Scaling-up Innovations Community Clinic in Bangladesh Dr. Makhduma Nargis Additional Secretary & Project Director Revitalization of Community Health Care Initiatives in Bangladesh (RCHCIB), MoHFW Concept of Community Clinic(CC) Public-Private partnership Activities Implementation Land for CC construction Community Construction GOB Medicine & other inputs GOB Service Providers GOB Management Community Group +GOB Community Group (CG) and Community Support Group (CSG) are the key player 2 Community support groups (CSG) CC catchments area has appr. SubDist. 1200-1500 HH & pop. CSG-1 (13-17 members) Health Complex 6000-10000 (UHC) CSG Promote the use of CC services CG and educate (13-17 members) CG community people Responsible in on health daily operation of CC, monitoring of CC function, fund raising for CC Local Govt. improvement (Union Parishod) CSG was introduced based on the successful community mobilization model named “Narsingdi Model” developed by JICA. 3 Background and History . The present Government during its previous tenure in 1998 planned to establish 13,500 Community Clinics. During 1998-2001 period 10,723 Community Clinics were constructed and 8,000 started functioning. Due to change of govt. in 2001 Community Clinics were closed and remained as such till 2008. Govt. in 2009 has taken initiative for revitalization of Community Clinic as priority program & is being implemented through RCHCIB under MoHFW 4 Tertiary Level Services of CC Medical University Medical College Hospital Specialized Hospital Service Level: Primary Level (Service time: 9 AM-3 PM) Secondary Level Service Providers: District Hospital Mother and Child Welfare Center Community Health Care Provider (CHCP); Health Assistant; Primary Level Upazila (Sub District) Health Complex Family Welfare Assistant; Union Health & Family Welfare Center Community Clinic (CC) Available services: Maternal & neonatal health care services (ANC/PNC); Integrated Management of Childhood Illness (IMCI); Reproductive Health and FP services; EPI; Nutritional education and micro-nutrient supplements; Health education & counseling; Screening of Chronic Non Communicable Diseases Treatment of minor ailments, common diseases & first aid Establishing referral linkage with higher facilities 5 Coverage and Functionality of CC 90.3% 15000 achieved 10000 5000 Please check and put data if available 0 Target Functional Service seekersService attendedseekers CC 28% 100408157 up! 72233952 48% up! 37299744 23691306 14627416 2009 2010 2011 2012 2013 Process of CC Scaling-up Service Provision Wing Recruitment & MIS & Construction Training of Supply of monitoring of CC service Drug/logistics system provider development Community people donated the land for CC Community Engagement Wing CG CG members CSG formed & Operational Local Govt. revised & CG CSG training Guideline held training is training held coming… developed JICA provided technical (“Narsingdi Model”) & financial (Yen Loan) support to the entire process of nurturing community engagement. Roles of the government: leading scaling-up Designing and guiding partnership; ◦ To optimize available resources for CC revitalization Recruitment and training of health service providers and relevant parties; ◦ To ensure the quality of service delivery Mobilize community engagement; ◦ To make people’s representatives directly involved with CC Monitoring achievement: ◦ To make all efforts are accountable Key for scale up: Partnership Development Partner: JICA: technical and financial support to develop and conduct CHCP/CG/CSG/ Local govt. bodies training, and monitoring of CC/CG/CSG WHO: CHCP Training development and ToT conduction, and monitoring of CC GAVI HSS: construction of delivery rooms at 105 CCs, and monitoring of CC NGO & Local Government: 14 Partner NGOs (MoU with RCHCIB ) works for capacity development of CG & CSG and submit quarterly reports. Quarterly NGO coordination meeting is held to monitor and update the NGO activities Local govt. bodies use annual budget for improvement of CC 9 NGOs/DPs provide support for CC functioning (as of June 2014) P A N C H A G H A R H N I L P H A M A R I D I N A J P U R K U R I G R A M R A N G P U R G A I B A N D H A J O Y P U R H A T J A MA L P U R S H E R P U R N E T R O K O N A S Y L H E T N O A G O A N S U N A MG A N J B O G R A N O W A B G A N J MY M E N S I N G H R A J S H A H I S I R A J G A N J K I S H O R E G A N J MO U L V I B A Z A R N A T O R E T A N G A I L H A B I G A N J P A B N A G A Z I P U R B R A H MA N B A R I A K U S H T I A MA N I K G A N J ME H E R P U R R A J B A R I D H A K A N A R A Y A N G A N J C H U A D A N G A J H E N A I D A H F A R I D P U R MU N S H I G A N J C O M I L L A MA G U R A MA D A R I P U R G O P A L G A N J C H A N D P U R N A R A I L S A R I A T P U R K H A G R A C H A R I J E S S O R E R A N G A MA T I B A R I S A L L A K S H MI P U R F E N I J H A L A K A T I N O A K H A L I P E R O J P U R B A G E R H A T C H I T T A G O N G K H U L N A B H O L A S A T K H I R A P A T U A K H A L I B A R G U N A B A N D A R B A N C O X 'S B A Z A R Among 64 districts 40 districts (about 70%) already supported by partners. Lesson Learnt: Delivery Intervention CC functioning well where CG and CSG are proactive. Effective participation of UP facilitates CG and CSG function properly. Capacitated CHCP, CG and CSG act enthusiastically and ensure QoC. Involvement of external facilitation ensure regular supervision and monitoring. Community engagement makes CC service providers more accountable. 11 Lesson Learnt: Scaling-up Strong and continuous political will to revitalize CC made CC services stable and reliable Ensuring service delivery and creating a mechanism of community engagement resulted in community ownership of CC Partnership with multiple stakeholders is critical for the success of CC CC is not merely a one-stop health center but can be a center for sustainable development 12 Future Plan To intensify community engagement & Local Govt. To make CG financially solvent through local fund generation To train all the female CHCPs as C-SBA To establish E Health provision To establish an effective referral system To strengthen Supervision & Monitoring System with Quality of care H.E. Honorable Secretary General of UNO Mr. Ban Ki-moon talking with adolescent girls at the premises of Mobarokpur Community Clinic under Kulaura Upazila of Moulvibazar District on 16/11/2011. 14 Thank you so much 15 .