Scaling-up Innovations

Community Clinic in Bangladesh

Dr. Makhduma Nargis Additional Secretary & Project Director

Revitalization of Community Health Care Initiatives in Bangladesh (RCHCIB), MoHFW

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Concept of Community Clinic(CC) Public-Private partnership

Activities Implementation

Land for CC construction Community

Construction GOB

Medicine & other inputs GOB

Service Providers GOB

Management Community Group +GOB

Community Group (CG) and Community Support Group (CSG) are the key player

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Community support groups (CSG)

CC catchments area has

appr.

1200-1500 HH & pop.

6000-10000

Local Govt.

(Union Parishod)

SubDist.

Health Complex

(UHC)

CSG-1 (13-17 members)

CG

(13-17 members) CG

Responsible in

daily operation of

CC, monitoring of

CC function, fund

raising for CC

improvement

CSG

Promote the use

of CC services

and educate

community people

on health

CSG was introduced based on the successful community mobilization model named “Narsingdi Model” developed by JICA.

Background and History

The present Government during its previous tenure in 1998 planned to establish 13,500 Community Clinics.

During 1998-2001 period 10,723 Community Clinics were constructed and 8,000 started functioning.

Due to change of govt. in 2001 Community Clinics were closed and remained as such till 2008.

Govt. in 2009 has taken initiative for revitalization of Community Clinic as priority program & is being implemented through RCHCIB under MoHFW

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Services of CC

Service Level: Primary Level (Service time: 9 AM-3 PM)

Service Providers:

Community Health Care Provider (CHCP);

Health Assistant;

Family Welfare Assistant;

Available services:

Maternal & neonatal health care services (ANC/PNC);

Integrated Management of Childhood Illness (IMCI);

Reproductive Health and FP services;

EPI;

Nutritional education and micro-nutrient supplements;

Health education & counseling;

Screening of Chronic Non Communicable Diseases

Treatment of minor ailments, common diseases & first aid

Establishing referral linkage with higher facilities

Tertiary Level Medical University

Medical College Hospital

Specialized Hospital

Secondary Level District Hospital

Mother and Child Welfare Center

Primary Level Upazila (Sub District) Health Complex

Union Health & Family Welfare Center

Community Clinic (CC)

0

5000

10000

15000

Coverage and Functionality of CC

Target Functional

1462741623691306

37299744

72233952

100408157

2009 2010 2011 2012 2013

Service seekersService seekers attended CC

Please check and put data if

available

90.3%

achieved

48%

up!

28%

up!

Process of CC Scaling-up

Construction of CC

Recruitment &

Training of service

provider

Supply of Drug/logistics

MIS & monitoring

system development

CG

Operational

Guideline

developed

CG members

revised & CG

training held

CSG formed & CSG training

held

Local Govt. training is coming…

JICA provided technical (“Narsingdi Model”) & financial (Yen Loan) support to the entire process of nurturing community engagement.

Community people

donated the land for CC Community Engagement Wing

Service Provision Wing

Roles of the government: leading scaling-up

Designing and guiding partnership; ◦ To optimize available resources for CC

revitalization

Recruitment and training of health service providers and relevant parties; ◦ To ensure the quality of service delivery

Mobilize community engagement; ◦ To make people’s representatives directly

involved with CC

Monitoring achievement: ◦ To make all efforts are accountable

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Key for scale up: Partnership

Development Partner:

JICA: technical and financial support to develop and conduct CHCP/CG/CSG/ Local govt. bodies training, and monitoring of CC/CG/CSG

WHO: CHCP Training development and ToT conduction, and monitoring of CC

GAVI HSS: construction of delivery rooms at 105 CCs, and monitoring of CC

NGO & Local Government:

14 Partner NGOs (MoU with RCHCIB ) works for capacity development of CG & CSG and submit quarterly reports.

Quarterly NGO coordination meeting is held to monitor and update the NGO activities

Local govt. bodies use annual budget for improvement of CC

NGOs/DPs provide support for CC functioning (as of June 2014)

K H U L N A

R A N G A M A T I

B H O L A

S Y L H E T

B O G R A

T A N G A I L

S A T K H I R A

B A N D A R B A N

B A G E R H A T

P A B N A

C O M I L L A

D I N A J P U R

N O A G O A N

N O A K H A L I

M Y M E N S I N G H

C H I T T A G O N G

B A R I S A L

S U N A M G A N J

J E S S O R E

H A B I G A N J R A J S H A H I

P A T U A K H A L I

R A N G P U R

N A T O R E S I R A J G A N J

N E T R O K O N A

D H A K A

K U R I G R A M

F E N I

G A Z I P U R

F A R I D P U R

K H A G R A C H A R I

J A M A L P U R

K U S H T I A

G A I B A N D H A

M O U L V I B A Z A R K I S H O R E G A N J

J H E N A I D A H

C O X ' S B A Z A R

B A R G U N A

C H A N D P U R

N I L P H A M A R I

S H E R P U R

N A R A I L

R A J B A R I

N O W A B G A N J

B R A H M A N B A R I A M A N I K G A N J

G O P A L G A N J

M A G U R A

P E R O J P U R

S A R I A T P U R

L A K S H M I P U R

M A D A R I P U R

P A N C H A G H A R H

C H U A D A N G A

J O Y P U R H A T

M U N S H I G A N J

J H A L A K A T I

M E H E R P U R N A R A Y A N G A N J

Among 64 districts 40 districts (about 70%) already supported by partners.

CC functioning well where CG and CSG are proactive.

Effective participation of UP facilitates CG and CSG function properly.

Capacitated CHCP, CG and CSG act enthusiastically and ensure QoC.

Involvement of external facilitation ensure regular supervision and monitoring.

Community engagement makes CC service providers more accountable.

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Lesson Learnt: Delivery Intervention

Strong and continuous political will to revitalize CC made CC services stable and reliable

Ensuring service delivery and creating a mechanism of community engagement resulted in community ownership of CC

Partnership with multiple stakeholders is critical for the success of CC

CC is not merely a one-stop health center but can be a center for sustainable development

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Lesson Learnt: Scaling-up

Future Plan

To intensify community engagement & Local Govt.

To make CG financially solvent through local fund generation

To train all the female CHCPs as C-SBA To establish E Health provision To establish an effective referral system To strengthen Supervision & Monitoring System

with Quality of care

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H.E. Honorable Secretary General of UNO Mr. Ban Ki-moon talking

with adolescent girls at the premises of Mobarokpur Community

Clinic under Kulaura Upazila of Moulvibazar District on 16/11/2011.

Thank you so much

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