Community Health Clinics are Struggling to Provide Doorstep Services at Rural Areas in Bangladesh: Field Observation

 

Tanjil Ahmed, Assistant Professor, Department of Public Administration and Governance Studies, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh.

Community health clinics (CCs) have garnered significant attention from Bangladesh's rural inhabitants as they provide primary and emergency healthcare services directly to their doorsteps. Between 1996 and 2001, the government of Bangladesh (GoB) aimed to establish community clinics at the village level to provide basic health care directly to rural inhabitants. During that time, 10,723 community clinics were established in Bangladesh, whereas 8,000 of them commenced operations.

Community clinics provide complimentary treatment, medicines, and vaccination services to individuals and healthcare tailored to their necessities.  These clinics served as the lowest level of healthcare facilities, providing an additional layer of protection in coordination with the local sub district healthcare system known as the Upazila tier. Community clinics have the potential to serve as a bridging phase toward a decentralized healthcare system in the future in Bangladesh. Nonetheless, the efficacy of these services is contingent not only upon their availability and accessibility but also on the perspectives and contentment of the individuals who depend on them.

Multiple factors influence rural people's decision to utilize community healthcare services in rural areas of Bangladesh. These factors include citizens' inclination to use these services, people's knowledge about these services, the proximity to community health clinic centers, the available services provided by CHC, the service cost of the community health clinic center, and the availability of doctors, nurses, and staff, among others.

However, over the past few years, community clinics have faced significant challenges in providing basic healthcare services to their targeted citizens. I have conducted a field survey in Kishoregonj and Jamalpur District in Jun 2024, which revealed that rural residents in Bangladesh encounter numerous unavoidable challenges in their quest for community healthcare services. Geographic isolation remains a major obstacle, as many rural regions are located far from healthcare facilities, leading to costly and time-consuming relocation. Inadequate infrastructure, such as dirt roads and limited public transit options, exacerbates this problem.

Moreover, rural healthcare facilities are also often understaffed and have a shortage of trained medical personnel, which results in lengthy wait times and poor healthcare services. Another issue is a lack of understanding about available services, with many rural people not receiving enough information about healthcare alternatives, preventative care, or treatment programs. Financial limitations make access even more difficult, since rural residents sometimes cannot afford transportation, medical costs, or critical prescriptions. The digital divide is also a factor, since restricted access to technology and internet connections prohibits rural communities from taking advantage of digital health solutions or telemedicine services.

In particular, it was found that most (63%) of the community health clinics are struggling to ensure qualified healthcare professionals, which indicates that these community clinics are providing below-average healthcare services to the rural inhabitants in Bangladesh. Besides, it was investigated that the majority of the community clinics (80%) in Bangladesh do not provide digital healthcare services and are unable to provide modern healthcare facilities (Field Survey, Jun 2024).

In a similar vein, 67% of the respondents argue that community clinics did not provide real-time services and emergency services. 24% of the respondents articulate that the doctors and staff of community clinics did not always cooperate; 51% of the respondents expressed dissatisfaction with the consultation time; 47% of the respondents did not get the prescribed medicines from the CCs; 27% of respondents expressed dissatisfaction with the post-treatment facilities, while 75% of respondents expressed dissatisfaction with the CCs' infrastructure (Field Survey, Jun 2024).

Addressing the identified challenges requires a multifaceted approach that can effectively resolve the existing challenges faced by community clinics in rural areas of Bangladesh. Firstly, the concerned authorities should take some effective measures to enhance the awareness of the rural people about the significance of community healthcare services at their doorsteps. Simultaneously, concern authorities should enhance the digital literacy of rural people to enable them to access digital healthcare services from community health clinics in Bangladesh.

Secondly, the interim government and concerned authorities should strengthen the infrastructure of the existing community health clinics throughout the country so that they can perform well and meet the expectations of the rural inhabitants in Bangladesh. Thirdly, to ensure the availability of health providers such as doctors, nurses, and staff at community health clinics in Bangladesh, concerned authorities should implement notable initiatives such as regular monitoring, inspecting, and installing biometric attendance systems, etc.

Fourthly, the health advisor should take some notable measures to improve the skills of the community doctors and staff. Qualified and skilled doctors and staff can provide quality healthcare services in rural areas of Bangladesh. Fifthly, to enable rural residents to access real-time and emergency health services, there should be improvements in the cooperation between health practitioners (service providers—doctors, staff, and nurses) and service recipients.

Sixthly, concerned authorities should provide necessary medicine supplies, enabling rural people in Bangladesh to access standard health services from community health clinics. Seventhly, it is crucial to enforce some essential rules to ensure the cleanliness and hygiene of community health clinics, thereby controlling infectious diseases and fostering a healthy medical care environment.

Eighthly, the concerned authorities should implement certain measures to ensure the post-treatment and follow-up services of community health clinics in Bangladesh are provided. At the same time, the concerned authorities should regularly monitor the overall performance of the CCs so that they can provide quality healthcare services to rural citizens in Bangladesh. Respectively, the interim government and health advisor should concentrate on endowing more funds to reconstruct and renovate the community health clinics in rural areas. These initiatives will certainly improve the acceptability of the CCs among the rural poor. 

Moreover, including the community in healthcare planning and decision-making is crucial for fostering trust and enhancing the entire healthcare experience for rural people. By emphasizing these areas for improvement, community healthcare services in Bangladesh may more effectively address the requirements of rural residents, resulting in improved health outcomes and increased patient satisfaction in rural areas of Bangladesh.

The writer is a researcher and an Assistant Professor, the Department of Public Administration and Governance Studies, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh. Email: tanjilahmedtaj@gmail.com To read the published manuscript, click here