Lack of facilities plagues community clinics 

Md Rabiul Alam, a resident of Shikarmangal union in Madaripur, came to the Char Daulatkhan Community Clinic for medical care. He had been suffering from a cough and other cold-related problems for some time. But he had to leave the clinic empty-handed because there was no medical care nor any medicine available there.

It was a hot summer afternoon in May when a team of The Business Standard visited the rural clinic and found poor patients like Rabiul waiting in the rickety single-storey structure.

The scorching summer heat made patients at the clinic look for water, but there was no source of drinking water there. 

This clinic that was established in 1998 and started operation after an 11-year interval in 2009, has no sanitation facilities either.

Another patient, Jewel Mia, who was not given any medicine for an allergy problem, said the staff of the clinic are absent on most days. He added that even when they are in the office, they barely provide any medicine to the service seekers.

"It is their duty to provide primary treatment, but we never get the expected service. They also misbehave with people," he said.

The Community Health Service Provider of the clinic, Shikha Khanam, was absent. So were the health assistant and the family welfare assistant.

This is not an isolated scenario in the country's community clinics. Almost all the clinics share the same lack of service.

In the Kalaisardarer Char Community Clinic at Enayerpur union in Kalkini upazila under Madaripur district, at least 20 people were waiting for the community health service provider on May 14. The other staffers were also absent.

The patients said they came from different wards of the union but could not get any service.

Dr Al Bidhan Mohammad Sanaullah, upazila health and family planning officer at Kalkini, said that the CHSP was not on leave and that his mobile phone was switched off.

Professor Dr Md Abul Hashem Khan, line director of Community-Based Health Care (CBHC) under the Directorate General of Health Service (DGHS) said, "We will take stern action against anyone who neglects duties."

He admitted that at present there is a lack of infrastructure and manpower, and the appointment of 80,000 people was underway.

The Business Standard witnessed no visible improvement during a further visit to three of the health facilities in Daulatkhan upazila on October 23, five months after the previous visit.

Anticipations mostly unfulfilled
Government data says that there are 13,707 community clinics across the country, most of which were built between 1998 and 2000.

The government spends Tk575 crore per year for this service intended for rural poor people. Of this amount, Tk350 crore is spent on salaries of the staff and maintenance, and Tk225 crore for medicine.

Currently, the government is providing 30 types of medicines to the patients at these clinics.

But this noble venture has proven to be useless because of the lack of proper implementation.

"The government must appoint at least one registered doctor at every clinic to provide minimum healthcare for the poor," said Professor Dr AKM Mosharraf Hossain, chairman of the Respiratory Medicine Department at the Bangabandhu Sheikh Mujib Medical University (BSMMU).

Professor Mosharraf also said that even the medicines distributed by these clinics are mostly useless.

He added that it is impossible to provide proper medical service by using staff who have no knowledge of healthcare.

"A CHSP gets three months of training only. They cannot accurately identify any problem of a patient," he said.

This correspondent visited six community clinics in Dawlatkhan upazila under Bhola district on May 21. All the clinics were closed.

Jahangir Miar Dorjay Community Clinic at Char Khalifa union in Daulatkhan upazila was also closed.

"It opens occasionally, but not for more than three to five days a month. I have learned today that it is a government community clinic," said Kamal Uddin, a resident of the area.

The Business Standard team visited 20 community clinics in Kalkini, Dawlatkhan, Bhola Sadar and Bauphal Upazila, and found all their structures to be in a poor state.

Admitting the matter, Dr Barendra Nath Mandal, consultant of Community-Based Health Clinics (CBHC) said, the buildings were built between 1998 and 2001, and they were not well planned.

"The Health Ministry has a plan to rebuild the community clinics. About 200 new buildings have been built since 2018. About 2,000 buildings will be built by 2022," he said.

Community clinics were closed in 2001-2009
The community clinic project was put on a hold in 2001 after the BNP government came to power, and all the staffs were discharged. Officials said it was a political decision.

"The community clinics were established to provide healthcare to poor people in both urban and rural areas. Unfortunately, the initiative was stopped after the change of the then Awami League government in 2001. The service resumed with 10,624 clinics after the AL government returned to power again in 2009," said Dr Barendra Nath Mandal.

Dr Khondaker Mosharraf Hossain, who was the health minister under the BNP government (2001-06), said in an interview that the then cabinet postponed the community clinic service but did not close it. This interview was published in a document supported by the World Health Organisation titled "Community Clinic Health Revolution in Bangladesh." 

"The service was put on hold for a brief period only for a proper stocktaking of its activities. The situation at that time demanded this," the interview read.

"It would create unnecessary pressure on the existing manpower of the union health centres if they were given the additional responsibility of running community clinics on the top of their ongoing responsibilities," said Khandakar Mosharraf.