Healthcare access in spatial inequalities and disasters: A case study of Nijhum Dwip, a remote island in Bangladesh

This research presents a case study on the health and healthcare access of residents living in a remote island, Nijhum Dwip of Bangladesh. The study used multi-strategy research methodology and applied various methods: household survey, FGD, KII and observation to collect data from 10 villages of the Nijhum Dwip. Data analysis suggests that inhabitant's healthcare access is in poor condition, and this situation gets worse during cyclones. The majority of Nijhum Dwip residents (70.4%) purchase medicines from the drug stores (70.4%) without visiting a doctor. Just 25.5% of the residents accesses government or private healthcare facilities, and 4.1 % of them visit Kabiraj. Majority of the child deliveries occur at home with the presence of unskilled midwives (84.7%).The major reasons which work behind this scenario are lack of healthcare facility, high travel cost due to poor communication networks and poverty. In Nijhum Dwip, 79.4% of the population lives below the poverty line, making it difficult for them to pay for medical care (which costs more that 13 USD) and expensive travel (each trip costs more than 26 USD). During the emergency periods, the severity of these problems increases. Only 66.3% of the residents mentioned that they can obtain any medical care during cyclones, of those only 18.1 % visit healthcare centre and 81.9% purchase medications. However, 33% of the resident is left without access to medical care or medications for their injuries or illness in times of calamity. The study identifies two major influencing factors of healthcare access in Nijhum Dwip: spatial inequalities and disasters, both of which require specific attention to improve inhabitants' health and wellbeing and to reach the Sustainable Development Goals 3 and 10 by 2030.