Community clinics to be renamed as rural health centres

The Health Sector Reform Commission has recommended renaming community clinics as ‘rural health centres'. The commission in its report also suggested changing the designation and roles of the field-level health workers, and proposed a clear definition and boundary for primary healthcare.

The commission has stated that the constitution should recognise primary healthcare as a right. The government will be legally obliged to provide free primary healthcare to all the citizens. The formulation of a new law has been proposed for that.

Members of the Health Sector Reform Commission submitted their reform report to the chief adviser of the interim government, Professor Muhammad Yunus, on 5 May. The report noted that numerous questions had been raised regarding the definition and jurisdiction of primary healthcare. And the commission has provided a clear definition of primary healthcare in context.

Overall, five different types of services will be covered under primary healthcare. First, information services by providing people with information on health, nutrition, and family planning. Second, health improvement services for child and maternal wellbeing, adolescent health, and the care and improvement of elderly health.

Third, limited-scale medical treatment for pneumonia, diarrhoea, filariasis, black fever, malaria, tuberculosis, dysentery, conjunctivitis, ear infections, skin diseases, gum infections, nasal infections, normal fevers, nausea, headaches, acidity, dog and snake bites, drowning incidents, choking, minor accident-related injuries and bleeding, bone fractures, deworming, anaemia, uncomplicated diabetes and hypertension, chronic respiratory diseases, arthritis, mental health issues, and bacterial sexually transmitted infections.

Fourth, family planning services. Fifth, disease prevention and control services including EPI (expanded programme on immunisation), disease surveillance, and waste management.

Kazi Saifuddin Bennoor, convenor of the civic organisation named ‘Shushasther Bangladesh’ and a pulmonary disease specialist, told Prothom Alo that the recommendation to bring primary healthcare within legal obligation is a people-oriented move. The reform commission has clearly outlined the scope of primary healthcare.

However, including conditions like chronic respiratory diseases within the scope of primary healthcare would not be fitting as diagnosing and treating such conditions requires specialised knowledge and expertise. It’s not possible to do that on the primary healthcare level, he noted.

The report states that community clinics have to be renamed as rural health centres. The commission has proposed renaming union health subcentres as union health centres, and upazila health complexes as primary referral health centres.

Back in 1998, the then government launched the initiative to establish a community clinic for every 6,000 people in the rural areas of the country. However, the establishment of the community clinics was halted after 2001.

Then in 2007, during the caretaker government’s tenure, efforts were made to revive the community clinics. And the Awami League government again tried to expand community clinics across the country as a health infrastructure on the bottommost level.

According to the commission’s report, currently there are 13,926 community clinics across the country. These clinics serve about 600,000 to 700,000 (6 to 7 lakh) people every day. Community health care providers or CHCPs work six days a week, while health assistants and family planning assistants each work three days a week in these clinics. The community clinics are currently operated under the community clinic health assistance trust.

Not just renaming of the community clinics, the reform commission has also recommended changing the designation of three categories of health workers associated with these clinics. The positions of CHCP, health assistant, and family planning assistant would all be merged under a single title, rural health development worker. There will also be some changes in the area of work for these health workers.

At an event marking doctors’ week at Bangladesh Medical University on 24 April, special assistant to the chief adviser (acting as state minister for health), professor Md Sayedur Rahman remarked that the issue of community clinics is a sensitive one. There is a duplication of services in the community clinic zones.

Sometimes, the same family is being visited separately by a health assistant, a family planning field worker and a CHCP, whose main role is to distribute medicines. The government is considering ways to better coordinate the services provided by these three health workers to avoid duplication, he added.

The commission has further recommended that the community clinics have to have the facility to sell essential medicines at low cost, as per physician’s prescriptions. Additionally, these clinics also should have the arrangement to sell over-the-counter drugs that can be purchased without physician’s prescriptions so that people can access essential drugs in emergencies without unnecessary delays.