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Urban Health Project Reaches Out to Dhaka’s Poor

Project Result / Case Study | 19 December 2014

A maternity clinic run under a public-private partnership provides a model for delivering primary health care to the urban poor in Bangladesh.

Sheuly Begum, 25, panicked when the arrival of her second child was delayed by about 2 weeks. Her husband immediately took her to a maternity clinic, a 15-minute drive by rickshaw in Dhaka City’s congested Pallabi area.

Within the next 24 hours, Begum gave birth to a healthy boy without any complications, thanks to the doctors at the clinic. The Al-Haj Jahurul Islam Matri Sadan (maternity center) is run by Khulna Mukti Sheba Sangstha (KMSS), a nongovernmental organization (NGO) working in partnership with the Government of Bangladesh under the ADB-supported Urban Primary Healthcare Services Delivery Project.

Saving lives

Begum’s doctor, Kamrun Nahar Dolly, said another day of delay could have been disastrous for either the baby, the mother, or both.

“The baby could have died inside the uterus. Or Begum could have suffered fistula (a hole in the birth canal),” said Dolly, who is also manager at the 10-bed clinic.

“The doctors here have saved me and my baby. I’m grateful to them,” said Begum.

She was 20 years old when she gave birth to her first son, Mohammad Kamrul, at her home in northern Netrokona district 5 years ago. “At that time there was no clinic close to my village,” said Begum.

At the maternity center, about a dozen women, some of them accompanied by their husbands, were waiting with their newborns to get post natal care and routine follow-up.

Among them was Salma Akter Runa, 22, who gave birth to her second son at this clinic 8 months ago. Before coming to this center she first went to Dhaka Medical College Hospital, the largest state-run hospital in the city.

“There at the hospital my husband and I had to move through at least six desks to get an ultrasonogram done,” said Runa. “Frustrated, we left the hospital and then came to this clinic, thanks to information given by my cousin.”

A day after Runa got admitted to the clinic, she gave birth to a girl, said Kazi Nazneen Sultana, the doctor who supervised her delivery.

Since then Runa visited the clinic every month as part of the regular health checkup of her daughter who suffered from frequent diarrhea and severe malnutrition a month after her birth.

“The baby is fine now. She is gaining weight,” said Runa.

Serving poor communities

Kazi Nurun Nabi, program director of the KMSS, said the maternity center covers an area with a population of over 200,000 people, 40% of them living in 22 slums. The clinic focuses on slum dwellers and poor garment workers who came from impoverished rural areas to the city in search of employment.

“The number of slum women coming to the health center for delivery and other health care services has risen to over 70%, almost double the number a few years ago,” said Nabi referring to a baseline survey. There have also been a number of related benefits spawned by the project.

“Five years ago only 45% of mothers exclusively breastfed their babies for the first 6 months. Now it has climbed to 70%, higher than the national average,” he said.

A key feature of the project is that 30% of services are free for people who earn less than 700 taka (about $9) a month.

Free services

Among the other services provided by the center are family planning and immunization.

A key feature of the project is that 30% of services are free for people who earn less than 700 taka (about $9) a month. At the KMSS-run center there are more than 14,000 such people who are given Red Cards so they get free services, said Md. Tauhidul Islam, project manager of the Urban Primary Healthcare Services Delivery Project.

Creating awareness among the adolescent girls and boys about sexually transmitted diseases, HIV/AIDS, reproductive tract infection, and family planning methods is another service provided by the project. Health workers meet with a group of 15 girls every Sunday and 15 boys every Tuesday on the second floor of the center for 3 months.

“I’ve learned here about the benefits of using clean sanitary napkins,” said 13-year-old Sufia Akther from the Bhola shanty town. “I did not know that it is important to change the napkins regularly.”

“Before coming here I had no idea about HIV or AIDS,” says Saifuddin Ahmed, 16, a rickshaw driver in the northern Mirpur area. “Now I know how to keep myself protected from a deadly disease like AIDS.” He used to feel shy about talking about sexually transmitted diseases. “I thought these are the subjects that are not to be discussed publicly. Now I feel free to share the knowledge with my peers.”

The success of the project has shown the important partnership of government and NGOs in delivering of health services effectively, especially to the urban poor. The government supervises the project, while the NGOs provide the services based on the public-private partnership (PPP) model.

The project is financed by ADB and the Swedish International Development Cooperation Agency (SIDA) with technical support from the United Nations Population Fund (UNFPA). It is the third phase of ADB-supported Urban Primary Health Care Project in Bangladesh and will run through 2017; the first phase was approved in 1998 and completed in 2005. The goal of the project is to provide primary health services mainly to the urban poor for free or at a low cost.