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BackgroundLack of trust in public health institutions hinders care-seeking and limits community support for contact tracing, information and communication uptake, and multi-sectoral or multi-stakeholder engagement. In light of these understandings, our aim was to determine levels of impersonal and interpersonal trust in the context of COVID-19 pandemic response in Bangladesh.MethodsAs 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 in which 50 purposively selected male and female clinicians and non-clinicians took part. Quantitative data was subjected to descriptive and comparative analysis, whereas content analysis was applied to the qualitative data.ResultsSurvey respondents have less trust in the health system (a mean score of 3.77/10) than in the service providers (4.95/10). In the context of impersonal trust, the lowest level of trust is observed in the Fairness domain (3.12/10), followed by the Confidence domain (3.38/10). In the context of interpersonal trust, the lowest level of trust is observed in the Fairness domain (3.81/10), followed by the Communication domain (4.83/10). While some non-clinical participants blamed doctors for shying away from caregiving during the early days of the pandemic, most praised them for providing care, risking their life due to the shortage of PPE, and even sacrificing their life in the process. Several participants also cited lack of fairness in pandemic management, such as imposing lockdown in periphery areas of the country without arranging transport for those requiring medical help to the centrally located modern health facilities, and visible attempts by the political 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.ConclusionsHealth sector stewards in Bangladesh should learn the lessons from other countries, ensure multi-sectoral engagement involving the community and political forces, and empower public health experts to organize and consolidate a concerted health system effort in gaining trust in the short term while striving to build a resilient and responsive health system in the long term. |
