Infra-structure

Infra-structure

• Construction: Target for construction of CC is 13861. Among these 10624 CCs were constructed under HPSP and 2752 under RCHCIB resulting total number 13376. Among the remaining 485 of the targeted CCs, 300 will be constructed under JICA, 36 under PPD. For 149 CCs, no source /support has yet been confirmed. The CCs will be constructed under PFD OP & necessary fund needs to be kept in PFD OP.
• Construction of CC beyond existing target: For equity of service delivery there should have at least 1 CC in all the old wards of union without any other health facility. After establishment of all the targeted CCs (13861) there will remain 1029 such old wards. So as priority (very hard to reach, isolated, poverty stricken areas etc.) at least 500 new CCs may be included as target with approval of competent authority. If so then the CCs will be constructed under PFD OP & necessary budget needs to be kept in PFD OP.
• Boundary wall for all the CCs needs to be made for security & demarcation of the CCs. HED will implement as before
• Birthing room: For further improvement of Maternal & Neonatal health through reduction of Maternal and Neonatal mortality & morbidity, 1 CC of each Union may be developed with normal delivery provision. In that case construction of 1 birthing room in the CC is needed. In the meantime with GAVI-HSS support, birthing room has constructed in 162 CCs. On priority 1 birthing room in 1000 CC need to be constructed. This will be implemented by HED. Necessary fund will be proposed in PFD OP.
• Community Clinic Building: For smooth management of the country wide gigantic program (Community Clinic) and for accommodation of the officers, staff, store, training & other activities an individual building needs to be built at headquarters.
• It is to be mentioned that as per instruction of MOHFW, land has been selected at Mohakhali IPH Compound. With all necessary documents including Site Mapping & recommendation of DG, DGHS, MOHFW has allocated 2 acres of land for construction of Community Clinic building.
• Major repair of the most of the CCs constructed during 1998-2001 is needed. In a few cases (Demolished due to river erosion and very poor condition unfit for repair) replacement/rebuilding is needed.
• Water & Sanitation: Water (Tube well) & Sanitation of a large number of CCs need to be improved through installation/re-sinking of tube well and major sanitation work.
• HED will accomplish the repair activities of CCs & other upazila level facilities. For Repair & Maintenance of the Community Clinic building, CG needs to be involved for quality of the work and their ownership as well.
• Electric line: Electric line to be installed with connection to CCs where nearby Electric line is available.
• Solar panel: Solar panel to be established in CCs which are very isolated or absence of nearby electric line & has got no possibility of getting electric line within near future. On priority solar panel to be established at CCs.

Supervision & Monitoring

• Supervision & Monitoring Plan: Ensure monitoring, supervision as per plan and evaluation to ensure services under CBHC.
• Strengthening of existing system: Monitoring & supervision needs to be strengthened with the participation of all dedicated stakeholders. Circular from both DGHS & DGFP is in place with clear instruction for supervision of CC by supervisors of different levels from head office to union level with use of specific checklist. It is to be further strengthened both in quantity & quality.
• Involvement of 1st line supervisors: All sorts of preparation (finalization of training manual, trainer’s guide, planning) have been taken regarding training of 1st line supervisors both of health & family planning. After the training their supervision will be improved in quantity and quality as well.
• Updating of the checklist: The checklist in place consists of general management, infrastructure, supplies & other non-technical issues. This was developed quite earlier & needs to be revisited and fine-tuned. Checklist to be updated with the participation of the stakeholders.
• Central monitoring unit: A central monitoring unit comprising of IT experts need to be established at head office for continual vigilance on online reports, analysis, feedback, follow up etc keeping close contact with MIS,DGHS.
• Technical supervision: For improvement of the service quality Technical supervision along with mentoring is very important. It has been piloted in a small scale with the support of one of our partners following a specific checklist developed earlier. This will be scaled up all over the country in phases. In this regard WHO has extended their support. Technical supervision checklist has been finalized with the participation of GO-NGO experts and academicians.
• Union Medical officers: Union MOs will be assigned as the overall in charge for all the CCs of the respective Union for supervision & monitoring.
• Mobile tracking: Service providers are to be monitored through mobile tracking from different levels-head office, division, district and Upazila
• Monitoring through Skype: It has already been started in small scale-e.g. Moulavibazar. It is very effective and will be scaled up all over the country. For this, technical support will be sought from MIS, DGHS.
• Tracking of the beneficiaries: CHCPs can track the pregnant mothers for ANC, Delivery Plan, PNC and children for growth monitoring- particularly the drop outs through mobile phones & can ensure services. CHCPs may be supported with mobile bill or this can be met up from local fund through CG’s decision
• Divisional Review workshop: Divisional workshop will be arranged to review the progress, share the experiences, identify the strengths & loop holes, the way forward etc. with the participation of all the stakeholders. It will be organized 6 monthly/yearly.

E-health and MIS

Strong MIS: Online report (DHIS-2) is going on from all the CCs & other relevant facilities. It is to be further strengthened with the support of MIS, DGHS.

• Establishment of E-health: E-health services are to be introduced & continued from CC to UHC to provide more quality and specialist services. This is to be organized as a routine program with prior intimation to all concerned to make it more effective. It is to be done with support of MIS, DGHS.
• Local Monitoring: Monitoring will be done locally by the Community Clinic management committee, Union & Upazila parishads. The local health authority will be intimated with the observation/findings.
• Monitoring of higher authority: Monitoring will be done on regular basis with the help of checklist showing information on performance, supply of logistic and other relevant issues.
• Functional linkage: Functional linkage of domicile and static Health, Family Planning and Nutritional Services in the Health system needs to be established along with harmonization of report to avoid any duplicity or under reporting.
• Research/ Study/Survey: Document needs to be prepared keeping in mind the pledge to achieve SDGs like MDGs.