Despite not being economically solvent, Bangladesh has built an expanded health network in the rural areas.
The country of 170 million has a strong rural-based health infrastructure. Such a network and infrastructure are not usually seen. This infrastructure has an important role in the achievement of health sector in the last 50 years.
There are community clinics near the residents of people. There is union sub-centre each union and there are also upazila health complex in each upazila. There are district hospitals, sadar hospital or Medical College Hospital. With these organisations, a strong network has been created in every district. This network has not been built in a day.
The benefit of this network has been found while giving coronavirus vaccine. This vaccine is being given in every upazila and the government is centrally collecting this information from across the country within a short time. Many developing countries are lagging behind in the vaccine inoculation in absence of such expanded network.
Chief executive of the Public Health Foundation Bangladesh Taufique Joarder has carried out research on the institutions of the primary health services.
Speaking to Prothom Alo, Taufique Joarder said, "Special importance was given on building health infrastructure in the first five-year plan (1973-1978) adopted after the independence. At that time, an initiative was taken to establish hospitals at the thana level. The last initiative was to establish community clinics."
Bangladesh local government system is extended to eight divisions, 64 districts, 492 upazilas, 4,571 unions and 40,977 wards. The health infrastructure is established simultaneously in those areas.
The health ministry through the Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP) delivers services like family planning, immunisation, tuberculosis treatment and nutrition.
After the independence of Bangladesh, the health sector started delivering services through eight medical colleges, one post-graduate medical institute, 37 tuberculosis clinics, 151 village health centres and 91 maternity and child welfare centres. In 50 years, not only the number has increased but also a strong network has been built among the organisations.
Upazila Health Complex
Bangladesh was one of the signatories of Alma Ata Declaration in 1978. The declaration said that the health for all has to be ensured by 2000. It was necessary to build infrastructure to meet the objective. Health complexes were built in six upazilas under a project named Dishari.
Under the second five-year plan (1980-1985), the decision was taken to establish a health complex in each upazila and union health and family welfare centre in each union.
Now there is one health complex in each upazila. This is a hospital with 31 to 100 beds. There are emergency, outdoor and internal departments in these hospitals. Besides, there are separate department for mother and new born babies. Except specialisation, there are arrangements of all types of treatment facilities. Immunisation, treatment for respiratory problems and family planning services are also available in these hospitals. There are special corners for nutrition services. There are also facilities of different tests including X-ray.
Union sub centre
There is a government primary health centre in every union of Bangladesh. DGHS and DGFP operate them. Except Friday, these centres remain open from 8:00am to 2:30pm. There is a post of a physician in every centre.
Meanwhile, the government has created posts of midwife in 100 unions. A few centres have already recruited midwives. The purpose of this is to deliver maternity service, safe delivery and health services for new born babies.
Community clinic
The work for the establishment of a community clinic to provide primary health services for every 6,000 people started in 1998. The government has so far established about 14,000 community clinics across the country. This is the lowest tier of health service providing organisation. This is now operated through a trust. The clinics have been established in the land donated by the local people.
Some 30 types of medicines are provided from the community clinics. The services delivered from the community clinics include integrated maternal, neonatal and child health care, reproductive health and family planning, immunisation, nutrition education and health education.
The community clinics remain open from 9:00am to 3:00pm. Three people mainly work in each community clinic.
NGOs and voluntary organisations are working with the strong primary healthcare service network has been built across the country, comprising community clinics, union health centres and upazila health centre.
*This report, originally published in Prothom Alo print edition, has been rewritten in English by Rabiul Islam