The Community Clinic (CC) initiative in Bangladesh is a groundbreaking effort to provide essential healthcare services to rural communities. These primary-level health facilities are established by the government in collaboration with local communities. Bangladesh has recently authored a resolution at the United Nations highlighting the Sheikh Hasina Initiative on community clinic.
The journey of the CCs faced numerous challenges since its inception in 1998. Sheikh Hasina launched this unique CC-based health system with the objective of ensuring primary healthcare (PHC) for all citizens of Bangladesh. However, after a change in government in 2001, support for the CCs was withdrawn, leading to a suspension of services. It was not until 2009, when Sheikh Hasina re-elected, that the project “Revitalisation of the Community Health Care Initiatives in Bangladesh” (RCHCIB) was introduced, which reinvigorated the CCs. Subsequently, the project continued under the operational plan of the 4th Health, Nutrition, and Population Sector Programme (HNPSP).
Mainstreaming of CCs in the health system in Bangladesh
Bangladesh has made significant strides in improving the health status of its population through a pluralistic health system and CC initiatives as part of PHC approach. These efforts, coupled with improvement in the social determinants of health, have resulted in notable progress in various health parameters, surpassing neighbouring countries and many other developing nations.
The establishment of CCs has been a flagship program of the government of Bangladesh. Under this initiative, one CC is set up for every 6,000 people to provide essential healthcare services at the grassroots level. These clinics have been playing a crucial role in improving healthcare accessibility. Basic services are now available at rural people’s doorsteps, and complicated cases can be referred to higher-level facilities. This approach has particularly benefited the poor, especially women, by increasing their access to public health, population and nutrition services. CCs earned communities’ confidence, which is evidenced by its ever-increasing utilisation.
The CCs have not only facilitated access to healthcare but also raised awareness among the population about health problems and the importance of seeking care from trained professionals. This has reduced reliance on unqualified practitioners and traditional healers. Moreover, the clinics have enabled women to seek health services outside their homes, reducing the need for extensive domiciliary care.
The CCs offer a range of services free of charge to marginalised individuals, including maternal and child health, disease screening and tests, routine immunisation, sexual and reproductive health care, mental health support and referrals to higher-level facilities when necessary. The provision of 30 types of medicine and healthcare items has further improved the overall healthcare experience for the population.
To ensure long-term sustainability and enhance community participation, the government enacted the ‘Community Clinic Health Assistance Trust Act 2018”. This legislation transferred the ownership and management of CCs to an autonomous Trust, governed by a Trustee Board and an Advisory Board. None of the board members are public servants, and the president of the Advisory Board is the Prime Minister of Bangladesh. The Act allows the Trust to raise funds to supplement government support, ensuring the clinics’ continued operation and development.
Sheikh Hasina’s Contribution towards establishing Community Clinic
The CC concept, which has had a transformative impact on healthcare in Bangladesh, draws its inspiration from Prime Minister Sheikh Hasina. Her unwavering commitment to pro-poor and pro-people health initiatives is evident in her personal involvement in the Advisory Board and her genuine concern for the well-being of her people.
The concept of CC was first introduced by Bangabandhu Sheikh Mujibur Rahman, the father of the nation, with the aim of ensuring PHC at the grassroots level in the newly independent country. On 26 April in 2000, Sheikh Hasina inaugurated the first CC in Patgati of Tungipara in Gopalganj district, and since then, this initiative has revolutionised the delivery of government primary healthcare across Bangladesh. The prime minister’s consistent support for this endeavour has garnered widespread appreciation from all segments of society and has exemplified the remarkable development achieved under her dynamic and visionary leadership.
The ultimate objective of the premier is to eradicate poverty from Bangladesh. CC-based healthcare services contribute towards reducing poverty (SDG 1) by improving access to quality healthcare for underserved populations, including those living in poverty. When people have access to preventive care, early treatment and chronic disease management, they are more likely to remain healthy and avoid costly health crises. Additionally, the establishment of CCs across the country has created employment opportunities, helping reduce poverty and enhance overall financial stability. Through collaboration with community organisations and local leaders, community-based healthcare services empower communities and contribute to the establishment of a strong, healthy and equitable society for all.
CCs directly contribute towards achieving SDG 3 (Good Health and Well-being) by providing preventive and curative healthcare services in the community, thus alleviating the burden of disease. They also play a crucial role in advancing various other sustainable development goals (SDGs), including SDG 2 (Zero Hunger), SDG 4 (Quality Education), SDG 5 (Gender Equality), SDG 6 (Clean Water and Sanitation), SDG 8 (Decent Work and Economic Growth), and SDG 10 (Reduced Inequalities).
Recognition by the United Nations, ‘The Sheikh Hasina Initiative’
The successful initiative of CC in Bangladesh has gained worldwide recognition, thanks to the efforts of the Permanent Mission of Bangladesh to the United Nations in New York. The United Nations itself praised this initiative, leading to the unanimous adoption of a historic resolution titled ‘Community-Based Primary Health Care: A Participatory and Inclusive Approach to Achieving Universal Health Coverage’ on 16 May 2023, after more than 4 months of intensive negotiations with 193 member states. That 70 countries have co-sponsored the resolution is a testimony to Bangladesh’s strength in multilateral diplomacy. This recognition highlights the innovative leadership of Prime Minister Sheikh Hasina in establishing a CC-based PHC model in Bangladesh through public-private partnership. The resolution refers to this initiative as ‘The Sheikh Hasina Initiative’, reflecting the PM’s strong commitment to improving public healthcare and promoting equity in global health.
The adoption of this resolution marks a significant milestone in the global pursuit of achieving universal health coverage by 2030. The successful implementation of this resolution will play a crucial role in improving healthcare for billions of people worldwide through the introduction of CC-based health systems. It also has broader implications for international cooperation, as it calls upon international financial institutions, multilateral and regional development banks, and donors to provide technical and financial support for the implementation of this model in member countries, particularly in developing nations.
The belief is that under the supervision of the UN, this service will spread to every corner of the world, making it a proud moment for Bangladesh and a remarkable achievement for its multilateral diplomacy. The hope is that Sheikh Hasina’s innovative model will be replicated globally as a best practice example, further advancing global health systems.
The UN resolution holds three crucial global implications. Firstly, the CCs in Bangladesh serve as a reference point for successfully scaling up PHC, showcasing the Bangladesh model. Secondly, the resolution emphasises the need for both domestic and external financing to support the strengthening of innovative approaches in healthcare systems. Lastly, the World Health Organisation (WHO) and other UN agencies will provide technical support to other countries for the implementation and long-term sustainability of CC-based PHC.
This recognition of Bangladesh’s indomitable development progress under the leadership of Prime Minister Sheikh Hasina will enhance the country’s image in the international arena in the days to come.
The writer is the Deputy Permanent Representative, Permanent Mission of Bangladesh to the UN, New York