Community-managed Clinics: Empowering the community to improve their access to primary health care services in Bangladesh

BACKGROUND: In 1999, the Government of Bangladesh established Community Clinics (CCs) at village level to provide basic health services. In 2004, the Ministry of Health approved Plan International, a child-centered humanitarian organization, to pilot models of community-based service delivery and governance in 18 rural CCs serving 108,000 people. THE INITIATIVE: Representatives of the local municipalities and of the Ministry of Health signed a Memorandum of Understanding with Plan International. The catchment area and population to be served by each CC was identified and validated through community organizations. For each CC, a Community Clinic Management Group (CCMG) was formed with representation from different sections of the community including women, children and the poor. CCMG were trained on management and resource mobilization and to develop a plan of action to operate the clinics. RESULTS. Community participation in the identification of service needs, clinic's hours of operation, cost sharing arrangements (e.g. paying salaries of cleaner and guard) has increased the access of the people to basic health and family planning services. Regular monitoring by the CCMG and maintaining the books of accounts ensured transparency and accountability. A client satisfaction survey revealed that 98% of service recipients received the services for which they came and 99% of them were satisfied with the quality of services. 95% reported the clinic was situated at a place and time accessible to them. CONCLUSIONS. CCMGs has been successfully running the CCs with quality services. The Government is considering its replication in 18,000 CCs throughout the country.