Abstract

Background: Hypertension (HT) is the leading risk factor for cardiovascular diseases, yet its management remains inadequate in low-and middle-income countries like Bangladesh. As the burden of HT continues to grow, it calls for a robust and coordinated health system response. However, a comprehensive assessment of health facility preparedness for hypertension management in Bangladesh has not been conducted. This study aimed to evaluate the readiness of health facilities to manage hypertension and identify key determinants influencing this readiness.
Methods: The analysis draws on data from the 2017 Bangladesh Health Facility Survey (BHFS), a nationally representative, cross-sectional survey of health facilities. A total of 382 facilities at or above the sub-district level were included. Readiness to provide HT services was assessed using a composite index based on eight WHO SARA (Service Availability and Readiness Assessment) indicators, covering three domains: trained staff and clinical guidelines, equipment and supplies, and availability of essential medicines. A negative binomial regression model was applied to identify factors associated with service readiness, adjusting for overdispersion in the count data.
Results: Only 0.19% of facilities were fully equipped to manage hypertension, with an average readiness score of 3.72 out of 8. While basic diagnostic tools (e.g., BP apparatus, stethoscope) were available in over 94% of facilities, major deficiencies were noted in staff training (16.6%), clinical guidelines (20.5%), and availability of key antihypertensive medications such as ACE inhibitors (7.3%), thiazide diuretics (12%), and calcium channel blockers (24.6%). Multivariable analysis revealed that NGO-run facilities had higher readiness scores than their government or private counterparts. Facilities offering 24/7 provider availability (IRR=1.07, p<0.05), those with client feedback systems (IRR=1.12, p<0.05), and those with more trained staff (IRR=1.01, p<0.01) were significantly more prepared to manage HT.
Conclusion: Overall readiness to manage hypertension in Bangladesh’s health facilities is alarmingly low, largely due to a shortage of trained personnel, lack of standardized clinical protocols, and limited access to essential medications. Facility type, continuous provider availability, and systems for client feedback are key determinants of readiness. These findings underscore the need for targeted interventions to improve the health system’s capacity to deliver effective hypertension care.

Keywords:Hypertension; Health facility readiness; Bangladesh; Non-communicable diseases; Health systems strengthening