Bangladesh was one of the countries who signed the “Alma-Ata Declaration” in 1978 with a pledge to ensure “Health for All” (HFA) by 2000 through Primary Health Care (PHC). But in 1996 it has been observed that we were far behind the destination as per the set indicators. Unavailability & inaccessibility of PHC to the rural community of Bangladesh (about three fourths of national population) with lacking in community participation were the important reasons.
To address those shortfalls, the then Government of Bangladesh in 1996 planned to establish Community Clinic (CC) (1 CC for about 6000 population) to extend PHC at the door steps of the villagers all over the country. Community Clinic is the brain child of Hon’ble Prime Minister Sheikh Hasina. Construction started in 1998. During 1998-2001, 10723 CCs were constructed & about 8000 started functioning. HA & FWA were service providers in addition to their domiciliary services. They had been trained on ESP (Essential Service Package) under HPSP (1st Sector Program).For management of CC activities, there was 1 Community Group (CG) for each CC having 9-11 members headed by Land Donor/his or her representative. In CG there was no distinct provision for adequate women’s representation & scope for empowerment and adolescent participation. Even, the roles & responsibilities of local govt. representatives for smooth functioning and effective management of CC was not considered with due importance.
The CCs were on board for a short time as CCs were closed in 2001 after the change of govt. & remained as such till 2008. General people of the community couldn’t realize the benefits from CCs. They became very much disappointed. Due to closure and abandonment for years together, many CCs had been occupied by unauthorized occupants, became centers of unsocial activities e.g. addiction, gambling & others. As there was none to look after, the condition of most of the CCs (the low cost infrastructure in rural setup) became very poor and a substantial number of CC demolished due to river erosion. In 2009 the existing number of CC stands at 10624.
In this context in 2009, Govt. planned to revitalize CCs through a project “Revitalization of Community Health Care Initiatives in Bangladesh” (RCHCIB) as priority as it was in their election manifesto. It was a project of 5 years duration from 2009-2014. There after the span of the project has been extended for 1 year more i.e. up to 30.06.2015 in 2 phases
Under RCHCIB, Community Group (CG) -management body of CC, has been formed for all the functional CCs with some major changes. CG members’ number has been increased from 9-11 to 13-17 with at least one third women members and adolescent girl/boy. The group is headed by elected UP member of that locality instead of land donor/his or her representative. Land donor/his or her representative is life member & senior vice president of CG. Out of president & vice presidents at least one is female. CHCP is the member secretary in place HA/FWA.
Community Support Group (CSG): It is new & an addition for better community engagement under Revitalization of Community Health Care Initiatives (RCHCIB) project as there was no such provision with CC during 1998-2001. In the catchment area of each CC, there will be 3 CSGs comprising of 13-17 members with at least one third women members. For all functional CCs, CSGs have been formed. The CSGs help CG in CC management along with making community aware regarding the services available at CC and common health messages.
Community Health Care Provider (CHCP) - new category of service provider (1 for each CC) has been recruited in phases following all the necessary steps. After the last phase of recruitment the existing number of CHCPs becomes 13822. As their job is in developmental head, a significant number of CHCPs have quitted their job, getting better option otherwise. The latest working CHCPs’ number stands at 13622 & it is decreasing gradually, causing a substantial number of vacancies
- Community Based Health Care (CBHC):
From the beginning of RCHCIB, mainstreaming of the project had been thought of & implemented through the existing health system from the national to sub district level. For this one Operational Plan titled “Community Based Health Care” (CBHC), housed at DGHS under 3rd sector program (HPNSDP) is being implemented since July, 2011 complementary to RCHCIB .During the first 3 years mainly different types of local & overseas training and in the fourth year, pay & allowances of the manpower transferred from RCHCIB to CBHC along with local training have been accomplished out of CBHC. After the expiry of RCHCIB, all the activities of Community Clinics are being implemented through CBHC & will continue up to 31.12.2016