Dr. Ala Uddin: Community clinics are one of the most successful and effective initiatives to deliver health care to rural and marginalized communities. Established in 1998, this service organization is playing an important role in bringing healthcare to the doorsteps of the poor people of the country. So far 14,200 community clinics have been established across the country, providing multifaceted health care to people at the rural ward level. More than 5 crore village people get health care from this clinic.
13,667 Community Health Care Providers (CHCPs) are engaged in this healthcare. This number tells how much work they have to do to provide healthcare 6 days a week. Due to various difficulties, many leave the job, do not get interest, and the position remains vacant for a long time. For the sake of research, there has been an opportunity to learn about the deprivation of health workers through discussions with various services and stakeholders.
On an average, 500-1000 patients visit each clinic for healthcare every month. The services provided by the clinic play an important role not only in improving physical health, but also in social and mental health. Community clinics usually provide maternal and child health care, reproductive health, family planning, immunization programs, nutrition, and a variety of counseling services. In particular, critical health care for mothers and children, such as post-natal care and immunization programmes, is being managed very effectively.
Apart from this, 27 types of medicines are provided free of cost in the clinics, which is a boon to the poor people. Through this health care scheme they get all the services which help to improve their quality of life. During various calamities, these workers have been setting the example of door-to-door delivery of services, which proves their courage and sense of responsibility. Community clinic workers have risked their lives and become confidants to the public, especially during the coronavirus pandemic. However, lack of proper salaries and facilities is demoralizing the workers, which is a major challenge to the delivery of this vital service.
Community clinics have ushered in a revolution in the health care system of Bangladesh. Marginalized communities who previously had no access to health care are now able to access health care through these clinics. This clinic opened a new horizon for the poor people of the village. In particular, the success of community clinics in women's healthcare, childhood immunization programs, health awareness and reproductive healthcare is undeniable.
As these clinics ensure access to health care, the mindset of understanding the importance of health among women has changed. The contribution of the staff of this clinic in preventing child marriage and increasing women's health awareness in many areas is remarkable. Their efforts have also brought about positive changes in health care at various levels of society, which have helped improve the quality of life of the village people through community clinics.
One of the successes of the community clinic is building trust among the rural population. Those who are deprived of city facilities, get primary health care completely free from these clinics. Common people, who were deprived of health care, can now easily visit the clinics for services.
This globally recognized initiative has been particularly successful in maternal and child health. Community clinics have all the equipment women need for childbirth and safe delivery systems are being implemented effectively in many clinics. Antenatal care (ANC) and postnatal care (PNC) have been introduced in the clinics. Delivering in the presence of trained health workers saves many mothers and babies from health risks.
Maternal and infant mortality rates have decreased significantly in these clinics, proving that lives can be saved with the right services and support. Community clinic workers have played an important role as front fighters during the Corona pandemic. Risking their lives, they delivered emergency services including corona vaccination to the villagers. Their tireless work and humanity created the habit of seeking services among the villagers and opened a new horizon in healthcare.
Although the community clinic is providing services effectively, the staff of these clinics have been suffering from deprivation for a long time. The 2018 law promised to increase the salaries and benefits of the workers, but it is yet to be implemented. According to the Community Clinic Health Assistance Trust Act passed in October of that year, workers were supposed to get all the same benefits as government jobs. But in reality workers are getting the same salary for 13-14 years and many times their salary is not regular.
However, these workers are risking their lives to ensure the health care of common people. Even, many community health care providers (104 people) died while providing services during Corona, but their families did not get any financial support. Currently, community health provider workers have been without pay for three months, which has had a severe impact on their lives. The Health Advisor is aware of this plight; He promised to take immediate necessary measures.
This situation not only put them in financial trouble but also damaged their social status. Lack of fair wages and facilities for workers is undermining the trust and confidence of the society in them, which is a serious problem for the future of healthcare in the country.
The main demand of community clinic workers is to transfer their jobs to the revenue sector. They believe that if they shift to the revenue sector, they will get benefits like government jobs as per the 2018 law, which will remove the uncertainty of their lives. Under this Act they were promised better pay and benefits, but the reality is different. The workers have repeatedly appealed to the higher authorities but no progress has been made in resolving their problems.
However, many workers are the sole breadwinners of their families. Their families are facing extreme financial crisis due to non-payment of salary. In this situation, they have to face problems in providing education, food and health care for their children. Apart from this, those who risked their lives and worked during the Corona epidemic were not properly evaluated. No initiative has been taken to provide financial assistance to the families of the deceased workers, despite the fact that at that time they played a leading role in the health care of rural people at the risk of their lives. In the current scenario, the workers' request is that the government should take effective measures to bring about a positive change in attitude, so that they get their rightful rights and consolidate their social position.
The contribution of community clinics in reaching the poor population in rural areas has also received international recognition. Community clinic activities have been recognized by international organizations including the World Health Organization as a unique model of health care for marginalized people, which is a matter of pride for Bangladesh. But this service sector is plagued with many problems and the workers are drowning in despair. It is very important for the government to properly evaluate the community clinic workers and meet their fair demands.
If employees do not receive proper pay and benefits, their morale will decrease and the health care system may be adversely affected. The government should quickly transfer the workers jobs to the revenue sector and provide them with proper facilities. To make community clinic services more effective and to maintain public confidence, employees should be given fair benefits. These steps must be taken for the development of the healthcare sector.
Community clinics have opened a new horizon in healthcare in Bangladesh. The clinic provides free quality services to the rural poor, which plays an important role in improving their quality of life. Government needs to take effective steps to eliminate deprivation and uncertainty of Community Health Care Providers (CHCPs) to ensure quality services.
Providing fair pay and benefits along with the transfer of promised revenue to the sector will increase the morale of health workers and make health care more effective and sustainable. Through this, the health care system will be improved, which in turn will help improve the quality of health care of the people of the country.
alactg@gmail.com
*** Opinions expressed are solely the author's own.
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