Community clinics in dire state as snakes slither in, tidal waters come in

Community clinics are now in a state of neglect and disrepair. The roofs and walls of some are crumbling. Some have no access roads. Others are flooded by tidal water. The reality is that people are not receiving proper services from community clinics.

A Prothom Alo investigation has revealed this picture of community clinics across the country. Journalists found that glucometers are out of order in most community clinics. Some clinics have no healthcare workers. People in at least one area complained that they have to buy medicine for money from community clinics.

Prothom Alo correspondents visited 32 clinics in eight districts across eight divisions of the country during the last two weeks of August. They found that many clinics have no access roads, some are submerged during the monsoon, some are broken and dilapidated, a few have unusable toilets, and almost all have idle glucometer devices. There is a shortage of staff, and allegations of medicine sales persist. In fact, rural people are not getting the expected services from community clinics.

The eight districts are Panchagarh, Jhalakathi, Bagerhat, Manikganj, Mymensingh, Noakhali, Sunamganj, and Naogaon. In addition, the condition of community clinics in some other districts, including Khulna, was learned through phone conversations.

Prothom Alo journalists spoke to people who came to receive services, to Community Health Care Providers (CHCPs), and, in some cases, to the Civil Surgeons of the respective districts. Almost everywhere, dissatisfaction was evident.

CHCPs are employees under the government’s revenue sector, in the 16th grade. They are assisted by health assistants and family welfare assistants, who are also of the same grade. However, there is no cleaner (ayah) post in the community clinics. The government does not pay the electricity bills. Each clinic has an 11-member community group responsible for its management. Members include the Union Parishad member, the land donor, and the CHCP. The group raises local funds to pay the ayah’s salary and the electricity bills.

The Awami League government started establishing community clinics in 1998, with the goal of bringing primary healthcare to people’s doorsteps. The plan was to set up clinics in rural areas—one for every 6,000 people. A CHCP would be in charge of the clinic, assisted by two others. The health assistant would be present three days a week, and the family welfare assistant on the other three days, to help the CHCP.

The community clinic programme began as a project. Since 2018, it has been operated through the Community Clinic Health Support Trust. According to the latest data from the trust office, there are 14,467 community clinics currently in operation across the country. Each clinic provides 22 types of medicines free of charge. On average, about 500,000 people receive services daily from these clinics. The Health Sector Reform Commission has recommended renaming community clinics as “Rural Health Centres.”

Regarding Prothom Alo’s observations, the Managing Director of the Community Clinic Health Support Trust, Md Akhtaruzzaman, said in August that around 10 per cent of community clinic buildings are in poor condition and need renovation.

He also said that since September, medicines have been regularly supplied to every clinic.

However, inquiries made yesterday, Friday, in Dacope Upazila of Khulna revealed that medicines have not been delivered to the area’s 24 community clinics since last May.

A CHCP from one of the clinics told Prothom Alo yesterday, “I have nothing but paracetamol. When villagers come, I only give them paracetamol, provide health education, and express my regret.”

The Karuakathi Community Clinic in Karuakathi village of Magar Union under Nalchity Upazila in Jhalakathi district tells another story. Housewife Monowara Begum from the village said that except for fever-cold medicine and birth control pills, nothing else is available here. The few types of medicines that arrive run out within 15 days of the month.

Pointing to the dilapidated clinic, farmer Osman Sikder from the same village said, there is no environment for treatment here and the clinic needs renovation.

The Karuakathi Community Clinic, built in 2012, stands beside a canal in Nalchity Upazila of Jhalakathi district. When visited on 25 August, it was found that the clinic was built on low land. Due to tidal water levels, a ditch-like area has formed in front of the clinic. Water stains were visible on the walls inside and outside the building.

Talking to people who came for services, it was learned that the canal connects to the Sugandha River about two kilometers away. During new and full moons, when the Sugandha River experiences high tides, this clinic gets submerged. At least twice a month, the clinic goes under water. During those times, no one visits the clinic. This situation has persisted for many years.

Earlier, on 19 August, Prothom Alo visited the Barahit Community Clinic in Paikura village, beside the Ishwarganj-Uchakhali road in Mymensingh district, and found an even worse situation.

The clinic was mostly underwater, with plaster falling off the walls. At first glance, it looked like a clinic in a swamp. Locals said the entire area remains waterlogged throughout the rainy season. During this time, no services are provided.

Local resident Amena Khatun said, “The inside becomes knee-deep in water. It’s impossible to keep the clinic open. The CHCP, family welfare assistant, and health assistant don’t come then.”

On the same day, when visiting Alalpur Community Clinic in Mymensingh Sadar Upazila, an even more distressing scene was found. The clinic was surrounded by bushes and submerged in water. The inner rooms were also flooded.

CHCP Shahina Begum, in charge of the clinic, told Prothom Alo, “Because rainwater enters the clinic, I cannot sit inside. Snakes come in.”

Prothom Alo correspondents found several clinics with no access roads or severely damaged paths due to lack of maintenance. This has become a rather common scenario.

However, the condition of the Kayetkanda Community Clinic in Madan Upazila of Mymensingh district is worse. The clinic is surrounded by water, and there is no road leading to it. Since its construction in 2012, it has been submerged every monsoon. Yet, it cannot be said that the clinic’s operations completely stop during the rainy season. Local people said that the clinic operates from an abandoned tin-shed house belonging to Sudhangshu Talukder in Kayetkanda village.

On 19 August, CHCP Jyotirmoy Talukder was found at Sudhangshu Talukder’s house. He was sitting at a table, with some medicines placed on it.

Anita Sarkar, a resident of the village, said, “The clinic remains locked during monsoon. In the dry season, it opens. Then the clinic runs from a room in a house in Kayetkanda village.”

On 22 August, at the Kanyapara Community Clinic in Hajnagar Union under Niamatpur Upazila of Naogaon district, cracks were visible on the walls, pillars, and ceiling. In some places, iron rods were sticking out. The building had been declared abandoned. Yet, services were still being provided, and people continued to come for treatment.

CHCP Imran Hossain of Kanyapara Community Clinic told Prothom Alo, “The building has been declared abandoned. As there is no alternative arrangement, we continue to provide services here at great risk. I stay here in constant fear. Sometimes, plaster falls from the ceiling.”

There are more such dilapidated clinics. Two years ago, the Fulhara Community Clinic building in Pahrail Union of the same upazila was declared abandoned. Services are now provided from a room at Fulhara Borsomaspur Nurani Hafezia Madrasah.

CHCP Nuruzzaman Bulbul of that clinic told Prothom Alo that the building was constructed in the 1998–99 fiscal year. Due to long neglect and lack of repair, the plaster from the walls and ceiling began to fall off. Gradually, cracks appeared in the walls and ceiling. Two years ago, the building became completely unusable. Now the clinic is being run from a room in the madrasah.

Meanwhile, polythene sheets have been placed on the roof at the Chandash Community Clinic in Mohadevpur Upazila of Naogaon to stop rainwater from leaking. Still, water was seen dripping through the ceiling and pooling on the floor along the walls. At the Karuakathi Community Clinic in Nalchity Upazila of Jhalakathi, plaster was seen falling from the ceiling and walls.

The same situation exists at the Charkathi and Baruipara Community Clinics in Bagerhat district, and at the Hijulia Community Clinic in Ghior Upazila and the Ghior Community Clinic in Saturia Upazila of Manikganj district.

Naogaon Civil Surgeon Aminul Islam told Prothom Alo, “I have been serving as Civil Surgeon for six months. In this time, I have visited several community clinics in the district, and the situation is very disappointing. Nearly two-thirds of the community clinic buildings in the district have become dilapidated. Even renovation will not make them fit for proper service.”

A disturbing example of occupying a community clinic — established to serve rural people — has been set by Monir Hossain, former member of Ward No. 8 of Basanda Union Parishad in Jhalakathi Sadar and general secretary of the union’s Awami League unit. He was the CHCP of the Agarbaria Community Clinic.

Locals alleged that Monir Hossain ran the clinic as he pleased. Most of the time, it remained closed and opened only during immunisation programmes. After the student-public uprising on 5 August last year, Monir Hossain fled the area.

Later, the health department assigned CHCP Monira Khanam to the clinic. However, locals alleged that she too does not keep the clinic open all the time.

Regarding this, Monira Khanam said, “Since taking charge, I have tried to keep the clinic open. There was a six-month break in medicine supply. Now patients are receiving treatment regularly.”

Community clinics are supposed to distribute 22 types of medicines free of charge. At one time, 32 types, including antibiotics, were provided. Eventually, antibiotics were removed from the list. In some places, there have been allegations of charging money for medicines.

There are complaints of medicine sales at the Charkathi Community Clinic in Bagerhat. Each person who takes medicine has to pay two taka. Kulsum Begum from Charkathi village, who works at the clinic as an ayah, said her salary and the clinic’s electricity bills are paid from the money collected through medicine sales.

In the Mashimpur Community Clinic of Ashwadia Union in Noakhali Sadar Upazila, similar allegations exist. Rozina Begum, a housewife from Mashimpur village, told Prothom Alo, “When we go to the clinic for medicine, we have to pay money. Without money, they don’t give medicine. Because of that, now when we fall sick, we buy medicine from the shop.”

Citing one incident, Rozina said, some days ago she gave birth to a daughter. When she went to the clinic for saline, they said it would not be given without payment. As she had no money with her, she couldn’t take the saline and later bought it from a shop.

At the Mannargaon Community Clinic in Sunamganj district, Prothom Alo correspondents saw a box beside the CHCP’s table. People coming for services were seen depositing five taka each. Reportedly, this money is used for repairing the building and other operational needs of the clinic.

In most community clinics across the district, people seeking services said that clinics fail to provide medicines as per demand. CHCP Zahirul Islam of Mannargaon Community Clinic told Prothom Alo, “If someone needs three medicines, I convince them by giving one. But people don’t want to understand.”

The main responsibility for providing services at community clinics lies with the Community Health Care Providers (CHCPs). Due to the absence of a CHCP, services at the Syedgaon Community Clinic in Nandail upazila of Mymensingh district have been closed for 10 months.

Each clinic is responsible for serving the villagers through a CHCP, a Health Assistant, and a Family Welfare Assistant. The clinic remains open from 9:00 am to 3:00 pm. The CHCP is required to be present six days a week, except on Fridays and public holidays. The Health Assistant attends three days a week, while the Family Welfare Assistant attends the remaining three days to assist the CHCP.

During a visit on 19 August, the Syedgaon Community Clinic was found locked, with firewood left to dry on the steps. Talking to local residents revealed that the clinic has been closed for 10 months because there has been no one appointed to the CHCP post. Villagers are not receiving any services or medicines. For even minor health issues, they are forced to go to the upazila health complex. People are frustrated due to the delay in appointing a new CHCP.

Residents living near the Kayetkanda Community Clinic in Sunamganj complained that the other two staff members, apart from the CHCP, attend irregularly. Mahfuz Alam Khan, the CHCP of Mannargaon Community Clinic in the same district, said his two colleagues do not attend the clinic regularly.

Bilkis Akter, the CHCP of Chandash Community Clinic in Mohadevpur upazila of Naogaon district, said that the Health Assistant and Family Welfare Assistant have been assigned to two additional community clinics. As a result, they come to this clinic only once or twice a week.

In Manikganj, the Health Assistant does not attend the Hijulia Community Clinic, both the Family Welfare Assistant and the Health Assistant are absent from the Ghior Community Clinic, and the posts of CHCP and Family Welfare Assistant have been vacant for a long time at the Bastia Community Clinic.

In Noakhali, complaints have been received that Health Assistants and Family Welfare Assistants are irregular at the Anantapur, Uttar Shahapur, Mashimpur, and Purba Ambanpur Community Clinics.

Such complaints have been reported from more than half of all community clinics. Due to the shortage of manpower, many people in rural areas are being deprived of healthcare services. They are forced to travel to upazila or district headquarters, which takes more time and increases expenses.

In community clinics, there are supposed to be proper toilet facilities along with access to water and electricity. However, Prothom Alo correspondents found that not all clinics have these three basic facilities functioning properly. In many cases, contractors installed water pumps, but the pumps do not work. Many clinics have no electricity, and even where there is electricity, there are no electric fans.

Although each clinic has a toilet, more than half of them are not usable. In some clinics, the toilets are unusable because of a lack of water.

The problems in these clinics go beyond water, electricity, and toilets. Correspondents also noticed other shortages. Each clinic was given a glucometer to measure blood sugar levels among rural residents. The purpose was to increase awareness of diabetes and provide basic assistance in treatment. However, glucometers were found in use in only four community clinics. In the rest, the machines were either broken or unusable due to the lack of test strips, depriving people of necessary services.

Public health expert and WaterAid South Asia representative Khairul Islam told Prothom Alo that community clinics should provide necessary and adequate services to the people, which would help reduce healthcare costs. Secondly, by strengthening community engagement—meaning making community groups more active—minor weaknesses could be resolved. Civil surgeons and the Community Clinic Health Support Trust need to pay more attention to these issues.

[Mahmudur Rahman, Jhalakathi; Raziur Rahman, Panchagarh; Sardar Injamamul Haque, Bagerhat; Abdul Momin, Manikganj; Mostafizur Rahman, Mymensingh; Mahbubur Rahman, Noakhali; Khalil Rahman, Sunamganj; and Omar Faruk, Naogaon contributed reporting.]