cb\u003e(Olu, Muneene, Bataringaya, J. E., \u0026amp; A., 2020)\u003c/b\u003e. Overcoming these constraints requires context-specific research to evaluate the effectiveness and align community health strategies with evolving population health needs.\u003c/p\u003e \u003cp\u003eIn Bangladesh, the national community health program overseen by the Ministry of Health and Family Welfare aims to deliver an Essential Service Package (ESP) through community clinics and associated community health workers \u003cb\u003e(\u003c/b\u003eBangladesh, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e\u003cb\u003e)\u003c/b\u003eThe ESP targets maternal, neonatal and child health; family planning; nutrition; and control of tuberculosis, malaria, and other infectious diseases. This program helped Bangladesh make substantial progress on most of the MDGs related to maternal/child mortality, immunization, and infectious disease control in the period from 1990\u0026ndash;2015 \u003cb\u003e(K.\u003c/b\u003e, Streatfield, \u0026amp; Reza, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e However, with rising life expectancy and an epidemiological transition underway, the scope of the program needs to broaden to more adequately address prevalent non-communicable diseases, mental\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study employed a mixed methods design to comprehensively evaluate community health services in Pabna Sadar Upazila, a rural sub-district located in northwest Bangladesh. Quantitative and qualitative data were collected concurrently and integrated during the analysis phase.\u003c/p\u003e \u003cp\u003eFor the quantitative component, a population-based household survey was conducted using a two-stage cluster sampling design. The sample was first stratified by urban/rural areas, then 30 clusters (villages/mahallas) were selected probability proportional to population size, and finally 625 households were randomly selected from the clusters. The survey collected data on household demographics, healthcare utilization patterns, out-of-pocket expenditures, health status, and satisfaction with local health services.\u003c/p\u003e \u003cp\u003eQualitative data were gathered through in-depth interviews with community health workers (n\u0026thinsp;=\u0026thinsp;15) and district/upazila health managers (n\u0026thinsp;=\u0026thinsp;5), as well as direct observation of 12 community clinics using a structured checklist to assess service availability, infrastructure, equipment, and staffing levels. The interviews explored health worker roles, service delivery processes, supervision, monitoring, and perceived facilitators/barriers to effective community healthcare provision.\u003c/p\u003e \u003cp\u003eAdditionally, we conducted a document review of policies, program guidelines, and monitoring data related to Bangladesh's community health program. Quantitative data were analyzed using descriptive statistics and regression models in Stata 15.0, while qualitative data were analyzed using content analysis methods aided by ATLAS.ti software to identify major themes and patterns.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe household survey revealed that 77% of pregnant women received at least four antenatal care visits, and 65% of births occurred in facilities or were attended by skilled providers\u0026mdash;relatively high coverages but still short of universal access. However, only 39% of children under 5 with acute respiratory infections or diarrhea sought treatment, indicating gaps in care-seeking for childhood illnesses. Coverage of non-communicable disease services was very low, with just 27% of adults with hypertension receiving any treatment.\u003c/p\u003e \u003cp\u003eMarked inequities existed in healthcare utilization and effective coverage, with urban households faring substantially better than rural households across most indicators. For example, the percentage of facility-based births was 86% in urban areas versus 52% in rural areas (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Income and education levels were also strong determinants of access to quality care.\u003c/p\u003e \u003cp\u003eQualitative findings pointed to important health system constraints undermining community health service delivery. Supply-side challenges included health worker shortages (only 60% of sanctioned positions filled), high turnover, inadequate supervision, recurrent stockouts of essential medicines, and poor maintenance of water/sanitation facilities. Many community clinics lacked electricity and basic diagnostic equipment.\u003c/p\u003e \u003cp\u003eOn the demand side, low perceived quality of care and lack of trust in providers\u0026mdash;especially informal providers without proper credentials\u0026mdash;deterred care-seeking. Out-of-pocket costs were another barrier, as government services have many official and unofficial fees. Geographic access issues also impeded rural residents from obtaining care due to long travel distances and poor road infrastructure.\u003c/p\u003e \u003cp\u003eDespite these limitations, the community health program was perceived as an important and trusted service delivery platform, filling critical gaps in accessible care for underserved populations. Health workers reported high levels of job satisfaction stemming from community engagement and their ability to address prevalent health needs like maternal/child health and infectious diseases like tuberculosis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings indicate that community health services in Pabna make important contributions to achieving SDG targets 3.1 (reducing maternal mortality), 3.2 (ending preventable child deaths), and 3.7 (universal access to sexual/reproductive health services), but are hindered from more fully supporting other SDG 3 targets by health system constraints. Key barriers include gaps in human resources, inadequate financing and infrastructure, poor integration across levels of care, and a service package that remains too narrowly focused on select maternal/child health and infectious disease interventions.\u003c/p\u003e \u003cp\u003eThe results highlight the need to expand the scope of community-based services to better prevent and manage non-communicable diseases like cardiovascular conditions, diabetes, cancer and respiratory illnesses. With a rapidly growing elderly population, there are also increasing needs for services addressing age-related functional limitations, palliative care, and long-term care supports. Augmenting community health worker training, equipment Our study also revealed stark urban-rural inequities in access and utilization of community health services in Pabna. Such inequities hinder progress towards SDG 3's overarching goal of achieving universal health coverage and leaving no one behind. Tailored strategies are needed to enhance geographic accessibility in hard-to-reach rural areas, such as increasing the number of community clinics, deploying community-based providers for home visits, and leveraging digital health technologies like telemedicine to bridge distances. Demand-side barriers like out-of-pocket costs must also be addressed through health financing reforms that reduce household expenditures.\u003c/p\u003e \u003cp\u003eFinally, the critical human resource shortages documented suggest an urgent need for investments in recruitment, training, and retention of community health workers and frontline staff for these facilities. Evidence-based strategies like performance-based incentives, enhanced supervision and mentoring, and creating a established career path may help motivate and sustain this vital workforce.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCommunity health services represent a critical yet underutilized platform for accelerating progress on the health-related SDGs in Bangladesh and other low/middle-income countries. The services assessed in Pabna contribute substantially to reproductive, maternal, and child health targets, but an expanded, more comprehensive model of community-based primary healthcare is needed. Key priorities are broadening the scope of services to address non-communicable diseases and the needs of an aging population, redressing urban-rural inequities through improved accessibility and financial protection, strengthening human resources for community health, and better integrating community and facility-based care.\u003c/p\u003e \u003cp\u003eWith strategic investments and health systems reforms, the community health model has the potential to drive greater progress across multiple SDG 3 targets, from reducing mortality and morbidity to increasing access to quality essential services to attaining universal health coverage. Community engagement, multi-sectoral collaboration, adequate financing mechanisms, and strong governance and accountability will be essential for optimizing the impact of community health services in pursuit of the 2030 Sustainable Development Agenda.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAtiq Zaman Wrote the main manuscript text and Rafi Hasan helped collecting and sorting data\u003c/p\u003e\n\u003cp\u003eEthics Statement: This study adhered to established ethical guidelines and protocols for social science research involving human participants. Approval for all study procedures and materials was obtained from an independent ethics review (Equity in Health Ethics Committee, PUT) committee prior to data collection activities. The overarching principles of respect for persons, beneficence, and justice were upheld throughout the research process. Participant Consent Statement: For the quantitative household survey component, informed consent procedures ensured voluntary participation without coercion or undue inducement. Respondents received full information about the study\u0026apos;s purpose, risks, benefits, confidentiality protections, and their rights as participants. Only those providing affirmative consent were enrolled. The qualitative interviews and community clinic observations followed similar consent protocols. Verbal consent was obtained from all respondents after explaining the research objectives, plans for data management, and provisions to maintain privacy and confidentiality. Participants were made aware of their ability to refuse or withdraw from the study without consequence. Ethical duties of beneficence and non-maleficence guided efforts to maximize potential benefits of the research while minimizing possible harms or risks to participants. No minors or members of other vulnerable groups were involved. Data were carefully de-identified and separated from personal identifiers to safeguard confidentiality. The study procedures and findings will be disseminated in a transparent manner adhering to ethical standards for responsible reporting of research results. No ethical conflicts of interest were present.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBangladesh, G. o. (2016). \u003cem\u003eCommunity Clinic Revitalization: Operational Plan. Ministry of Health and Family Welfare.\u003c/em\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCometto, G. F., N., P.-Z., J., A., Lehmann, E. A., McPake, U., \u0026amp; Taylor, D. (n.d.). Managing the movement of skilled health care workers in the Pacific Region. . \u003cem\u003eHuman Resources for Health\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eK., A., Streatfield, ,. G., \u0026amp; Reza, M. M. (2017). \u003cem\u003eInstitutional readiness to support and sustain MNCH services in Bangladesh.\u003c/em\u003e International Journal of Health Policy and Management.\u003c/li\u003e\n \u003cli\u003eNations, U. (2015). \u003cem\u003eTransforming our world: The 2030 Agenda for Sustainable Development.\u003c/em\u003e United Nations. Retrieved from https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf\u003c/li\u003e\n \u003cli\u003eOlu, O., Muneene, D., Bataringaya, J. E., N., \u0026amp; A., \u0026amp;. S. (2020). How can we strengthen the close ties between non-communicable diseases and universal health coverage? \u003cem\u003eAMA Journal of Ethics,\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003ePerry, Zullige, \u0026amp; Rogers. (2014). Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. \u003cem\u003eAnnual Review of Public Health\u003c/em\u003e. Retrieved from . https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-032013-182354\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4429275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4429275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAchieving the United Nations Sustainable Development Goals (SDGs) requires strengthening community health systems, especially in resource-limited settings. This study evaluates the effectiveness and availability of community health services in Pabna Sadar Upazila, a sub-district in northwest Bangladesh, and analyzes their contributions toward select SDG targets. Using mixed methods including a population-based survey (n=625 households), in-depth interviews with health workers (n=15) and district managers (n=5), and direct observation of community clinics (n=12), we assess service utilization, population coverage, quality of care, and alignment with SDG 3 (Good Health and Well-Being). The study finds relatively high utilization of services targeting maternal and child health, but limited provision of services addressing non-communicable diseases and the needs of the rapidly growing elderly population. Significant inequities exist in service access and quality between urban and rural areas. While making important contributions to SDG targets 3.1 (maternal mortality), 3.2 (neonatal/child mortality) and 3.7 (sexual/reproductive health services), existing community health services only partially support other critical SDG 3 targets. We identify key health systems constraints as well as promising strategies to strengthen community-based health service delivery as a pathway for further progress on the SDGs in Bangladesh and other low-income countries.\u003c/p\u003e","manuscriptTitle":"Community Health Services in Pabna, Bangladesh: Assessing Effectiveness and SDG Contributions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-12 05:33:19","doi":"10.21203/rs.3.rs-4429275/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"28199ea8-125b-4496-9db0-d53773aaafe6","owner":[],"postedDate":"June 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-12T05:33:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-12 05:33:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4429275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4429275","identity":"rs-4429275","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}