A Locally Led Approach Strengthens Urban Health Care in Bangladesh
Stakeholders join together to support opening of primary health center in Habiganj
The well-organized health care system in rural Bangladesh is unlike that found in urban areas. This is because the Ministry of Health focuses on rural health care, while cities and municipalities historically have relied on development partner programs and private providers for their basic health care needs.
Laws passed in 2009 and 2010 place responsibility for urban primary health care in the hands of urban local government institutions (LGIs). However, as development partner support has shifted away from direct funding in recent years, critical gaps have arisen in accessible urban primary health care services. To address the situation, the USAID Local Health System Sustainability Project (LHSS) is collaborating with 14 LGIs in Bangladesh’s Sylhet, Rajshahi, and Chattogram divisions to increase local capacity to strengthen urban primary health care systems.
Rebuilding health standing committees to support local solutions
LHSS’s first step was to revitalize the health standing committees within 13 LGIs. While LGIs must ensure the provision of primary health care services in urban areas, it is the health standing committees that do the work of planning, executing, and monitoring primary health care services within each LGI.
LHSS collaborated with LGI authorities to engage a diverse and influential group of local stakeholders to serve on the committees. The committees brought in elected representatives; local health agencies including the Directorate General of Health Services, the Civil Surgeon’s Office, and the Office of Family Planning; private sector entities; and local NGOs. These new members improved local management capacity for addressing primary health care issues, making the health standing committees a multilayered platform to meet the diverse needs of the municipal health systems.
In Habiganj, a populous district in the Sylhet division, the reconstituted health standing committee is an example of the successful change that can occur through a combination of stakeholder partnerships and locally led initiatives. In 2021, the Habiganj committee started conducting regular meetings. They did a comprehensive mapping to identify zones that lacked functional primary health care sites and discovered that a population of over 100,000 from five contiguous wards had no access to a primary health care facility. Filling this urgent need became the committee’s highest priority.
Collaborative resource mobilization produces results
Lacking a ready source of financing for a new health facility, the committee focused on mobilizing resources from an array of collaborators. First, they located an unused building owned by the municipality and undertook a nine-month renovation project to transform it into a health center. The municipality invested over two million Taka — or about $18,000 — from its own development budget to complete the renovations.
The health standing committee then turned to other pressing issues of equipment, medicine, and service providers to operationalize the center. The Civil Surgeon’s Office extended its support by committing human resources to provide five days of treatment services per week through three specialized doctors, free-of-cost to the new health center. The Office of Family Planning provided two family welfare visitors for maternal and child services to work at the center three days a week.
The mayor of Habiganj, meanwhile, used his influence to collaborate with private sector entities like the pharmaceutical representatives’ association to source essential medicines for the center. The Habiganj Diabetes Hospital contributed three medical beds, and the municipality recruited a full-time nurse and cleaning and support staff for consistent service to the poor.
Finally, LHSS supported the health standing committee in forming a management committee to monitor the service quality and operations of the center. Members include elected ward councilors, the chair of the Habiganj Chamber of Commerce, and other individuals capable of providing financial, technical, or political support.
Thinking and operating differently
Aboni Kumar Das, the secretary of the Habiganj Health Standing Committee, is enthusiastic about the collaborative approach that brought the new health center to life. “In the past, we used to think and operate alone, but now we are working in collaboration with different stakeholders,” he said. “As a result, the outcomes of our health standing committee meetings have improved significantly as we are able to gather and incorporate different opinions and perspectives from the new members.”
The mayor inaugurated the Habiganj PHC center in December 2022, increasing access to care for thousands of municipality households. The center offers basic health services such as maternal and child health care, family planning, and treatment for common illnesses. It also integrates daily immunization services, which were previously provided by the municipality through a satellite program.
The impact of the Habiganj primary health care center has been immediate and far-reaching. Between January and September 2023, the center handled nearly 2,000 outpatient visits and provided immunization services to more than 4,000 children. The once abandoned building has now become a symbol of progress, reflecting the power of locally led collective efforts.