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Increasing the capacity of Community Clinics
EVER since the early 1990s, Bangladesh has witnessed visible strides in several human development indicators, especially with relation to healthcare accessibility. However, inadequate financial resource allocation, political instability and the scarcity of skilled healthcare workers, mean that there is still a high level of inequity in the national healthcare structure. Therefore, integrating the efforts of both the public and the private sector is important in achieving progress in healthcare in our developmental journey.
In 1978, the administration recognised the importance of formulating a national healthcare policy structure for rural citizens, and as such, Bangladesh became a signatory of the historic Alma Ata Declaration on Primary Health Care (PHC). In 1988, Bangladesh adopted the PHC approach as a guiding principle to the development of health systems in Bangladesh. Subsequent governments have put emphasis on healthcare as per this model, thereby assisting the reduction of infant mortality rates, the enhancement of vaccination schemes and the promotion of health services across the country. Nevertheless, the underinvolvement of local stakeholders in health provision remained a problem—and as such, when the Awami League came to power in 2008, they instituted a more pragmatic innovation in the health sector. Community Clinics were a flagship programme of the current government; through the development of public-private partnerships, primary healthcare services are being taken to rural populations in the country. The Community Clinic model is simple, and has its philosophical roots in Section VII (4) of the Alma Ata Declaration. The Declaration required and promoted "maximum community and individual self-reliance and participation in the planning, organisation, operation and control of primary health care"—thereby encouraging the empowerment of local populations in primary healthcare services. The Community Clinic model is indeed an innovative example of a publicprivate partnership, whereby the government provides structural services, medicines, service providers and other logistical support to local communities, who in turn donate land for the construction of these clinics and oversee the day to day affairs of these establishments. Importantly, the owners of these clinics are the people residing in the community—thereby operating in the spirit of Section VII (4) of the Alma Ata Declaration. From providing internet connections to better treatment procedures, over 130,000 Community Clinics receive constant support from the government, and in its totality, the scheme is working well across the aisle in the locations where they are currently operating.
Nevertheless, with relation to the broader question of healthcare in Bangladesh, there remain severe incapacities. The budgetary allocation for the health sector reduced from 1.1 percent in 2010 to 0.8 percent in 2017—showing a concerning trend in how development is perceived in the country. The strides made in achieving Goal 4 (reducing child mortality) and Goal 5 (improving maternal health) of the Millennium Development Goals are commendable. However, a growing young population demands the provision of further resources to this sector, especially at a time when worrying levels of pollution and infectious diseases remain a core concern for Bangladeshis. As such, emphasising the growth of further public-private partnerships in the form of Community Clinics is an efficient and relatively cheap method of enhancing the capacity of healthcare provision in the country.
Community Clinics have their challenges as well, and these stem from the lack of skilled healthcare professionals in rural Bangladesh. Prime Minister Sheikh Hasina has promised the development of five new national medical universities if her party is reelected to power in the upcoming elections—with universities in Rajshahi, Sylhet and Chattogram already under construction. In their 21-point manifesto, the Awami League highlighted their willingness to ensure "quality healthcare coverage for all" if elected to power. The BNP, on the other hand, has pledged to allocate five percent of the nominal GDP towards healthcare, if they receive the public mandate on December 30. Whilst electoral pledges are more symbolic in nature, it is important that whoever forms the next government will prioritise quality healthcare services in rural Bangladesh. Community Clinics are undeniably a positive way to get rural communities involved in healthcare systems, and one hopes that following the upcoming elections, further training institutes and tangible allocations are directed towards these establishments. The focus has to be on the development of human capital in this sector.
Community Clinics operate through the involvement and donations of local stakeholders—this is a unique way to universalise healthcare in Bangladesh, whilst ensuring an appropriate level of state support. Therefore, it is imperative for our political stakeholders to direct resources towards empowering local communities and their health systems, so that rural populations can work towards being self-sustainable in addressing healthcare challenges. Shrinking resource allocation towards this sector is concerning—and surprising—given the success of Community Clinics in mitigating the problems of inaccessibility in healthcare delivery. Therefore, with the aim of fostering a healthier and equitable population across the country, Bangladesh demands that its political stakeholders continue to engage in public-private partnerships such as this, but at the same time, ensure that they do as much as possible in enhancing the capacity of Community Clinics and broader healthcare systems through the training, education and growth of healthcare professionals in rural Bangladesh.
For far too long we have perceived development from the lens of real GDP growth. Education and healthcare remain two other pillars in the construction of human development. Without further resources being divested towards the health and education sectors, no levels of economic growth will be sustainable or equitable. And therefore one urges our political elites to think beyond mere numbers, and observe development from a broader lens of creating a healthy, educated and equal society. Mir Aftabuddin Ahmed Is a graduate (Honors Bachelor of Arts), Economics and International Relations, from The University of Toronto.
Email: aftab.ahmed@mail.utoronto.ca