Community Clinic in Bangladesh
Establishment of Community Clinic (CC) in 1998 was a significant sector-wide reform in the Health Sector of Bangladesh, which was revitalized in 2009 with a vision to provide primary health care service to 6000 population per CC. The proposed number of Community Clinics is 18,000 of which 13,500 yet to be constructed and remaining 4,500 to be established in the existing Union and Upazila level health and family planning facilities.
Eminence mandate is to improve access to basic health care and treatment at household and community level though its programs and research. Eminence has very good experience in implementing community intervention for the past eight years. Realizing the health care demand in the remote areas of the country, Eminence extended its interventions to the hard to reach and most impoverished areas of Bangladesh. As of now, Eminence has covered all the 5 Upazilas of Panchgarh District and 10 Upazilas of Brahmanbaria and Thakurgaon Districts. In this course of Eminence’s action, Eminence has been able to reach 50,000 community people. Women, children and adolescents have been emphasized in all the ventures to understand their needs and translate the needs into service. The implementation team and project management unit visits the project areas time to time to ensure improved accountability and increased services.
EMINENCE intends to strengthen the following service that has been planned to be offered through Community Clinic by public sector staffs:
- Essential service delivery packages including ANC (during pregnancy), safe delivery and PNC (within 42 days after delivery) and referring the mother to nearest health facility including MCWC in case of emergency or/and complications;
- Vitamin A distribution among post delivery mothers (within 6 weeks after delivery) and children specially children having acute malnutrition, chronic diarrhea and measles;
- Identification of anemia and treatment for women and adolescent girls alongside providing health service and counseling to adolescent boys and girls;
- Child vaccination to the target group following Government EPI schedule (TB, Polio, Diphtheria, Whooping cough, Tetanus, Hepatitis–B, Haemophilus Influenzae–B and Measles) and TT vaccination among the women of child bearing age (15-49 years). Identification of AFP (sudden paralysis or numbness in hand/leg or any other part of the body) among children less than 15 years of age;
- Provision of Vitamin-A to children aged 1- 5 years with 6 months’ interval and identification and prevention of night blindness among children;
- Identification and treatment (as prescribed by tertiary level hospitals) of iodine deficiency disorder, anti helminthes, ARI, TB (including DOTs), Leprosy (following MDT), malaria, arsenicosis, skin diseases etc.
- Rehydrating through oral rehydration therapy and zinc tablet (in case of children) and proper referral in case of emergency. Education with demonstration how to make oral saline;
- Registering newly married and pregnant women , preserving EDD and contacting pregnant women at the time of EDD including blood grouping of the pregnant women;
- Birth and death registration;
- Community and verbal autopsy for maternal and child mortality to provide maternal and child health related nutrition information;
- Essential service for new born;
- Implantation of IUD among motivated women, provision of first dose of injectable contraceptives and discussion on side effects of birth control methods along with the assigned FWV working in UH&FWC. Provision of providing similar services by MA, SACMO with regular interval;
- Giving 2nd and 3rd dose of injectable contraceptives by FWA and HA following proper procedure;
- Strong referral system in case of emergency and/or complication;
- Counseling and referral linkage for physical, mental, neuro, autism, blind and retarded children;
- Identification and treatment of general diseases like injury, fever, pain, cutting, burn, bite, asthma, skin diseases, dental, eye and care of ear;
- Raising awareness among the people coming to clinic on healthy lifestyle, hygiene and sanitation, safe drinking water, balanced diet, prevention of diseases through vaccination, providing anti helminthes, colostrums feeding and breastfeeding, preventing diarrhea, food safety, HIV/AIDS and STD, importance of family planning and various methods, harms of tobacco and tobacco products. In addition to these, raising awareness on danger signs of pregnancy, new born care, danger signs of new born and birth planning;
- Continuous supply and distribution of temporary family planning methods like condom, pill etc;
- Identification of dropout cases of temporary family planning users, DOTs users and pregnant women not seeking ANC and PNC care and provide services to them;
- Home visit and providing home based services in spite of having community clinic in the proximity;
- Planning for normal delivery by trained personnel – in case of presence of all required equipments and proper training;
- Providing services to care givers of chronic and palliative patients and making geriatric forum and arrangement for their regular health check up and entertainment through organization of various social events;
According to the Government plan, one Community Health Care Provider (CHCP) will be appointed for each Community Clinic. The immediate supervisors of these clinics are the Union level supervisors, i.e. Health Inspectors (HIs), Assistant Health Inspectors (AHIs) and Family Planning Inspectors (FPIs) from the directorate of health and directorate of family planning respectively. The clinics will also be visited on a monthly basis by the union level service providers, e.g., Family Welfare Visitors (FWVs) and Medical Assistant (MAs)/Sub-Assistant Community Medical Officers (SACMOs) from the two directorates respectively.
ECCP activities at a glance
- Assist in sstrengthening the institutional capacity of all community clinics in proposed Districts and Upzilas through full upazila approach in phases;
- Eminence will assist RCHCIB in strengthening and management of community management groups as per approved GOB module/guideline.
- Conduct advocacy, training, research and other supplementary programs to make this program more cost effective, participatory and pro-poor.
- Eminence shall maintain close contact with concerned Districts and Upazila health and family planning officials for successful implementation of the planned activities;
- Will assist in engaging local government (UP, UZ Parisad and Pouroshava) in effective and efficient management of CCs;
- Mobilize the community groups for identifying/mapping and bringing ultra-poor to avail the health care services.
Implementation Plan of ECCP
Eminence is interested to work with the Government for strengthening the institutional capacity of the Community Clinics and also strengthening the community participation to support a sustainable primary health care system in around 1500 Community Clinic of 78 Upazilas of 11 proposed Districts in all 7 Divisions of Bangladesh throughout the project life. It would be implemented under the guidance of the RCHCIB, Ministry of Health & Family Welfare in 4 years (April 2011-June 2014) program in phases. The implementation plan is summarized in the following table with a detailed description: