Health on Wheels a global initiative to serve workers locally

Farmers and industrial workers provide life-blood of the Bangladesh economy. The comparative advantage that Bangladesh enjoys in terms of cheap labour costs emanates from the hard-working labourers of the country. But it is unfortunate that despite making such an enormous contribution towards composition and growth of the Bangladesh economy, these workers are among the most neglected sections of society. Initiatives in both public and private sectors to cater to the social needs of these workers including healthcare coverage have been very few and far between. There is obviously a notable absence of appropriate policies, strategies, action plans and programmes to bring the working class under adequate healthcare coverage. People forget that by investing in healthcare of workers, their productivity could be enhanced significantly, which in turn would benefit all in the country including investors and entrepreneurs.
In this backdrop, collaboration between global and local players aimed at widening healthcare coverage of industrial workers in Bangladesh can indeed have a beneficial impact on the industries sector as well as generate awareness about the need for further improvements in the area. One such initiative has been the Health on Wheels, a healthcare service programme of the non-­profit American organisation Health and Education for All (HAEFA). It is providing free healthcare and medicines to garment workers of Bangladesh in joint collaboration with the Brown University, USA, Harvard Medical School, USA, Ministry of Health and Family Welfare (MoHFW) of Bangladesh and the UK Department for International Development (DFID).
Health and Education for All (HAEFA), the parent-body of Health on Wheels, is a non-profit organisation founded in 2012 by the faculty members and physicians of Harvard Medical School and Alpert Medical School of Brown University. The main objective of this organisation is to promote healthcare of  garment workers of Bangladesh. Its President, Dr. Ruhul Abid, MD, PhD, who was a medical graduate of Dhaka Medical College (DMC) from the 1980s (also a former Vice President of DMC Students' Union), has been working at Harvard Medical School and Brown Medical School since 1999. He developed a fast, On-Site Medical Check-Up system for garment workers back in 2013 and then involved other Harvard doctors in the project. They include Dr. Rosemary Duda, an Associate Professor of Harvard Medical School and Dr. Soumitro Pal of Boston Children's Hospital, Harvard Medical School. The HAEFA physicians have expertise in public health around the globe and are highly experienced in working for the underprivileged people in developing countries like Bangladesh, Haiti, Ghana and Micronesia.
Health on Wheels' main objective is to improve the healthcare of industrial workers through On-Site (inside the factories) preventive and curative healthcare, with a special emphasis on women's health. It also trains in-house, garment factory's medical and paramedical staff for better care and provides health and nutrition-cum-feminine hygiene education through educational training. Since 2013, Health on Wheels has been working to provide on-site healthcare to workers of garment factories in Gazipur, Sreepur, Ashulia, Tongi, Mawna, Savar, and Bhaluka, Mymensingh. Until recently, it has provided free health screening, diagnosis of hypertension, diabetes, anaemia, tuberculosis, asthma and high-risk pregnancy, followed by treatment and monthly follow-up for 2,200 garment workers. Recently, in collaboration with Harvard and Brown University Medical Schools, MoHFW and DFID (UK), it initiated health screening, treatment and follow-up of 5,000 workers in the garment factories of Gazipur, Tongi, Sreepur/Mawna and Bhaluka, Mymensingh.
According to a preliminary study by Health on Wheels released through an international conference held in Dhaka recently titled 'Healthcare Delivery System for the Garment Factory Workers: Challenges and Solutions', garments workers in Bangladesh contract most common but serious diseases like diabetes, hypertension, anaemia and respiratory problems. The study showed that 11 per cent of the total work force have been diagnosed diabetes. The workers, mostly females, lack awareness about their health, nutrition and hygiene; and there is a lack of access to healthcare and affordability. Brown University's Global Health Initiative faculty Dr. Ruhul Abid presented these findings at the conference.
The primary study sampled 2,000 garment workers, which identified new cases of hypertension, diabetes, suspected tuberculosis, anaemia and presumed cancer. The study will be finalised in December this year covering over 5,000 garment workers. It found that understanding of the current health problems of garment workers was a major challenge as there was no mapping on disease burden and suggested assessment of disease burden-based on gender and occupation. The study also recommended access to as well as affordability of healthcare for garment workers alongside creating awareness among them about health, nutrition and hygiene.
The mission of Health on Wheels is to empower the underprivileged through preventive and curative healthcare. As a healthcare delivery programme of HAEFA, it provides on-site healthcare to industrial workers, with a special emphasis on women's health. Health screenings are performed for common diseases; preventive care includes health and feminine hygiene education, immunisation, ante-natal and post-natal care. On-site diagnosis and treatments cover infectious diseases like diarrhoea, typhoid, tuberculosis, as well as chronic diseases like asthma, diabetes, hypertension, heart problems. The major goal of Health on Wheels is to help workers lead self-reliant, healthier, happier and more productive lives.
   Health on Wheels has devised an on-site mobile healthcare delivery system and uses on-site healthcare workers, sophisticated cell phone-based mobile-Health and Electronic Medical Record (EMR) software to coordinate screening test results, diagnosis, and treatment regime with physicians. As it is not an 'once and done' programme, all worker-clients receive health cards and unique ID numbers linked to their confidential electronic medical records, enabling the healthcare professionals to continue the ongoing and follow-up appointments, treatments and monitoring, by using the latest cell phone-based technology. All patient and employer records are kept strictly confidential and secure. Hundreds of workers are examined each month, with regular follow-up appointments to improve their physical and mental health, and sustain their well-being.
On-site preventive care by Health on Wheels includes:
* Immunisation;
* Ante-natal and post-natal care to ensure safe infant delivery;
* Health and general hygiene education;
* Feminine health and hygiene education;
On-site curative care by Health on Wheels includes:
* Treatment of infectious diseases like typhoid, malaria, tuberculosis, dengue, hepatitis, diarrhoea;
* Treatment of chronic and non-communicable diseases like diabetes, hypertension, heart problems, and high-risk pregnancy.
Current scenario of garment workers' health in Bangladesh has been found to be as follows:
--Eighty five per cent of the workers are females and under the age of 35 years;
---Thirty per cent of the female workers suffer from mild to moderate levels of anaemia;
--Twelve per cent of the workers are diabetic and most of them are undiagnosed;
--Eleven per cent of the workers are hypertensive (high blood pressure), and are undiagnosed; and
--Seventeen per cent of the workers have respiratory diseases including asthma and TB.
The following diagram depicts the Digital Connections for Medical Records of Garments Workers between the Garment Factories and the MIS wing of MoHFW/DG-Health in Bangladesh:
The long-term mission of Health on Wheels is to empower the underprivileged communities through improving their healthcare. It intends to break the cycle of poverty and uplift the living conditions of industrial workers and slum dwellers through education and better health. By making small improvements in dietary practices -by providing iron supplements and furnishing menstrual hygiene education - it is now trying to bring about sustainable improvements in the lives of garment workers in Bangladesh.
Both public and private sectors in Bangladesh should strive hard to establish an atmosphere where workers feel comfortable, secure and healthy. Well-planned policies and programmes should be put in place to build trust, reciprocity, and good relationships between employers and employees in order to enhance productivity, reduce inequality and ensure social-cum-moral justice. An empowered and healthy workforce will undoubtedly ensure higher productivity with reduced employee turnover, which in turn will help transform Bangladesh into a vibrant and inclusive industrial economy within a short period of time.   
The writer is a former editor of Bangladesh Quarterly.
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