Community Health workers institutionalize referral network from remote village to hospital

Since I joined CHMI earlier this year, I have seen a number of programs that use community level health workers to deliver key interventions that prevent maternal and childhood morbidity and mortality--a [hot topic recently]( I recently wrote about [Sadija Foundation's partnership with Click Diagnostics]( and my [colleagues in India wrote about SEARCH](, another program training local people as community health workers.

Recently, I traveled to Kaptai, a region in south-eastern Bangladesh, where Basic Medical Workers work relentlessly to achieve MDG 5 in remote areas where no other health facilities exist for poor villagers.

The Kaptai Upazila (subdistrict) is part of the [Rangamati District]( of [Chittagong Division]( Eleven types of tribes (ethnic minorities): Chakma, Marma, Tanchangya, Tripura, Pankua, Lushi, Khiang, Murang, Rakhain, Chak, Bowm,Khumi live in this district. Most of the tribal people live in hilly villages surrounded by [Kaptai Lake]( without basic facilities of water, sanitation, transportation, health and education. Local boats or foot are the means of transportation from village to village and village to Kaptai city area.

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In HarinChara, one of the most remove villages, there are no public or private sector facilities, just a few traditional healers and traditional birth attendant. People have no option but to seek care from those practitioners in times of life and death.

In 2006, [Christian Hospital Chondroghona]( (CHC) started organizing mobile health clinics and has started up a well-designed Community Health Program for nearly 50,000 people in 150 disperse remote hill villages in Rangamati. The program ensures community participation by recruiting community health workers called Basic Medical Workers from villages, working in consensus with village headman to create an up to date database of families in each program areas.

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They encourage each household to own a family health card with unique Identification number, which costs BDT 30 ($.40 USD). Families pay BDT 15/- for subsequent visit for each family member (for post natal visits, mother and baby are considers as a single family member).

The local health workers are given two months of training on basic health issues, primary care and health emergency management before they start work with CHC. Health workers regularly visit homes to keep villagers informed on basic health information on various primary care issues: national vaccine program, prenatal and post natal care, nutrition, family planning, quick management of diarrhea, respiratory infection, malaria and other common ailments.

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They are capable of identifying high risk pregnancy, severe diarrhea and pneumonia case for preventing maternal and childhood morbidity and mortality. Since malaria is one of the reasons of morbidity and mortality of these hilly villages, they are equipped with Rapid Diagnostic Test (RDT) for malaria (Paracheck Pf) and provide initial doses of anti-malarial drugs when necessary.

The workers also keep local families up to date on the schedule of the mobile health care facility, encouraging them to use the preventive and curative services offered, and refer them when necessary to hospital. The hospital authority provides special attention to the patients if come with referral documents from these community workers.

The mobile health team, which travels six days a week and provides day-long services to each village, comprises of a medical doctor, a nurse/paramedic, a laboratory technician, a pharmacist and a support staff. They perform diagnostic services for prenatal women and malaria tests. Government health workers for EPI and family planning match their schedule with the mobile team. This is a good example of public-private partnership in community health work.

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There hasn't been a formal evaluation yet of the community health program--it is scheduled to end on December 2012--but the intervention shows remarkable changes in health seeking behavior of tribal people.

A female representative of the local government expressed her satisfaction for this intervention along with other women who I met during my visit. Further, the regularly updated **household data shows an increased use of antenatal care, family planning and no maternal death since 2008.** The program shows notable results.