A new initiative through a Public Private Partnership
With critical shortage of health workers globally, community health workers (CHWs) are deemed essential to serve as a link between the rural community and the formal health system. The government of Bangladesh (GoB) strives to ensure equitable and quality health care for all citisens, emphasising reduction in maternal and infant mortality. This is done by expanding availability of Skilled Birth Attendants (Locally Known As Dokkho Dattri), Integrated Management Of Childhood Illness (IMCI), and Responsive Family Planning (FP) service delivery approaches based on the geographical regions and segments of the population.
In rural areas of Bangladesh primary health care (PHC) services are provided predominantly by a network of Family Welfare Assistants (FWAs) and Health Assistants (HAs). Community Health Care Providers (CHCPs) are scheduled to staff the Community Clinics (CCs) and a cadre of Community Skilled Birth Attendants (CSBAs) are being trained. Nevertheless, there is both : a shortage and mal-distribution of qualified health workers ; and a surplus of untrained or informal health care providers.
To act in this scenario, GSK-CARE Community Health Worker initiative was undertaken jointly by CARE Bangladesh & GlaxoSmithKline (GSK) to ensure consistent, high quality and sustainable Maternal, Newborn & Child Health (MNCH) services to a population of 1.4 million people in remote districts of Sunamgong Syhlet. This would be done, through a public-private partnership by mobilising 2000
community health volunteers, 700 local government members, 470 public and private health providers and development of 150 Private Community Skilled Birth Attendants.
This 3 years initiative is financed by GlaxoSmithKline (GSK), through their reinvestment of 20% of its profit, made in the least developed countries, into healthcare infrastructure and act as a catalyst of change. CARE is being the partner in Asia, including Bangladesh. This partnership is a very innovative one since it a true Public private partnership from national to local level. Moreover, it is a community led process, while being a complement to existing public health system to address inequity in accessing basic health services. It has the potential to influence public policy and practice.
On November 31, 2012, a very important milestone was achieved at national level with the signature of the Memorandum of Understanding (MOU) between Ministry of Health and Family Welfare (MOHFW) and CARE Bangladesh. This MOU actually sets the basis for sustainability by describing roles and responsibilities of each partner.
MOHFW for instance will provide Maternal Neonatal Child Health (MNCH) referral services through Upazilla Health and Family Welfare Complex, Upazilla Health Complex or district hospital, supplies and logistics such as Family Planning commodities, iron, folic acid etc. It will also supervise the 150 Private Community Skilled Birth Attendants (P-CSBA) developed through this initiative via Family Welfare Visitors, Sub-Assistant Community Medical Officer or Medical Officer.
CARE and GSK, on the other hand, will provide input support for trainings implemented by Government of Bangladesh accredited training institutions, establish Community Support Group, facilitate linkage between P-CSBA, communities, Union Porishad and health systems. Furthermore, it will also provide a business plan training to P-CSBA's for financial sustainability.
The proposed business plan training is a second reason for innovation within this initiative. This training will ensure indeed that P-CSBA's are able to develop their own business and become financially sustainable on their own over time.
The programme has therefore been launched on December 1, 2012 and recruitment of 150 candidates to be trained as Skilled Birth Attendants has started. CARE found many candidates, in the Sunamgonj area, which illustrates the willingness and entrepreneurship of women in such a very remote area.
One such woman is Rehana, a 29 old widow, with 2 children. She initially was trained for ACCESS, a pilot project in 2012. She was suffering economically, socially and psychologically at that stage so much that she had to go to hospital several times during the 21 days training session. She finally completed the training and went in the field.
10 months later, Rehana was warning for heur communiât, takin care of pregnant women and children. She could even save life of one beneficiary, when she followed Rehana's advice and went to hospital for eclampsia treatment. The community recognised her added value and Rehana is able today to earn up to tk 1,200 per month with the proposed services. But, it did not end here, she was so motivated to become a successful Private Community Skilled Birth Attendant in the new GSK -CARE programme, that she sat for her secondary exam, a recruitment criteria, and passed it with great aplomb. Such an example definitively illustrates how this initiatives can empower women, helps them to fight against poverty.
However this recruitment of attendents and ensuring their safety is the first challenge CARE is facing, considering the remoteness of the villages and the prevalent patriarchal attitude of the communities. But CARE is confident that this challenge will be overcome this and follow through with the 6 months training planned in April 2013.
In 2015, it is expected that this design of an unified vision of front line health workers; development of a consensus on how to improve their service skills and ignite the entrepreneurial spirit will create a sustainable healthcare system to ensure universal access in Bangladesh.
The writer is team leader of GSK-CHW, CARE Bangladesh & Isabelle Adeline GSK France Volunteer.