64% community clinics lack water supply: World Bank

Khalek-er Haat Community Clinic, a busy healthcare facility in Kalkini upazila of Madaripur, has two latrines and a tube-well, but none of these work.

The lack of proper sanitation and water supply in the clinic is making the already hard life of rural patients even more difficult. Healthcare providers use latrines in the nearby Union Parishad Office and bring potable water from home.

"The patients have no choice but to get water from neighbourhood homes; using the toilet entirely depends on the homeowners," said community healthcare provider Hafiza Akhter.

This is not an isolated case. Most of the community clinics in the country have the same problem.

A report titled "An Assessment of Water, Sanitation and Hygiene Access in Bangladesh's Community Health Clinics" published by the World Bank in June this year revealed that around 64 percent community clinics do not have water supply, while 30 percent lack effective sanitation.

Only 16 percent of the community clinics were found to have two functional latrines, and a significant number of these have no hand-washing facilities on their premises.

"Lack of such facilities not only affects service delivery but also creates a risk of spreading infection," said WaterAid Bangladesh's Country Director Khairul Islam, who was involved in the survey.

A staggering 2,280 community clinics – around 19 percent of the total number – do not have proper water supply, latrine and hand-washing facilities.

The survey further showed 14 percent community clinics do not have any facility for washing hands, while only 14.5 percent have facilities for testing for the presence of toxic arsenic.

The World Health Organisation guidelines state that a healthcare centre must have at least four effective and developed sanitation systems. However, less than 2 percent of the community clinics in Bangladesh have met this criterion.

The situation of water, latrine and hand-washing facilities is slightly better in clinics in the western region of the country, but it is quite terrible in most upazilas of Mymensingh.

Major challenge

The World Bank report stated that the present state of sanitation systems in Bangladesh's community clinics is a major challenge against their effectiveness.

The World Bank assessment used three yardsticks – Basic Service, Limited Service and Without Service – to conduct the survey.

In case of water supply, Basic Service means a clinic should have improved source(s) of water supply in the facility. Limited Service means there is a source of water supply within 500 metres of the clinic, but all types of demand for water are not met.

Without Service means the source of water is an unprotected well, river or drain; or one has to go more than 500 metres to fetch water. It may also mean water is not available at all. There are separate yardsticks for latrines and washing hands.

The World Bank report shows 99 percent of the community clinics across the country have at least one sanitary latrine, 13 percent have two, and 2 percent have three or more.

"The government cannot ensure proper water supply and sanitation in all community clinics overnight. It will take time," Khairul Islam of WaterAid said, adding that the budget allocation for the Ministry of Local Government can be used for the purpose.

Meanwhile, Prof Abul Hashem Khan, line director of the government's Community-Based Healthcare Programme, said: "From now on, water and sanitation will be provided in every new model clinic."

The community clinic project was launched in 1998 with an aim of providing primary healthcare services to people in rural areas.

Presently, there are 13,707 community clinics across the country – one for every 6,000 people. Three health workers are posted in each clinic, and 30 types of medicines are available free of cost to the patients.
More than four crore people avail the services of community clinics every year.