Updated: Jun 20
“Paracetamol, iron tablets, and antacids go out of stock before the third week of each month. As a result, patients go back empty-handed.”
Kabita Rani from Gotapara walked into a small but well-kept community clinic at Mukkhait to collect another dose of her regular cough medicine as she held the end of her brown cotton saree against her nose, guiltily apologising for not wearing a mask. “I won’t forget it next time, I promise,” she added after answering Mizanur Rahman’s, the Community Healthcare Provider (CHCP), questions.
Kabita Rani’s cough has been bothering her for quite a long time; her legs have been itchy for the last couple of days as well. “Here, take these pills today and tomorrow, and follow the same dosage as before,” said Mizanur in a caring voice. “And what about the itchy legs?” asked Kabita Rani. “Come early next month; I am out of the ointment now. And it would be better if you could go to the town and see a skin doctor.” Kabita was followed by sexagenarian Abdul Jabbar suffering from asthma and went home with a few days’ worth of pills. Several more patients were waiting in line to see the ‘medic’, as the locals fondly call him.
An EU-funded project in cooperation with Bangladesh government’s Cabinet Division, Platforms for Dialogue’s (P4D), formed the Bagerhat District Policy Forum (DPF) which has been trying to galvanise the clinic management committee. Thanks to their active engagement, this little clinic has made significant improvement on its quality of service. As part of their active participation, the management committee members have made it a routine to drop in at the community clinic randomly just to see if everything is fine. P4D District Facilitator, Gopi Nath Saha, played a vital role in forming the forum. “Those I chose as a DPF member have social status. I chose them because they have an impact on people in the community. Also, they meet the criteria to be a member of the forum. Some of them are recruited because of their previous experience working as a MAP member. We also considered journalists and CSO (Civil Society Organisation) members for the DPF.”
Current Vice President and former Ward Member, Abdul Gaffar, had come around and noticed that the large plastic bowl to weigh new-borns seemed quite uncomfortable without a cushion or mattress on it. “I will raise the matter at the committee meeting to gather some funds for that,” he told Mizanur as he left. The entire community clinic bore clear signs of regular maintenance. Clean washrooms with soap and running water were a welcome sight.
The District Policy Forum’s efforts to explain that the community clinics, part of the government’s public private partnership (PPP) that belonged to them too, had been successful. Consequently, the locals took an interest in its services as well as the facilities.
This community clinic is perhaps one of the very few in Bangladesh equipped with an oxygen cylinder, a special arrangement stewarded by the policy forum members. However, problems remain. Mizanur Rahman says he runs out of many of the commonly used drugs within three weeks of receiving medicine shipments. “Paracetamol, iron tablets, and antacids go out of stock before the third week of each month. As a result, patients go back empty-handed.”
Dr. Prodip Kumer Bokshi, the Sub-District Health Officer of Bagerhat said, “We have already set up delivery rooms in ten Bagerhat community clinics. We plan to train the personnel to ensure the presence of trained birth attendants.” He said that the joint efforts of government officials and locals have only strengthened after DPF members became active advocates to improve the community clinics.
“It was like being jarred to alertness from a lazy slumber. We have become far more active because we know the policy forum members will be on the case and enquire about every detail,” said Bikash Kumar Das, the Deputy-Director of Family Planning. He also thought that the public hearing, dialogue meeting, and campaigns of the District Policy Forum had been effective in pointing towards the lack of coordination between government and non-government platforms. The meetings were also useful in bringing crucial problems plaguing the community clinics, such as mismanagement, shortage of medicine supplies and skilled practitioners to provide services. Following DPF intervention, the DC ordered the local engineer in charge to collaborate with the local WASH committee to allocate necessary number of tube-wells, sanitary latrines for the schools, and community clinics in the area. With advice from the DPF, the management committee is also planning to reach out to the Health Ministry directly about the shortage of monthly medicine supplies.
A veteran journalist and DPF president, Babul Sarker remarked, “The DPF brought together 20 individuals in high social standing and with significant goodwill so that we could use that network and galvanise the local administration and local elected representatives as well.” That, he said, had been what the policy forum wanted to achieve in the first place — to act as a catalyst and facilitator. For instance, he pointed out that when at the dialogue meeting people spoke of their problems, the policy forum members were able to get commitments, albeit verbally, that these issues would be addressed. “In response to a complaint that the community clinics often did not have water, the local Head of the Public Health Engineering Department (DPHE) said he’d immediately order the necessary construction materials so that the next tube-well in the community be placed at the clinic.” Furthermore, he said, the District Policy Forum meetings and discussions had contributed significantly in raising awareness about social accountability tools and also about the people’s role in a public-private partnership initiative.
“People came forward to improve the community clinics just the way they do in cases of mosques and temples.”
M.A. Salam Shaikh, the General Secretary of DPF said, “Government officials have become more serious in visiting the community clinics, which has in turn made the clinic management committees more active and alert as they are often held accountable for lapses.”
The goal of the DPF members is to establish a sustainable chain of service so that even after the project ends, the locals can experience a hassle-free, long lasting, and effective distribution of the system. Furthermore, they are keen on providing adequate medicine to the patients and want to ensure they bring in modern healthcare facilities like x-ray and ultrasound machines to serve the community.
The District Policy Forum in Bagerhat is well on its way to creating an example of how continued collaboration between the government and private sectors can bring about prompt results. The Bagerhat DPF plans to move forward with renewed purpose to ensure steady flow of medication and quality hospital services so that people like Kabita can keep trusting their ‘medic’ for their health concerns well into the future.