Despite good infrastructures, the country is yet to exploit full potential of using the Union Health and Family Welfare Centres (UHFWCs) effectively for better healthcare at the grassroots level.
The family welfare centre is in fact the lowest-level government clinic in rural Bangladesh which serves some 24,000 people, the average population of a Union. The centres are now staffed by female paramedics known as family welfare visitors. These women, who provide family planning and maternal and child health services, typically have a high school education and some months of training. Most of these centres are without qualified doctors.
The family welfare visitors are supposed to conduct 'satellite clinics' eight times monthly at various sites in each union, to give contraceptive injections, insert IUDs, and provide prenatal care. For the most part, however, the system does not encourage women to establish a relationship with the local clinics for reproductive and general health problems as well as for family planning. Instead, the programme relies heavily on the domiciliary services provided by the family welfare assistants.
But then the rural people are, by and large, sceptical about the effectiveness of such centres providing basic health services. There is a lack of institutional support in the functions of the centres. Although there are around 4,300 family welfare centres throughout the country, many of these do not function well or are not able to provide requisite services in practice. According to the Union Parishad Ordinance 2009, UPs, like Parliament are authorised to form standing committees to oversee family planning services. Effective functioning of UHFWC could help control population growth and maintain overall health status of rural people by properly monitoring service delivery.
The UHFWC at Naujan of Matlab upazila of Chandpur is ideally located. Feeder roads connect it with villages where rickshaws and auto-rickshaws ply. The building that houses the centre is strongly-built and has about six rooms. But one is astonished to see a single health worker, given training only for a short period, runs the affairs there. She serves what a MBBS doctor is supposed to do: advising on do's and don'ts on basic health care to thousands of nearby villages that constitute a union parishad (UP).
Bangladesh still lives in villages. But the majority of the population, staying in rural areas, are deprived of minimum health care facilities the annual budgets are supposed to ensure. The government has, so far, failed to motivate qualified MBBS doctors to serve the rural populace although millions engaged in farming feed the entire nation. Ill-health in the absence of adequate healthcare as well as lack of hygiene and sanitation at the grassroots is taking its toll by the way of drastic fall in labour productivity there.
As reports have it, there is an acute shortage of doctors, nurses and technicians in rural hospitals. The rural masses are either forced to resort to traditional healers or, to seek medical care in the capital exhausting whatever meagre earnings they have. But there are thousands of positions vacant in rural hospitals, but those which are not, in reality remain so, with only a handful of doctors attending hundreds of patients a day.
According to a World Bank report, over 40 per cent of doctors at rural healthcare centres are regularly absent. Reasons for their absenteeism include poor pay and standard of living in villages, as opposed to that earned from their private practices in the urban centres. The insufficient supply of medicines, obsolete equipment and inadequate facilities in rural hospitals are also barriers to proper medical treatment within an infrastructure which was originally one of the best in the region. The union heath centres, if provided with doctors and adequate medicines, could go a long way in helping Bangladesh achieve health for all. Now the pertinent question is: where does an estimated Tk 111.46 billion allocated to the health sector in the 2014-15 budget go?
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