Dhaka – The Capital City |
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Marie Stopes Health Care System Set-up for the Urban Poor of Bangladesh The Bangladeshi government does not have a structured primary health care system for the urban poor. Instead, citizens rely on facilities that are run by non-governmental organizations and private sector health programs. One of the NGOs that have established clinical programs in order to compensate for the lack of government public health care structures in Dhaka is Marie Stopes International. Marie Stopes Comprehensive Reproductive Health Care Centers (CRHCCs) serve as top-level referral clinics. Referral clinics are located in district towns; they serve an average of 1,100 clients per clinic per month. They have an established pricing system with projects in place to assist those who are unable to afford services. Marie Stopes has a network of thirty-nine clinic programs in twenty-six districts of Bangladesh. Underneath referral clinics are fixed-location mini- and upgraded mini-clinics. Mini-clinics are set up in slum areas to provide services primarily to the very poor local residents. Marie Stopes currently has forty-one mini- and twenty-eight upgraded mini-clinics. These clinics are led by paramedics with a team of three to six volunteers who are responsible for counseling, service promotion, client management, and clinic maintenance. In addition, upgraded mini-clinics offer clinical services such as examinations, IUD and Norplant insertion, and Menstrual Regulation; mini-clinics do not. Each mini- and upgraded mini-clinic oversees four satellite teams. Every satellite team must run six satellite sessions per month. This means that every static clinic oversees a total of 96 satellite sessions per month, or total of over 800 satellite sessions per month across the urban areas of Bangladesh.
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DIT II Circle in Gulshan, Dhaka
One of forty-one Marie Stopes mini-clinics photo courtesy of Marie Stopes |
Youth Friendly Health Clinics To be designated as “youth friendly,” a clinic must be set up so that it can accommodate adolescents separate from adults—the services are offered separately, and logs and records are kept separately. Clinic signs are brightly-colored in yellow and blue, and effort is put into cultivating a visibly youth-friendly atmosphere. Adolescent-specific hours at mini-clinics are daily after normal clinic hours finish, generally from 4:00 until 6:00 pm. The services provided by staff are very counseling-focused and everything takes place with consent from parents, usually established through advocacy programs. There are a certain number of meetings with parents from the community per month; with their permission, youth are able to join the afternoon services. Reproductive health services are mixed together with life skill development activities and recreation periods. Programs for boys and girls are held seperate from one another. Often there are separate spaces for male and female youth. The programs cover topics focused on adolescent sexual health, such as counseling on pubertal changes, personal hygiene, ejaculation, and menstruation. On some days counseling services are made available; other days, educational or creative group activities are organized. Any youth from the area are welcome to participate in these programs.
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Illustrations by peer educators on display in a Marie Stopes mini-clinic |
Peer Educators Peer educators are youth between the ages of 10 and 19 who are recruited and trained to provide community education services to youth and adults in their local communities. They are required to be educated up to Class 5, possess leadership qualities, and be unmarried. For their efforts, they receive a very small amount of monetary compensation–500 taka, or $7.31 USD. Peer educators undergo a training process for six months and serve in their role for an additional six months afterwards. They implement community outreach programs along with adult field coordinators, covering topics such as adolescent reproductive health, personal hygiene, and early marriage. Along with providing community education, peer educators are often the most active participants in mini-clinic programs.
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In some larger referral or maternity clinics, such as the City Maternity Center in Bash Bari, “adolescent corners” have been established. These are areas set up specifically for adolescents with programs for boys and girls held on separate days. Each day a specific health education topic is covered, ranging from nutrition and drug resistance to reproductive tract/sexually transmitted infections. This service is similar to the community group services offered at mini-clinics. Adult field officers are responsible for going out into the community to recruit new groups of interested youth for these educational programs, about 15-20 boys and the same number of girls, each month. These young people are encouraged to attend the variuos health sessions; afterwards, they may decide that they would like to be trained as peer educators.
Limited Access – Mobile Satellite Clinics When it comes to health care for very poor families and individuals, it may be argued that providing something is better than providing nothing—satellite clinics embody this theory. Although adolescents are able to use these clinics for health services, no specific adolescent reproductive health program is offered. The minimal staff provided for each of these mobile clinics work hard with the limited amount of resources that they are given. A paramedic takes care of the counseling and limited medical treatment while outreach workers and field officers work within the community to establish a site or the impermanent clinics and encourage their utilization. At least four satellite clinics operate under the guide of each larger static clinic. The demand for services and medicine is often more than a particular clinic can accommodate. Often a satellite clinic will operate within a dilapidated community center. The satellite clinic visited on the 21st August 2007 on Nurjahan Road in Mohammadpur was situated within a dark concrete building. Behind a single small table sat the paramedic, a plastic box of medicine and supplies at her feet. A crowd of approximately twenty women and children was gathered closely around her. Advice, diagnoses, and medications are handed out in front of all who is waiting. There are no specific services offered to adolescents at this clinic, and no advertising or sign posts are available to encourage youth in particular to utilize this facility. Other satellite clinics may operate out of a home in the slum that has been voluntarily offered for this purpose. On this same date, 21st August, satellite clinic sessions were held in a single room house on BG Post Office Road in Mohammadpur, less than three square meters large. The paramedic stood by the bed with the medicine spread over the blanket, counseling the first woman standing in a line of waiting patients. No auditory or visual privacy was afforded as women crowded against each other; no adolescents stood in line.
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Created on December 19th, 2007, for Politics 116 with Professor Vinnie Ferraro, Mount Holyoke College Molly McCue, Class of 2008 |
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