Government health services

City people know less about services than rural people

Prothom Alo

Pakhi Akhter (38), a resident of Nandipara area in capital’s Khilgaon has received allowance under the mother and child benefit programme for three years in total, since she became pregnant.

She had received the allowance from a different area with help from one of her relatives. The allowance is available in her village also.

When she went to tell many poor pregnant women in Nandipara about this allowance, she found out that most of them didn’t know about it. In fact, she herself doesn’t know where to go or who to ask in case a pregnant woman of Nandipara wants to receive this allowance.

While taking to Pakhi Akhter in Nandipara on 28 November, a female cancer patient of the same area shared her story as well.

She said, she didn’t know about the one-time assistance cancer patients are provided by the social services department. Once she learnt about it, she applied to the local social service office a few months ago. But, she hasn’t received any response yet.

Development agency ActionAid Bangladesh has done two social assessments in urban and rural areas on the issue of gender sensitive public services. For this they had selected Nandipara in capital’s Khilgaon and Katabari union under Gobindaganj upazila of Gaibandha.

The assessments showed that many people in the area do not know where and what kinds of government services are provided. Again poor people in the city know less about these services than village people.

A total of 321 people participated in the survey in the capital’s Nandipara from 26 to 31 October. Of them, 246 were women. And 200 people from different sections of the society of 28 villages participated in the survey at Katabari union from 29 September to 12 October. Of them, 123 were woman.

Among the participants of the survey, 18 per cent people in the city and 11 per cent people in the village don’t know anything about government services. Even, government institutions and public representatives have little initiative to inform public about what kind of services can be found and from where.

On this issue, South Asian Network on Economic Modeling (SANEM) chairman professor Bazlul Haque Khondker told Prothom alo that following independence, village based service-structure was established in the country.

Many poor people from villages are now moving into cities. But the service-structure hasn’t been city-centric. Because of there being less social security and government services in cities, urban people know less about it, he added.

Besides, rural people are more connected to each other. When a person learns about a service, it travels on people’s tongue. City people are self-centric and less connected. Interchange of information among them is quite low.

SANEM chairman believes that arrangements for ward-based campaign should be made to inform people more about govt services in cities.

According to the assessment report, many did not receive government services despite making an effort. Then there is dissatisfaction among those who did receive the services. Many women even feel unsafe to seek services for reasons like overcrowding, long queues etc.

Meanwhile there’s discrimination between cities and villages when it comes to providing services.

While, rural women get services during pregnancy as pre and post-partum services, birth control services, immunisation for newborns, children and adolescents, etc. for free, city people don’t.

Less idea about services

The assessment of Nandipara stated, according to data provided by government officials the list of services includes child protection, hygiene, safe water supply, vegetable garden, sanitation, social allowance (old age, disability, transgender, backward community), family planning, vaccine, mental health and adolescent healthcare.

However, the survey showed that only 78 per cent respondents know about any one of the government services.

Among people aware of the services, 39 per cent know about healthcare services while 40 per cent know about different other services. People know least about ration, government scholarships and youth trainings; the rate is only 3 per cent.

The picture is comparatively better in villages. The number of government services available in villages is high as well. Among people participating in the survey at Katabari, 82 per cent know about health services while 63 per cent know about social allowances.

Khadiza Akhter, a young woman from Nandipara told Prothom Alo she learned hand printing from the women affairs department’s Income Generating Activities (IGA) training project for women. Now she wishes to do business but doesn’t know what she has to do to avail a government loan.

Meanwhile, most of those who know about the services have learnt about it from their neighbours. The rate of getting information from public representatives is higher in villages than in cities. A total of 17 per cent people in cities and 51 per cent people in rural areas have found information from public representatives.

Non-government organisation Spriha Bangladesh Foundation ran the survey in Nandipara on behalf of ActionAid Bangladesh. Project coordinator of the organisation Swapan Debnath said that Nandipara has been under the city corporation for only two years. Earlier it was under the union parishad.

They are not fully aware of the kind of services currently available to them in the area.  Neither the government organisations run any campaign about this. Many are being deprived of government services for not having the information.

Cost of getting services   

Kanika Rani Mandal of Khilgaon’s Nandipara got her child’s birth registration done through the councilor’s office. She had to spend Tk 800 for that.

However, the birth registration fee for children aged below 5 years and aged more than 5 years are Tk 25 and Tk 50 respectively. No fee is required for registration within 45 days of the birth.

Rubina Akhter of the same area believes, earlier people used to get family planning services right at their homes. That’s closed now.

Adding to that Chandana Rani Sarker said, now we have to pay for the pills and condoms. It takes money to even get injections (temporary injectable birth control) after every three months. These used to be free before.

In Nandipara, girls have to pay Tk 100 to get Tetanus (TT) vaccine card that’s supposed to be free.

And Tk 50 is charged for each dose of the four-dose course. In fact, Tk 50 is charged for children’s vaccines as well.

Different non-government organisations work in partnership with the city corporation to conduct the vaccination activities. Those agencies provide birth control services too. Despite these services being free, private organisations charge money.

About the allegation of charging money Nazmun Nahar, project manager of Khilgaon region at non-government organisation Shimantik, working in Nandipara (Ward no 74 of Dhaka South City Corporation) said no money is taken for services that are free.

Some additional services are provided during vaccination, and a 'service charge' is taken against that, she added.

In this regard, chief health officer of Dhaka south city Fazle Shamsul Kabir told Prothom Alo, there no scope of charging money for EPI-enlisted vaccines of young girls and children. If any organisation charges money, measures will be taken after investigating the accusation.

Disparity in urban and rural services

When visiting Katabari Union, following the assessment report, to know about the status of government services in the village, it was found that the services for pregnancy, child and adolescent vaccines, and birth control services are free there. But, extra money is charged for social allowances, birth registration etc.

About the birth control products, line director of field services and delivery unit of the family planning directorate Niazur Rahman told Prothom Alo that the directorate provides this service in villages for free. There’s disparity regarding this service in cities. The issue needs to be resolved.

Shyama Rani Pahari (30), a farmer from Helalipara union of Katabari Union, told Prothom Alo over the phone, her husband Ripon Pahari is rickshaw-van puller. They have two daughters, one aged 7 and the one and a half months.

She had health tests for free at the local government health centre while pregnant with her second child. She also got both of her daughters vaccinated for free. However, she had to spend Tk 300 to get her elder daughter’s birth registration from the union parishad office.

Shyama never applied to be included in the mother and child benefit programme. In her words, “We are poor. It takes money to apply. So, I didn’t apply.” Her mother-in-law Gouri Rani Pahari is a senior citizen and widow. Even she doesn’t get any allowance.

Almost 24 per cent people who participated in the survey at Katabari union said they never received any government services. They believe, they didn’t receive the services for not having acquaintances or relatives at the service providing organisation. And, it takes money to get service.

Pakhi Akhter of Nandipara had talked about people in the area knowing less about mother and child benefit activities.

An enquiry in the area following her lead showed that ‘mother and child benefit programme’, launched in 2019 combining ‘maternity allowance (2007)’ in rural area and ‘lactating allowance for working mothers (2010)’ in city, is active extensively in villages but less active in cities.

While being under Dakshingaon union parishad, poor mothers of Nandipara were covered under the ‘mother and child benefit programme'. They don’t get this service anymore since the area came under the city corporation.

In this regard, programme director (mother and child benefit programme) of the women affairs department Rubina Ghani told Prothom Alo, the programme was less active in cities. The programme was supposed to be re-launched across country including the city corporation. Mothers can apply online.

From now on, five expecting mothers from each of the 75 wards of Dhaka south city and 54 wards of north city will get allowances every month. More than 1.2 million (1,254,000) mothers across the country will come under this programme.

Campaign must be increased

 

Country director of ActionAid Bangladesh Farah Kabir said, government officials should see to why free government services have to be bought with money and where are the loopholes.

Information about what government services are available and which ones are free has to be put on notice boards of all government offices. Campaigning activities have to be increased.

Non-government organisations and the media have to work alongside government agencies for that. Those who need services will be deprived of it if they don’t have the information, she added.