How community clinics get closer to marginalised people

Smriti Khondoker, from the Hariabari village of Islampur upazila, Jamalpur, was anxious about her health condition while pregnant. She was uncertain where to get proper pregnancy counselling in her area.

A community nutrition promoter (CNP) from a non-governmental organisation (NGO) advised her to seek maternity care services from the Hariabari Community Clinic (CC), 30 km away from Jamalpur town.

"I followed the advice and got four regular check-ups done at the clinic after I became pregnant. The clinic even supplied iron folic acid tablets regularly during the period of my pregnancy for free," she said.

However, when it was time for delivery, a community health care provider (CHCP) of the community clinic referred her to the Upazila Sadar Hospital for safe delivery where she gave birth to a daughter.

"My daughter is 5 months old now. Both my daughter and I are in good health. The community nutrition promoter regularly visits me to ensure that I am taking my medication regularly," she said.

Like Smriti Khondoker, around 12,000 people from the villages of Mojaata, West Mojaata, Hariabari and West Hariabari in the remote areas of Jamalpur are now taking medical care at the Hariabari Community Clinic thanks to the BIeNGS Project of the World Vision.

The project has introduced Citizen Voice and Action (CVA), a social accountability model, to raise awareness among community people about their rights. Workers and volunteers of the project are now influencing people to seek services from the community clinics to make them more effective.

People concerned said after introducing the project, the people associated with the community clinic services are now more accountable to provide quality services.

These clinics are managed by Community Groups (CG) and Community Support Groups (CSG) composed of community members, landowners and local government representatives.

A CG member, Ataur Rahman, said, "Although many were reluctant to seek treatment in these clinics earlier, now almost all the people of these four villages are receiving various services here. The BIeNGS Project has mobilised and sensitised us to improve the services of the clinics."

The Community group (CG) , who are responsible to managed community clinic, holds monthly meeting that makes community clinic more functional and provide equality service. Photo: Courtesy

The project emphasises on taking antenatal care (ANC) and postnatal care (PNC) services for pregnant and lactating mothers along with other services. The project has ensured that 100% of the area's adolescent club members take iron folic tablets from community clinics.

Since its inception, the project has been working to strengthen the services of the 224 community clinics covering three upazilas in Jamalpur- Jamalpur Sadar, Islampur, Dewanganj, and three upazilas in Sherpur- Sherpur Sadar, Jhenaigati, Sreebardi.

World Vision has implemented the CVA approach in 46 of these 224 community clinics. Their intervention improved the quality of services in these clinics.

Last year, around 14,000 patients received services from the Hariabari Community Clinic. Lipa Begum, community health care provider of the clinic, said, "The number of patients at the clinic is relatively higher than in other clinics due to the continued motivation and counselling by the BIeNGS project."

Kurra Khatun, an SSC candidate and president of the Hariabari Adolescent Club, said, "The project helped us form a club with 20 girls. We meet at least once a month and discuss menstrual hygiene, reproductive health, and issues related to adolescence." 

"We learned a lot of things about menstrual hygiene here. Our members are now taking iron folic tablets from our nearest community clinic and taking services from there as well," she added.

Chandan Z Gomes, senior director (operations), World Vision Bangladesh, told TBS, "These community clinics are a landmark initiative of Prime Minister Sheikh Hasina. These clinics are working to ensure health services for marginalised people. The demand for treatment from these clinics by the masses is steadily increasing."

He added, "Basic health services are being provided in these clinics with the participation of community people. The BIeNGS project works to ensure public participation and quality of services. As a result of improved services, infant mortality and maternal mortality have decreased a lot in our working areas."

The Bangladesh Initiative to Enhance Nutrition Security and Governance (BIeNGS) is a multisector nutrition project aimed at improving maternal and child nutrition for 153,825 nutritionally vulnerable families or more than 17 lakh people in Jamalpur and Sherpur districts. 

The project also ensures the strengthening of health and nutrition service delivery systems.

The project is co-funded by the European Union, and the Australian Government through the Australian NGO Cooperation Programme (ANCP), and is being implemented by a consortium of national and international development entities- Unnyan Sangha (US), International Food Policy Research Institute (IFPRI-HarvestPlus, USA), Institute of Development Studies (IDS, University of Sussex, UK), and World Vision (Bangladesh, Australia and the UK).