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Basic medicare banks on community clinics

Staff Correspondent
Health experts at a roundtable welcomed the Awami League govern-mbnt’s move to make the community clinics functional. saying that the pro ject on community clinics will help ensure basic health services for the grassroots people.
The Daily Star and I lealth 2 k a platform for health rights group, organised the rcAindtable titled "Community Clinics: Effect on our Health Services" on September 12 at The Daily Star conference room.
The previous Awami League government started setting up community clinics for every 6,000 people in rural areas in 1998. About 11,500 such clinics were established till 2001. But those remained non functional since then. Now the present government has taken initiative to set up another 6,500 clinics and make the existing ones functional.
Dr Makhduma Nargis Project Director, Community Clinic Project Dr Nargis in her keynote paper explained the purpose, principles and operating procedures of the community clinics and formulation of the community groups who would own the clinics.
To make the community clinics more viable, the government has brought it under a project titled “Revitalization of community health care initiatives in Bangladesh” that is waiting for the approval of the Executive Committee of the National Economic Council (Ecnec). She also explained the services that are supposed to be provided by the community clinics which includes primary health care, immunization, vitamin A supplementation, treatment of diarrhea, identifying anemia among the women and adolescent girls and its treatment, ante natal, post natal care and infant care, birth and death registration etc.
The community clinics would also work as a referring centre (from where patients would be referred to referral hospitals for better treatment), as there would be no doctors, except the Health Assistants and Family Welfare Assistants, to provide services, she added.
The proposal that is waiting for the nod of the Ecnec also includes recruiting permanent health workers for each community clinic that will remain open 9:00am to 3:00pm, she added.
As the community clinics were closed down for the past seven years, so people lost their trust on commu-nity clinic concept. Therefore, the government has to work to regain the trust of the people and also try to sensitize them to donate their lands for communityclinic construction.
The government initiated to provide health services through community clinic under the Health and Population Sector Programme (HPSP) project in 1998. The project was initiated to ensure the participation of the community people in the health services by providing their land and efforts as well. On the land provided by the community people, the government would construct the structure, provide medicines, equipment and employ the manpower to provide health services in community clinics.
A community group comprising at least 9-11 members with local representative, representation from local influential sector, teacher, poor landless, women and landowner, will be responsible to maintain the clinic. They will also be liable to ensure security and cleanliness of the premise. About one lakh community members have already received training to run these clinics.
She said that the government also initiates to integrate the activities of the health assistant and family planning visitors for running the community level
health services. The com munity clinic is construeted with two rooms, patients' waiting room, toilet and water supply facilities.
At the community clinics, the permanent health workers will also keep the birth and death registration, do counselling about the family planning and contraceptive methods, give drugs for minor injury, fever, pain, snake bite, burn, asthma, skin-disease, eye, ear and dental care, said Dr M a k h d u m a at the roundtable.
She also stated that the government has already opened 11,500 clinics and more 6,500 will be set up immediately. "Manpower and other logistic support will be provided as soon as possible," she said.
Prof Syed Modasser All Health, Family Welfare and Social Welfare Adviser to Prime Minister Prof Syed Modasser All said a demand for community clinics has to be created among people if the clinics are to survive in future. "Community clinics are people's institutions, not government organisations. It's the people who own them." he said.
Prof Modasser said they want the community clinics to become an asset to the people.
As a chief guest he also said, "We have to create demand of the community clinics among the local level to continue its operation in future, then the change of government will not hamper the institution as earlier happen. The AL government initiated to set up community clinics and BNP government first shut down those clinics.”
“Feeling of ownership should be created at the community level for smooth running of the clinics", said the health adviser. He was also criticizing the role of bureaucrats to set up such project.
“As the AL government pledged in its election manifesto that they would set up 18,000 community clinics during their tenure, so there is no alternate to it,” he said. He called for community people, non-government and government collaboration to implement the project.
Prof Abul Barakat
Department of Economics University of Dhaka Terming bureaucracy as a big problem Prof Abul Barakat said taking the bureaucratic problem under consideration the government should think of the remedies.
Community participation should be effective and at the same time the socio economic pyramid of the country should be clear, he said adding that it would be violation of the constitution if we try to manage the primary health care services through public private partnership.
Quoting Nobel laureate Amartya Sen he said, inequality and socio economic differences in mortality might be singled out as criteria of success or failure ofa nation.
The mortality ratio of the rich and poor defines the situation of the nation, he said adding that infant mortality ratio between the poor and the rich is 1:1.7 while the rate of stunting and wasting for malnutrition is 2.5 times more in the poor families.
The government should be concerned about the poor people's health and at the same time it should be found out why the poor don't want to go to the health facilities.
He talked on the barriers that hinder poor people to seek health services from the health care centres, and the amount of service they receive from the centers.
He also suggested that public health must be seen as a real public good where public-private partnership should not come, government must see investing in people's health as not just a social sector investment, and poor and marginalized people must know about their human rights, health Dhiraj Kumar Nath Former Adviser, caretaker government
Dhiraj Kumar Nath said the government should not take tlie community clinic as a
political issue, rather a social issue to ensure health services for poor people. He requested all not to consider the community clinic as hospital, it should be considered as centre for primary health care and a referring centre (from where patients would be referred to referral hospitals for better treatment), as there would be no doctors, and only the Health Assistants and Family Welfare Assistants to provide services.
He also said that the government should consider the security of the health workers who will work at the community clinic and sufficient supply of medicines that will help to provide health services for all. of the fourth and fifth goals of Millennium Development Goals (MDGs), the government should make opera tlonal the community clinic within the shortest possible time. Without taking the health services at the corn munity level of the remote areas, the government would not be able to reduce the maternal and infants mortality."
To create the demand for community clinics, the government can utilize the image and activities of the
family welfare visitors and health assistants as they already have the exposure in the local community, suggested the DG family planning. During the recruitment of health workers exclusively for the community clinic, the policy makers should consider the amount of pay and their workload; otherwise they will not work for long period, he said.
ABM Jahangir Alain Ex-director
Primary Healthcare, DGHS ABM Jahangir Alam stressed the integrated efforts of GO, NGO, and community people to ensure the health services. He also said that the health worker who will be appointed at the community clinic, shall have to be trained on basic health care, family planning and contraceptive and nutrition information. The MBBS doctors from the union level will visit the community clinic once each week. He also informed that the community clinic would refer the complicated cases to the union complex, then upazila health complex.
They also talked on the issues like involving the non government organizations (NGOs) and local government for smooth functioning of the clinics, budgeting process for the clinics, service delivery mechanisms and coordination among the upazila health provide the lands for the community clinics. But the process of giving lands is very complex for even the educated people. How would the uneducated people be able to give their lands in such a complex system. One has to visit many offices to give his land for the communityclinics.
The procedure of giving land should be made easier, he said.
Dr Faisel also said the community people would provide the lands to govern
ment for the clinics. At the district level the civil surgeon would be the owner of that land which ultimately would go to the Directorate General of Health Services. This will reduce the authoritative pressure from the Directorate General of Family Planning.
He said community ownership in the community clinics should be established for its sustainability.
Prof AKM Nurun Nabi Department of Population Sciences
University of Dhaka
Prof AKM Nurun Nabi said considering and accepting the economic vision of the community clinic, it's great. People will be aware about the necessary health service.
He also said if we want to ensure health security, food security, contraceptive security, we must functionalise the community clinics. Sustainability of this project is very important so that no government can stop it.
Demand of the clinics should be established among the people for their basic healthcare services. This can be done through creating proper environment and by ensuring everybody of the society working together. And if the demands are there, then none would be able to stop the project. The recruitments in the community clinics should be transparent and the project's success depends on it, he said.
Dr Jahangir Hossain Director (Health), CARE Dr Jahangir Hossain said the effect of community clinics is already proven. As a concept, it is very good. There is no other better idea for the health services' decentralisation.
Success of any good model depends on its implementation. A question lies on the sustainability and continuity. Once the service demand is created among the people, then those would be scared who wants to stop the project, he said.
Dr Jahangir also said we need to invest for the community clinics' capacity development. Community should be the part of the services and they should own it. They should be made feel responsible for effective services In the clinics. All necessary health services should be ensured in the clinics.
Prof Dr Rubaiul Murshed Executive Director, Health 21
Prof Dr Rubaiul Murshed said the community clinics
Zobair Hasan
Researcher, DORP
Zobair Hasan said, "Before fully fledged operation of the community clinics, the policymakers should think about the budgeting and its proper utilisation."
Dr SM Kamal
Radda MCH-FP Centre
Dr SM Kamal said people want the community clinics functioning with trained manpower and logistic support. On the other hand, the clinics should be linked with referral hospitals to where health workers can refer the complicated cases.
Dr Zeba Mahmud
Health 21
Dr Zeba Mahmud stressed on the need to Involve the
community clinics among die people could be created through necessary and quality service. The continuity of the project is very important for the country s health service but it will not continue if there is no demand for the clinics.
on the anaemia disease and its proper treatment. She