During the last week of September, I traveled to Bandarban, a remote tribal area of Bangladesh, to visit a health care model called Kollyani, which means “doing well”. Bandarban is one of the most remote districts in terms of its geography: forest, hills and peaks, and very limited road access. The majority of the population of less than 300,000 is from thirteen tribal and ethnic groups and the languages and customs are distinct from the mainstream population of Bangladesh. Unfortunately, formal health facilities and health care providers are almost entirely absent. As a result, the religious leaders of the various tribal groups, traditional healers or unqualified village doctors are the usual providers of care in these communities.
In 2008, some active community members came forward looking to improve the health situation of their villages. With technical support from Concern Universal and Gram Unnoyon Shangshtya (GRAUS), these community members led the process for establishing a formal health care system. One of the community leaders donated land for building two-room clinics, while another donated home grown bamboo and bamboo products, along with trees, branches, ropes and other materials for constructing the clinics. Those who could not donate anything contributed in the form of manual labor in the actual building of the facilities; others provided food for the laborers as daily wages. A total of six community clinics were built in key locations for easy access by the communities, with each clinic covering a population of 2000-3000. The clinics were branded with the name “Kollyni” and are now in full operation.
Every clinic has two workers, chosen by the clinic’s executive committee: one service provider / health worker and one service promoter. There are also a number of volunteers that assist each clinic with health education and health promotion. The executive committees aim to find local women to fill these positions; nevertheless, it is frequently difficult to find locals with a proper level of education. The selected women from local communities receive three months of intensive training by Concern Universal and GRAUS on providing primary health care, including trainings on ante-natal care, post-natal care, diarrhea, the common cold, cough and care for minor ailments.
The government has extended its supports to the clinics in the form of anti-malaria drugs and malaria testing, along with family planning services, including pills, condoms and other drugs and commodities. Further, as part of its mandate for achieving Millennium Development Goal (MDG) 4 – to improve Child health - and MDG 5 – to improve maternal health - the government sends health workers to make monthly visits to the clinics for EPI sessions.
Additionally, each of the clinics maintains emergency funds by collecting a small user fee. In case of a health emergency, especially involving maternal health, the executive committee can allow the use of the funds. The executive committees meet regularly for decisions such as this and to ensure the general successful operation of the clinics.
The Kollyani clinics are producing results. There has been a significant reduction in mortality for mothers and children under the age of five, because the villagers are now aware of pregnancy complications and how to use the referral system. Villagers have also been innovating by making “human ambulances” to transport pregnant women to the clinics (where other villages will carry the woman in need). Deaths from malaria have also come down sharply due to availability of tests and drugs at Kollyani. Higher-level government health officials’ have also acknowledged the importance of the Kollyani facilities in the absence of public ones; they will occasionally visit the clinics to improve the morale of the community people and the providers. These results, and the general satisfaction of the villagers, show that the community-led Kollyani model is an effective intervention to contribute to the national health system.