Community clinic lecture for students of community medicine which is an important topics both for undergraduate and post graduate students.

2. Community Clinic

3. Background
 Bangladesh was one of the countries who signed the
“Alma-Ata Declaration” in 1978 with a pledge to
ensure “Health for All” (HFA) by 2000 through
Primary Health Care (PHC). But in 1996 it has been
observed that we were far behind the destination as
per the set indicators. Unavailability & inaccessibility
of PHC to the rural community of Bangladesh (about
three fourths of national population) with lacking in
community participation were the important reasons.

4. CONTD.
 To address those shortfalls, the then Government of Bangladesh
in 1996 planned to establish Community Clinic (CC) (1 CC for
about 6000 population) to extend PHC at the door steps of the
villagers all over the country. Community Clinic is the brain child
of Hon’ble Prime Minister Sheikh Hasina. Construction started in
1998. During 1998-2001, 10723 CCs were constructed & about
8000 started functioning. HA & FWA were service providers in
addition to their domiciliary services. They had been trained on
ESP (Essential Service Package) under HPSP (1st Sector
Program).For management of CC activities, there was 1
Community Group (CG) for each CC having 9-11 members headed
by Land Donor/his or her representative. In CG there was no
distinct provision for adequate women’s representation & scope
for empowerment and adolescent participation. Even, the roles &
responsibilities of local govt. representatives for smooth
functioning and effective management of CC was not considered
with due importance.

5. CONTD.
 In 2009, Govt. planned to revitalize CCs through
a project “Revitalization of Community Health
Care Initiatives in Bangladesh” (RCHCIB) as
priority as it was in their election manifesto. It
was a project of 5 years duration from 2009-2014.
There after the span of the project has been
extended for 1 year more i.e. up to 30.06.2015 in
2 phase

6. CONTD.
 Under RCHCIB, Community Group (CG) -
management body of CC, has been formed for all the
functional CCs with some major changes. CG
members’ number has been increased from 9-11 to
13-17 with at least one third women members and
adolescent girl/boy. The group is headed by elected
UP member of that locality instead of land donor/his
or her representative. Land donor/his or her
representative is life member & senior vice president
of CG. Out of president & vice presidents at least
one is female. CHCP is the member secretary in
place HA/FWA.

7. CONTD.
 In the catchment area of each CC, there will be 3
CSGs comprising of 13-17 members with at least
one third women members. For all functional CCs,
CSGs have been formed. The CSGs help CG in CC
management along with making community aware
regarding the services available at CC and common
health messages.
 New category of service provider, Community
Health Care Provider (CHCP) (1 for each CC) has
been recruited in phases following all the necessary
steps.

8. WHO WORKS ?
 Each CC is headed by a community
healthcare provider (CHCP) who works 6
days a week; a health assistant (HA) and a
family welfare assistant (FWA) work
alternatively 3 days a week. Community
Group (CG) is pivotal in the management
of CC.

9. CONTD.
 After assuming the office in 1996, Prime
Minister Sheikh Hasina inaugurated the
first community clinic at Patgati of
Tungipara in Gopalganj district on April
26 in 2000.
Bangladesh has established more than 13,000
community clinics (CCs) to provide primary
healthcare with a plan of each covering a
population of around 6,000.

10. CONTD.
 Community participation is an essential part of
promoting health as it is "a means of organizing
action and motivating individuals and communities"
and it helps people to shape policies and projects to
meet their priorities. It is an important means of
changing people's attitude and actions towards
promoting a sense of responsibility in any
interventions and this behavioural change is
consistent with the community norms and re-affirms
the role of people in managing their own health .

11.  Based on this premise, the World Health Organization
(WHO) and the United Nations Children's Fund
(UNICEF), in the Alma Ata Declaration in 1978,
emphasized the participation of community people in
primary healthcare. Since then, 150 Member States of
the WHO and UN are committed to promoting people's
participation in the management of healthcare facilities
at the community level. It was intended to revolutionize
the health systems development for achieving the aim of
“health for all by the year 2000”. Moreover, universal
health coverage is the major target of sustainable
development goal (SDG-3). To achieve the target,
cooperation, collaboration and partnership between
private and public sector is needed .

12. FUNCTIONS
 Community clinic (CC) is a revolutionary
initiative to provide basic health care
services in the rural communities of
Bangladesh. The CCs are the primary level
health facilities have been established and
functioning by the government along with
participation of local communities.