When Abul Kalam Azad, a District Policy Forum (DPF) member of Jamalpur, pointed out that the road leading to Chandanpur Kabi Kafiluddin community clinic was dilapidated and that the clinic did not have running water because there was no deep tube well, the sub-district’s top health official promised that he would look into it as soon as possible.
This happened at a meeting that the Jamalpur DPF organised as part of its campaign to improve services at local community clinics using social accountability tools. The forum is working to bridge the gap between government officials and local citizens, and DPF members are hosting activities geared towards raising awareness about four social accountability tools. The goal is to use them to influence the District Administrations and encourage action and improvement of local community clinic service.
The District Policy Forum is Platforms for Dialogue’s (P4D) newest initiative that is working to strengthen civil society and government accountability mechanisms in Bangladesh using four key social accountability tools (SATs) – Citizens’ Charter (CC), Right to Information (RTI), National Integrity Strategy (NIS), and Grievance Redress System (GRS). Funded by European Union and in partnership with the Government of Bangladesh’s Cabinet Division, P4D has formed 12 DPFs in 12 of the country’s districts focusing on three crucial issues – quality education, child marriage, and health care in community clinics. DPFs aim to bring together both local government representatives and the community leaders for a more collaborative and unified approach towards community development using the key SATs. P4D District Facilitator, Mr. Shafiquzzaman, played a vital role in forming the forum. “I tried to choose people with an influential social position to join the DPF because they have an impact on people. Also, they meet the criteria to be a member of the forum.” Some of the members were recruited because of their previous experience working as a Multi-Action Partnership (MAP) member in a previous phase of the project, and the DPF also recruited journalists and CSO (Civil Society Organisation) members to join the DPF.
“People know about all the community clinic services now, so there is a steady flow of patients at my community clinic,” said Nazmul Alam, the Community Healthcare Provider (CHCP) of Kabi Kafiluddin Community Clinic. Masuma Akter, the Head of Family Planning at the clinic said she sees 5-7 women daily, and most of them come to enquire about family planning methods and to get birth control pills or injections. The policy forum has managed to make people aware that community clinics are in fact an initiative under the public private-partnership, which makes the public owners of the clinics too. As soon as they realised that it was no different from the local mosque, temple, or school, they began raising funds for the clinic. Though it is not enough for major repairs, citizens are trying their best to contribute to the clinic. “But even that is a good start,” said Abul Kalam Azad, who also pointed to the increased flow of patients as a sign of the DPF’s success.
This small clinic, besides having a Citizen’s Charter, also has a complaint box where patients can submit their complaints and recommendations. The community group members, who constitute the steering committee of sorts for the community clinic, said they had learnt about social accountability tools such as RTI and GRS through the DPF.
Septuagenarian Shamsul Haque was suffering from asthma and a stomach ache. Living practically next door to the clinic, it was a quick trip back for him with antacids that would last five days. “I come here whenever I feel any discomfort, which is rather often at my age. The official is kind and listens to me before prescribing something. The medicine works every time. So, I’m happy,” he said. Haque said, thanks to the community clinic, they do not have to travel all the way to town anymore.
The top health official of the district, Civil Surgeon Dr. Pronoy Kanti Das, said that the community clinics in Jamalpur were playing a vital role in reducing the mortality rate of children under the age of five and pregnant women, hence working towards SDG 3 - Establishing Good Health and Well-being. “Working hand-in-hand with the DPF members was satisfactory,” he said, adding that it was particularly effective to bring down the number of C-section deliveries, which accounted for up to a fourth of the births in the area.
“They have raised awareness and motivated people to consider natural delivery through their advocacy and training.”
While C-sections can be necessary considering the safety of both the mother and the child, in many cases they were proven to be unnecessary and posed greater health risks in the long term. That is why pregnant women are encouraged to opt for vaginal birth provided their overall condition permits it. “DPF members have motivated pregnant women and their families to opt for natural delivery, if possible,” said the top family planning official of Jamalpur, Mazharul Haque Chowdhury. Apparently, the recent figures show these efforts have started yielding results with just nine cases out of 120 opting for a C-section.
Due to the DPF’s campaign on SATs, local citizens are also more aware of and invested in the services offered at the community clinic. The civil surgeon said,
“I had received complaints that a local community clinic was not open. So, I made a surprise visit to the site and fixed the problem. Now, the CHCP does not skip work, and the locals are happy.”
Although the pandemic created obstacles for the policy forum, they are still trying to continue their awareness raising campaign and other activities. They conducted blended meetings, trainings, and campaigns on SATs where DPF members, government officials, and the stakeholders were present. In the dialogue meeting, service providers and the general public were able to communicate frankly and openly, resulting in fruitful discussions which helped resolve some critical issues that had never been brought up before. A local government official promised to ensure that the clinics would be more easily accessible in response to a complaint about broken roads needing repair. DPF President Shamima Khan had rightly chosen to focus on community clinics, which has helped the locals during the ongoing pandemic. Besides planning forum activities, Khan said she was planning to sit with the health care providers at community clinics and see if it would be possible to raise their pay which has not increased in 10 years. “After all, they are the ones who provide the service, and we must look after their welfare as well to make sure that the clinics run efficiently.”
Jamalpur DPF has had an exciting journey and has tapped the right chords so far. It wishes to continue bringing positive changes to the lives of everyone in the community by ensuring a collaborative approach to fixing local issues.