‘Clinical Appeal’ creates new appeal in Bangladesh rural health

Not many women give birth at hospitals in Bangladesh, with only four in every 10 women delivering with the help of skilled hands. Postnatal care is also rare.

But Suchitra Sutradhar is one of those few who, despite living in a remote village, gave birth at a facility and keeps coming to that centre for her post-delivery check-ups.

“This is my third child. But this was the first time I delivered at a hospital,” she told bdnews24.com at Dighalbak Union Health and Family Welfare Centre, in a far-off village in the north-eastern Habiganj district.

“In fact we received this hospital only recently,” she said, at the facility, holding her seven-month-old daughter.

The two-storied Centre which stands out in the village for its modern building façade is giving a new life to the ailing rural health of that union.

It was inaugurated in October last year after being built through an “unusual” private approach, and later handed over to the government.

The government’s doctor and field staff, FWV, sit at the facility and it is now open round the clock.

From muddy path to modern facility

The FWV, Mira Saha, is glad. With one and a half years to go before her retirement, she has found a place to sit and attend her clients.

“When I started my job in 1981, it was a very difficult time to talk on family planning or women issues. I used to walk along a muddy path. Over the years things have been changed. Until recently I used to sit at the union parishad; now we have this new facility,” she told bdnews24.com.

“Women feel comfortable coming to this building. We can now maintain their privacy. This is a very attractive place now,” she said, adding that “my job has also become comfortable”.

The Dighalbak Centre is one of seven such centres, including one under-construction, set up in Habiganj district with the support of USAID's MaMoni HSS project and Save the Children's ‘Clinical Appeal’ project.

Local people were motivated to donate land for the building, and then the facilities were handed over to the government’s Directorate General of Family Planning.

All the necessary equipment including autoclave, urine and blood test facilities for pregnant women, access to which is still unthinkable in many upazilla level hospitals, was also provided.

Solar panels have been installed to keep the power supply uninterrupted. Even additional staff were recruited under the project.

“It is unusual for NGOs to construct this kind of hospital. But the UK-based private donors formed a group, Clinical Appeal, and came up with the idea to construct those buildings where there is no facility,” said Dr Ishtiaq Mannan, a Save the Children director, told bdnews24.com.

“Those people never thought that they would get such a facility in their locality,” he said, adding that the centres would contribute to reduce maternal deaths further.

Each of the centres is carrying out 10 to 12 childbirths a month and referring the complicated cases to the Upazila or district facilities.

Changing risky tradition

Another centre, Lukra Union Health and Family Welfare Centre’s Paramedic Nasira Akhter said women traditionally do not go out of their homes for giving birth in the Sylhet division, of which Habiganj is a district.

This is a highly conservative region of Bangladesh where, despite economic growth, many of the health indicators are much lower than the national average.

The national contraceptive prevalence rate was found to be 54 percent in the latest Bangladesh Demographic and Health Survey (BDHS), whereas the rate in the Sylhet division was only around 40 percent.

Childbirth at the hands of skilled providers is only 28 percent there, compared to the national rate of 42 percent.

“With this facility, every month 10 to 12 babies are born here, and we can refer six to eight complicated cases to the Sadar hospital,” the paramedic said.

“This facility is very close to the community and we can ensure privacy to women who can easily come here after convincing their families and in-laws.”

Twenty-year-old Sena who came for her second pregnancy related check-ups told bdnews24.com during a recent visit that she would continue coming for the check-up.

“My husband and my in-laws bring me here. They won’t stop me. I have planned to deliver my first baby here,” she said.

Uncertainty remains

But uncertainty remains whether the centre will be able to keep offering this service after the NGO project ends in 2018.

Save the Children director, Dr Mannan, said it is the “duty” of the government to keep it functional.

“We constructed this hospital at a place where people could not think of having such a facility in 100 years. The project also shows the way that it is possible to run such a centre at remote places,” he said.

“For us it’s a hospital. But for the people of the area it’s a big motivation.”

Ending the project would also mean the additional staff and the paramedics would no longer be there.

Nazma Begum, who is the district coordinator for MaMoni project in Habiganj, hoped that the government would fill-up the vacant posts by this time.

“Even the local government has the authority to appoint part-time staff for a vacant post,” she said.