Community Health Programme N-W Bangladesh

Bangladesh is a poor country, which has position 146 out of 187 on the Human Development Index. The maternal mortality ratio is 340 per 100,000 live births. The proportion of births attended by skilled health personnel is only 18% (State of worlds midwifery report 2010). About 50% of pregnant women get any form of antenatal care, but only 21% gets all 4 ANC check ups. Women and adolescents are highly vulnerable to STDs (23.2% suffer from a STD) and thus to HIV/AIDS.

The project is implemented in Northern Bangladesh, a poor part of the country. This part of the country has major problems with floods, every year. Most district hospitals have Emergency Obstetric Care, but not fully functional. Health services are hard to reach for people and there is a lack of skilled staff.
Discussions about sexuality and reproductive health are not open and it's not easy for women to go to seek for health care on these subjects.

Current status

This project is an extension of a 3 years project funded by Cordaid, that set up the community health programme in the same area. Within this project, 1 maternity center, 120 weekly antenatal clinics, 22 eye clinics and 45 TB and leprosy clincis have been set up. Also, several awareness raising and prevention activities on different health subjects have been carried out.

As the current project started in 2011, the results of the first year are expected to be reported in the beginning of 2012.

The project is conducted in 27 sub districts of 6 districts (Lalmonirhat, Kurigram, Nilphamari, Thakurgaon, Panchagar and Dinajpurin) in northern Bangladesh.

RDRS works in 19 sub districts on reproductive health (120 clinics). In 14 sub districts, they offer services for TB and leprosy patients. RDRS also runs a rehabilitation centre for visually disabled children, of which 50 will be helped by integration into regular education.

For the work on reproductive health, the following activities are done.

Reproductive health clinics are operated weekly by trained Community Health Workers (CHWs). One CHW is responsible for 3 clinics. She is assisted by 3 trained TBAs on clinic days. The clinics offer routine check-up, conduct education sessions on reproductive health rights; health, hygiene and sanitation; encourage birth registration, urine test, medicine distribution, immunization (T.Toxoid) and limited treatment of STDs. High risk and complicated pregnant women are referred to nearby health complexes. The strength of the project is that all 360 TBAs, 40 CHWs and some of the managers will be female providing services to the pregnant population. Under this project period annually 50,000 pregnant women are expected to bring under antenatal care service.

There are monthly meetings between management of a sub district and CHWs and TBAs. All CHWs and TBAs are trained.

Street based /floating Sex workers of the area will have access to a Drop In centre (DIC). This particularly serves as a resting place for the sex workers during day time. Treatment services, health education, condom promotion and counseling are offered.

RDRS will continue to operate 25 clinics, 20 microscopy centres and 95 out reach smearing centres with the assistance of CORDAID in all 14 Upazilla of Lalmoniraht & Kurigram districts. At 14 upazilla the clinics and labs are organized at the Upazilla Health Complexes (UHC). Rest clinics and labs are organized in RDRS or community premises. The clinics will be operated daily by trained TLCAs (Paramedics). The main emphasis is for DOTS and follow-up irregular patients.

RDRS will continue to operate 22 weekly community based clinics at the Federation centers (at union level) in Lalmonirhat and Kurigram district. One eye hospital (15 bedded) with modern operating facilities in Lalmonirhat unit office serves for all the referred case and surgical service. Ophthalmic Health Assistants (OHA) will be responsible to run outreach clinics at the Federation centers. Complicated patients and patients who need surgery will be referred to our Lalmonirhat Eye hospital.

RDRS is managing the Rehabilitation Centre for visually disabled children at Haribhanga, Lalmonirhat Sadar Upazilla, Lalmonirhat. RDRS established this centre with the support of CORDAID, Netherlands. Construction completed in 2002 and centre started its journey on 1 January, 2003 by enrolling 20 visually impaired children aged less than 20 years. At present 50 children are enrolled. They have been received training on mobility and daily living skill education through Braille method, skill training for better livelihood and integrate them at community.

Direct target groups:
Female 150000 under reproductive health
Tuberculosis patients 9000 (5% women)
Leprosy patient (45% women)
Eye patient 90000 (50% women)
Visually disabled children 150
Adolescents 840
Sex worker 500

Indirect target groups:
All people living in 6 districts in north-west Bangladesh (249,450)

Long term objective:
- To improve the health status of people living in 6 north western districts in bangladesh.

Short term objectives:
- To promote access to prenatal, delivery and postnatal care of women (150,000 pregnant women).
- To reduce the TB and leprosy burden in the project area (9,000 TB and 300 leprosy patients).
- To restore eye sight and to reduce the burden of eye diseases (90,000 patients).
- To mainstream the visually disabled to lead a full life (150 children).

Goals

• 120 clinics deliver quality ANC services (to 150,000 women)
• Treatment 9000 tuberculosis and 300 leprosy patients
• Treatment 90000 eye patients
• Rehabilitate 150 visually disabled children
• Promote safe sex practice among 500 sex workers through DIC

The sustainability of the project is mainly guaranteed by the community approach. Local community groups are involved and part of the system. The project invests in training of birth attendants, which will work in the rural areas of north Bangladesh. The union health standing committees have been sensitized to create eqitable access of health services from the government health facilities for the poor and disadvantaged people.