Challenges of performing essential public health functions by the physicians at leadership positions in peripheral level government health system in Bangladesh: A qualitative exploratory study

Introduction Identifying and ensuring the Essential Public Health Functions (EPHFs) is one of the core agendas of the World Health Organization to strengthen the health system of a country. The definition of EPHFs varies widely, considering country needs. In Bangladesh, the physician cadres are in the leadership position to oversee the EPHFs at the district and sub-district levels. However, there is a dearth of contextual information regarding the purview of essential EPHFs in the country. The purpose of this study was to document the perception of key stakeholders on what constitute the EPHFs at district and sub-district level and identify the challenges they face in providing the services. Methods We carried out a qualitative exploratory study consisting of document review and Key Informant Interviews (KIIs). The desk review included the organograms of the government district and sub-district level health facilities and the job description of Civil Surgeons (CSs) and Upazila Health and Family Planning Officers (UHFPOs). In addition, 15 KIIs with relevant professionals and stakeholders from the Directorate of General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW) were conducted. Collected data were analyzed thematically. Results Three major categories of EPHFs were identified: i) population-oriented preventive functions, ii) clinical preventive functions, and iii) administrative/management functions. The CSs and UHFPOs need to ensure these wide range of EPHFs at the district level and below. However, at peripheral level, the leadership positions' clinical and public health roles often get amalgamated. Therefore, ensuring public health functions are hampered. Besides, these positions need training and adequate support staff to perform the EPHFs effectively. Conclusion Recognizing the EPHFs in the Bangladesh context is crucial. Revisiting the job descriptions and strengthening appropriate public health services at different tiers in the country health system should be prioritized to achieve health-related Sustainable Development Goals.