Challenges

In rural Bangladesh, where 70% of population live, there was no provision of government-owned static one stop comprehensive Primary Healthcare (PHC) Center at door steps of people.

Available government health services included only preventive healthcare by CHWs & government-owned Union Health Center (a PHC center), one for roughly about 25,000 population. So, comprehensive PHC was not easily available & accessible. People generally required to depend on nearby unqualified medicine shops or on quacks for treatment Children & women did not have required & adequate care for their illnesses or pregnancies.

Toward a Solution

Community Clinic (CC) is the innovation of Bangladesh Government to extend Primary Health Care to the doorsteps of rural people all over rural Bangladesh. Thousands of people are getting services from the CCs and it has become an integral part of national health system. It is a unique example of Public-Private Partnership (PPP) as all the CCs have been constructed on community donated land while construction, medicine, service providers, logistics and all other inputs are from Government (GoB) but management is both by community and GoB through Community Group (CG). Community owns CC and plays active role for its improvement. People are satisfied with the services of CC as it is a ‘one stop service outlet’ in respect of health, family planning & nutrition.

One Community clinic for every 6,000 population have been established in the rural areas.

At present 14,000 Community Clinics are on operation (Source: WHO) and the number is increasing gradually. From 2009-2015, about 460.88 million visits were made to CCs for services of which 9.071 million emergency and complicated cases were referred to higher facilities for proper management. Among the service seekers of Community Clinics about 80% are women and children. On average 9.5-10 million visits are in Community Clinics per month and 38 visits per day per Clinics. For primary level, service time is 9am-3am. It is a one stop service outlet for Health, Family Planning and Nutrition. It is a preventive-biased center as it provides mainly health education and health promotional services. All the Community Clinics are outreach sites for routine immunization and NID. In addition, it provides limited curative care (treatment of minor ailments), screening of NCD-Hypertension, Diabetes, identifying emergency and complicated cases with referral to higher facilities in urban health care. In a substantial number of CCs, normal delivery is being conducted subjected to the availability of skilled manpower, proactive CG, committed local health management and where from patients can be referred within a short time or necessary support.

Community clinics are built on the land provided by the community people and all other supports are provided by the Government. In collaboration with community people and government this initiative is sustainable because as long as community people need service they will provide the logistic support and so long as government face the demand from people they will provide support from their side.

This programme is easily replicable because the resources and services are provided by government so according to the change in demand from community people over time government can change the supply and programme module.