Catalog

More than Medicine

Background

At a primary health care center (PHC) in Dhaka, 23-year-old Munni Begum waits to have her dressing changed. Her second baby was born at the PHC 9 days earlier by Cesarian section. Her home is 2 hours away by bus, but her brother and sister live in a slum only 1 kilometer away from the Dolaipar PHC.

She moved to their house toward the end of her pregnancy so that she could have her second child at the PHC.

“I suffered during my first delivery, even though that was not a Cesarian,” the woman says with a shudder. “There were so many complications.”

She decided not to take any chances with the second delivery. “Here, I felt much safer,” she says of the PHC.

And for good reason. Bangladesh has high maternal and infant mortality rates: 390 mothers died per every 100,000 live births in 1996–2000, and 54 babies died per every 1,000 live births in 2000, according to ADB’s Key Indicators 2002.

“More and more women are coming to the center now for deliveries,” says Dr. Humayra Begum, manager of the PHC. Apart from safe deliveries and antenatal and postnatal care, the PHC’s 20-bed comprehensive reproductive health care center also provides advice on hygiene, nutrition, and health care for the mother and child.

The Bangladesh Women’s Health Coalition (BWHC) runs this PHC with financial support from ADB. BWHC, one of 14 partner nongovernment organizations (NGOs) that runs such PHCs, takes charge of the doctors, counselors, and other health workers. The Nordic Development Fund and the United Nations Population Fund have provided equipment for the center.

This is one of 105 PHCs that ADB supports in the country’s most populous cities of Chittagong, Dhaka, Khulna, and Rajshahi. Among them, the PHCs serve about 5.3 million people—most of them poor. The Urban Primary Health Care Project, supported by a $40 million loan from ADB, is implemented through partnership agreements with 14 NGOs and the Chittagong City Corporation.

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Treatment for Less

The project covers 60 PHCs in the capital. In the PHC in Dhaka’s Arambagh-Mirpur area, Rani Begum describes her 3-year-old son’s symptoms to the paramedic who registers new cases. Little Ismail has had a nagging cough for about a year now, explains his visibly worried mother. Ismail has also been losing weight. “I took him to a private doctor, who treated him for asthma.” She spent 1,040 taka (Tk) on the treatment. “But there was no improvement,” she says.

Three months ago, as Ismail’s condition worsened, Rani Begum gave up her job to care for him. She had worked in a garments factory since the age of 10 to supplement the family income, first in her parents’ home and then in her husband’s. She was married at 13 and became a mother when she was not quite 17.

She is hopeful the PHC doctor will be able to treat Ismail’s problem. Not only that, the treatment will also cost her less than the private doctor’s. “Here, we charge a one-time Tk10 registration fee and the doctor’s fee is only Tk20 per visit,” says Dr. Afrosa Sultana, manager of the PHC, which is run by an NGO called the Pragati Samaj Kallan Pratishtha. Medicines are provided at half their market value.

“I heard about the PHC from a health worker at the satellite clinic,” says Rani Begum. Every PHC supported by ADB under the project has between three and six “satellite clinics.” These are weekly outreach clinics run by health workers in slums and other poor communities. They provide first aid, health education, and referral to the PHC.

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Advice, Counsel, and Health Education

The medical professionals at the PHCs and the satellite clinics provide both preventive and curative medicine; they also advise, counsel, and educate their clients. “For example, if someone comes to us with a skin infection, we provide treatment, of course, but we also provide advice on good hygiene practices,” explains Dr. Afrosa Sultana. Similarly, when the doctors and health workers see a malnourished mother or child, they counsel the mother about good dietary habits.

PHC staff members advise on family planning, an important issue in a country with one of the highest population densities in the world. They also counsel women who are victims of domestic violence.

The majority of the patients at the PHCs are women and children. Common problems among children include diarrhea, usually a result of drinking contaminated water, and acute respiratory tract infections, prevalent in urban slums because of poor ventilation and inadequate sanitation facilities. Women most often come to the centers for deliveries, and antenatal and postnatal care. The project helps fill a gap in the development of the country’s health sector , which has traditionally focused on reaching the rural poor rather than the urban poor. Yet in recent years, it is the urban poor who have had the worst health status in Bangladesh.

The Urban Primary Health Care Project is helping prevent and cure illnesses, and reduce preventable deaths, especially among women and children.

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