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Govt sits on community clinic launch

Naimul Haq
The government is yet to decide about the launch of over 11,000 community clinics (CCs) at union level across the country despite its success in operating and managing a number of CCs for providing basic healthcare services as test cases.
Policy makers, stakeholders and beneficiaries agree that the CCs should be put into operation immediately in view of their effective functioning in collaboration with private sector or non government organisations, sources said.
Over 11,000 CCs built since 1999 at a cost of around Tk 2.25 lakh each under the previous five-
year Health and Population Sector Programme (HPSP) still remain non-functional. They were intended to provide a range of essential healthcare and family planning (FP) services including reproductive healthcare and child healthcare.
The government's Programme Implementation Plan (PIP) prepared by the Planning Wing of the Health Ministry in January 2004 under the on-going Health, Nutrition, Population Sector Programme (HNPSP) said, "In the efforts of building and running so-called CCs, scarce resources have been spread thinly and in many places misused in the name of building prototype uniform struc-
tures."
But the PIP recognised public-private/NGO partnership in delivering basic primary healthcare services and said, "effective partnerships between the public and the private/NGOs sectors have shown considerable positive results that need to be harnessed and promoted in HNPSP".
Acknowledging the contributions of public-private/NGOs partnership (PPP), the health ministry contracted and commissioned a number of NGOs under a Joint Implementation Committee (JIC) that monitored and supervised NGO activities in running some selected CCs mostly in remote areas.
A total of 73 CCs were commissioned to provide Essential Services Package (ESP) particularly for the hardcore poor and most vulnerable population.
Five NGOs (Brac, TMSS, PAPAN, DUS and JAKAS) were partners in the PPP for running 43 CCs under DFID and NICARE funding and the rest 30 CCs were run by PLAN, NSDP and BPHC/PHD partner NGOs under projects funded by CIDA and other development partners.
The health ministry appreciated the PPP approach to run the CCs at the final dissemination workshop and launch of NGO network for the PPP in December 2004.
Earlier, a national workshop report titled 'Community clinics and community mobilisation for ESP delivery' prepared in May 1999 praised primary healthcare delivery from the CCs by village health volunteers (VHV) under thana functional improvement pilot project (TFIPP). A remarkable increase of patient attendance was observed in CC approach, it said.
The CCs were built to serve an estimated 6,000 people in every union with the aim of replacing traditional home visits by FP workers and weekly satellite clinics so as to provide both healthcare and FP services under a single roof termed, 'one-stop-shopping'.
But the government is now going for more piloting on the use of CCs by NGOs or private sector, which some policy makers term unnecessary, sources said.
"Lessons learnt from operating 43 CCs showed PPP approach is practical and feasible since local community involvement gives some sort of ownership to the beneficiaries," said Dr Md Azam Ali, Team Leader of Northern Ireland Centre for Health Care Cooperation and Development, NICARE.
"If the government ignores ownership of local people in operating the CCs, it would not work effectively. So, the idea of local level ownership of the CCs would eventually lead to accountability and quality services," said Habibul Hasan Siddique, Director Programme of Thengamara Mohila Sabuj Sangha (TMSS).
When contacted, Health Secretary A F M Sarwar Kamal said the government is considering commissioning private bodies or NGOs to run CCs through Management Support Agency (MSA) which will, in turn, contact, finance and monitor NGOs and private sector providers of health services.
"We hope to begin contracting out initially 350 CCs to NGOs within three to four months. The piloting would last up to 36 months and a technical team (TA) will be appointed to undertake the development, management, coordination, monitoring and evaluation of the CCs programmes."
The CCs were built by the Construction, Maintenance and Management Unit (CMMU) and the Local Government-Engineering Department (LGED) during fiscal 1999-2001 on land donated by people roughly at the centre of each union to facilitate easy access.