Strengthened public health care institutions to render universal and quality health, nutrition and sanitation services
In the Bangladesh context, access to improved and quality health care not only depends on the capability of the system itself to provide proper care but also on the acceptance and ability of the service seeker. Especially the poor and marginalized parts of the communities are not use to contact the health services and often lack the knowledge of what these services can provide. In spite of the well-designed public health structure, access and utilization of health/ nutrition/ sanitation services is compromised due to poor management, field worker absenteeism and easy access to unregulated private service providers. Furthermore, the public health structure is insufficiently organised in the different tiers of the health system and is still stressed in prevention of non-communicable diseases, ensuring food safety and nutrition.
To ensure improved and quality access to health, nutrition and water & sanitation services, DASCOH works with an approach stressing system strengthening, community engagement and social accountability.
A first step towards change is to identify and analyse the existing gaps in the service provision system concerning human resources, skills, infrastructure, logistics and coordination. LGIs are part of this activity since they will also be the ones involved in improvement action. As part of this analysis, assessing community perceptions and health care seeking behaviour are important building blocks for designing demand-oriented interventions. DASCOH acts on the identified gaps to start strengthening the system of inclusive service delivery and at the same time create awareness within the community on improved health care seeking and WASH-related behaviour. Social accountability and community engagement in the system of health service delivery is one of the key focus areas to ensure system sustainability. For enhanced institutional change, DASCOH promotes volunteerism in the community and works towards developing capacities through networking, advocacy and improving communication skills.
We envision the following changes to which DASCOH’s Public Health projects will contribute:
· The management systems for community clinics (CCs) stipulated in the national health Program Implementation Plan (PIP) are functional
· Union health and family welfare centres (UH&FWCs) and upazila health complex (UHC) are consistently responsive to local health needs and deliver services as defined in the essential services package for PHC facilities.
· Increased use of sanitary latrines with proper hand washing facilities at the household level and schools in intervention areas
· Target communities and students adopt and demonstrate improved health and hygiene behaviour