Health systems trust in the time of Covid-19 pandemic in Bangladesh: A qualitative exploration

Joarder, T.; Bin Khaled, M. N.; Zaman, S.

Background: Lack of trust hinders care seeking, and limits community support for contact tracing, care seeking, information and communication uptake, multisectoral or multi-stakeholder engagement, and community participation. We aimed at exploring how trust might be breached and what implications this may have in COVID-19 pandemic response by the Bangladesh health systems. Methods: We conducted this qualitative research during the pandemic, through seven online focus group discussions, with purposively selected mixed-gender groups of clinicians and non-clinicians (n=50). Data were analyzed through conventional content analysis method. Results: The common thread throughout the findings was the pervasive mistrust of the people in Bangladeshi health systems in its management of COVID-19 pandemic. In addition to the existing health systems weaknesses, few others became evident throughout the progression of the pandemic, namely, the lack of coordination challenges during the preparatory phase as well as the advanced stages of the pandemic. This; compounded by the health systems and political leadership failures, lead to opportunistic corruption and lack of regulations; leading to low quality, discriminatory, or no service at all. These have trust implications, manifested in health seeking from unqualified providers, non-adherence to health advice, tension between the service seekers and providers, disapproval of the governance mechanism, misuse of already scarce resources, disinterest in community participation, and eventually loss of life and economy. Conclusions: Health sector stewards should learn the lessons from other countries, ensure multisectoral engagement involving the community and political forces, and empower the public health experts to organize and consolidate a concerted health systems effort in gaining trust in the short run, and building a resilient and responsive health system in the long.