“The most important thing is that the healthcare services have reached every doorstep and people are coming to take treatment there.”
– Prime Minister Sheikh Hasina
Acknowledging the noteworthy efforts of Prime Minister Sheikh Hasina in the establishment of exemplary community clinics in Bangladesh, the United Nations has recently passed a pioneering resolution on community-based health care, entitled “Community-based primary health care: a participatory and inclusive approach to universal health coverage,” with unanimous support. The resolution highlights an innovative public-private partnership model, commonly known as “the Sheikh Hasina Initiative,” as an exemplary practice. The resolution recognizes the pivotal contribution of community clinics in promoting primary healthcare, enhancing women’s agency, promoting community involvement, and striving towards the attainment of comprehensive healthcare coverage.
It is recommended that member states undertake an examination of strategies to expand and leverage effective national practices, with specific reference to the Bangladesh Community Clinic Model. This resolution, which has received sponsorship from 70 countries, represents a ground-breaking initiative within the United Nations and the World Health Organization.
On the other hand, the adoption of the aforementioned resolution highlights Bangladesh’s unwavering commitment towards enhancing the health and overall welfare of its populace while also demonstrating its pledge towards advancing global health parity. Moreover, by ensuring the health coverage of Bangladeshi people, Bangladesh is also showing its commitments towards the Sustainable Development Goals (SDGs), and it is also anticipated that the required need will be fulfilled by the year 2030. On the other hand, Bangladesh is also playing a role model for other developing or even developed countries in the domain of expanding healthcare facilities for the mass population at a low cost and adding other private partners.
In particular, the resolution highlighted the ‘leadership role’ of Bangladesh in this field, which is essential for other actors. Besides, the COVID-19 pandemic and mass vaccination process also proved the need for community-based medical care. Therefore, the Sheikh Hasina initiatives for community clinics will also be an inspiration for the future world to fight against mass-level medical emergencies. Also, the effective execution of the resolution will yield substantial implications for the healthcare of a vast population across the globe by means of the establishment of health systems based on community clinics.
Moreover, the resolution has significant implications for promoting global collaboration in the pursuit of these objectives. The proposal urges international financial institutions, multilateral and regional development banks, and donors to extend suitable technical and financial assistance to facilitate the establishment and execution of health systems based on community clinics in member nations, especially those categorized as developing countries.
Bangladesh is known as the world’s most densely populated nation, with a population of over 163 million people living in an area of under 56 thousand square miles. As a consequence, the nation’s healthcare business has faced several challenges since its independence, mostly due to a lack of healthcare facilities across the country. Furthermore, socioeconomic problems have hampered Bangladesh’s healthcare industry for most of its history.
In 2023, the days of rural people in Bangladesh suffering from numerous ailments are long gone. Prior to the establishment of community clinics, practically, in every Upazila in Bangladesh, there was not a single healthcare facility dedicated to treating people living in rural areas. Therefore, the community clinics have shown to be an efficient and low-cost primary healthcare provider at the grassroots level by bringing vital healthcare services to the doorsteps of millions of rural people.
The journey started in 1996 when the Sheikh Hasina government started an initiative to cover the rural peoples under the healthcare structure. In between 1996-2001, Sheikh Hasina, a charismatic leader with a forward-thinking mindset and empathetic disposition proposed an ambitious strategy to enhance the healthcare industry. She had a deep concern for the health issues faced by rural villages and their inhabitants. Acknowledging the necessity of providing primary healthcare services to the entire population of Bangladesh, particularly those residing in underprivileged and geographically remote regions, she implemented the innovative “Community Clinic Model ” program.
The innovative community clinic model has revolutionized the provision of healthcare services by facilitating their accessibility to individuals in various regions of the nation. Between 1996 and 2001, a total of 11,000 community clinics were established during the individual’s term in office. Moreover, the process also facilitates the other supporting institutions to connect and create more health-related opportunities for the rural Bangladeshi’s.
Regrettably, following the departure of Prime Minister Sheikh Hasina from office in the early 2000s, successive administrations curtailed their backing for the community-based healthcare framework. Nevertheless, in 2009, the initiative was reinstated by Prime Minister Sheikh Hasina with a renewed vision and heightened determination. On this occasion, she not only secured the ongoing presence of the clinics but also reorganized the entire healthcare industry through the creation of multiple medical universities, nursing institutions, and instructional facilities. The endeavours undertaken have established Bangladesh as an exemplar for healthcare initiatives that are community-based.
The Sheikh Hasina Initiative; a role model for the world
The government has established more than 14,000 community clinics around the nation, with each facility serving a population of 6,000 people. Furthermore, Bangladesh now has 112 recognized medical schools, of which 37 are state operated and 70 are privately owned. Furthermore, the Ministry of Defence controls the functioning of six medical institutions linked with the Armed Forces in Bangladesh. The country has 43 nursing institutions that are run by the government and provide a three-year diploma program in nursing. In addition, the total number of hospitals in Bangladesh was 5,816 in 2022, signifying revolutionary progress in the health area.
Furthermore, the above advancements are closely tied to the greater advancement of the healthcare business, in which community healthcare plays an important role. In Bangladesh, it is a mandatory requirement for government physicians to work in rural areas for at least two years. The coordinated efforts aim to reduce healthcare disparities and provide access to high-quality healthcare for all people throughout the country.
Furthermore, thanks to the implementation of the “Community Clinic Health Assistance Trust Act,” millions of people now get treatments from community clinics, when only a decade ago, healthcare facilities in rural regions were severely underfunded. Furthermore, the legislation insured that the process of constructing and operating the community clinic would not be halted in the future.
According to a study titled ‘Community Clinics in Bangladesh: A Unique Example of Public-Private Partnership,’ practically all (96.9%) CCs are in easily accessible places with adequate infrastructure. The different communities give the land in each CC. The majority of the CCs (93.7%) are secured by community members. Cleaners, or ayas, selected by local communities maintain the cleanliness of the CCs. Community Groups (CGs) account for 88.9% of CCs, while Community Support Groups (CSGs) account for 96.8%. Monitoring is carried out in the majority of CCs (98.4%) via the review of monthly reports. For pregnant women, all CCs provide referral services.
Furthermore, health care delivery is rated as ‘good’ in more than three-quarters of CCs, while health education service is rated as ‘good’ in 96.7% of CCs. All CCs reported an increase in service consumption and the number of normal child births. Free medications (82.1%), free treatment (81.2%), simple access (76.3%), need-based health care (75.0%), and vaccination programs (68.6%) were viewed as benefits of CCs by service consumers. CGs are active in the administration of CC activities, according to almost all (99.0%) of CC service consumers.
The Sheikh Hasina Initiative as implemented in Bangladesh is a comprehensive approach aimed at tackling healthcare obstacles, with a particular focus on disadvantaged and geographically isolated regions. The program endeavours to furnish fundamental healthcare services to the entire populace and has achieved noteworthy advancements in closing the healthcare disparity within the nation. The United Nations has acknowledged Bangladesh’s accomplishments in this endeavour, establishing it as an exemplar for healthcare advancement. Recognition of Bangladesh’s potential to spearhead the worldwide advancement of rural health represents a distinctive prospect for the country to establish just healthcare frameworks that serve the global humanity.
– S. M. Saifee Islam is a Research Associate at the KRF Center for Bangladesh and Global Affairs (CBGA).
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