Habiganj – A Rural Northwestern District |
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HFWC in Habigonj – the yellow sign advertises the clinic . |
The primary health care system in rural Bangladesh is comprised of community level, union level, and upazila level services. Upazila Health Complexes are the highest level primary care facilities in rural areas. Each serves a population of between 250,000 and 300,000 and has a minimum of 31 beds available in its hospital. Health and Family Welfare Centers (HFWCs) are the lowest level fixed facilities, located at the union level. Each covers a population of approximately 30,000. HFWCs offer counseling, limited curative care, maternal/child health care, and family planning methods to clients. Under each HFWC, two satellite clinics are operated by a team of field workers and one paramedic per week. During the days when these satellite clinics are not in session, field workers travel to houses throughout the village to provide doorstep services. There are currently no youth-targeted doorstop services.
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Ideally, the staff within each HFWC is comprised of a family welfare visitor (FWV) for female clients and a medical assistant (MA)/sub-assistant community medical officer (SACMO) for male clients along with support staff such as pharmacists and custodial staff; however, rural health care practice is not consistent with rural health care theory. Many health service positions are lying vacant. As of August 2007, the Bangladeshi government is disallowing recruitment for health service jobs. Health funding is limited and service providers must work with what they have, which is not always adequate to meet the needs of their communities. Given this situation, it is difficult to imagine support for a program targeted specifically to adolescents. HFWCs have traditionally reached out only to women and children. The reproductive health needs of youth and adolescents are acknowledged significantly less in rural areas than in Dhaka. Consequently, there is a lack of youth-friendly service delivery systems in Nabigonj. The distance between a household and the nearest HFWC in Habiganj can be up to 5-10 kilometers. This makes it difficult to imagine a peer educator program similar to the Marie Stopes initiative in urban slums, especially when religious and social culture will not permit young girls to travel so far on their own.
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Bridge outside of an HWFC in Habigonj
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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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