Community clinics to become primary health centers

The much-discussed community clinics introduced during the Awami League government are set to undergo a name change. Not only will their names change, but their structure and scope of services will also be revised. They will be renamed Primary Health Centers (PHCs).

In this regard, the concept of primary healthcare introduced by the late Prime Minister Begum Khaleda Zia will replace the idea associated with ousted former Prime Minister Sheikh Hasina of the Awami League government.

The proposed changes have been included in a project recently sent by the Health Services Division to the Planning Commission. Titled “Construction, Reconstruction, Upgrading, Renovation, Repair and Rehabilitation of Health Infrastructure at All Union and Ward Levels in Bangladesh,” the project outlines the proposed changes. Several officials and employees familiar with the matter confirmed the information.

At a meeting of the Executive Committee of the National Economic Council (ECNEC) held on September 29, Social Welfare Minister Dr AZM Zahid Hossain proposed changing the names of community clinics across the country.

He made the proposal during discussions on the approval of a project titled “Health System Strengthening Through MNCH Service Improvement and NCDs Control.”

Local Government, Rural Development and Cooperatives Minister Dr Abdul Moin Khan also made negative remarks about community clinics while participating in the discussion.

Several participants in the ECNEC meeting said the Social Welfare Minister supported changing the name of community clinics. He said the 1996 concept of community clinics needed to be reviewed. He also proposed renaming them Primary Healthcare Centers in line with the vision of former Prime Minister Begum Khaleda Zia and changing the name of the trust to Primary Healthcare Trust.

According to him, existing community clinics lack qualified doctors. Instead of recruiting trained personnel, only politically affiliated individuals had been appointed. As a result, people have been deprived of the services they were supposed to receive.

He therefore proposed turning 3,939 Union Health and Family Welfare Centers into primary referral centers and recruiting medical assistants holding four-year diploma degrees.

In line with these proposals, the Health Ministry is preparing to undertake a new project.

The initiative aims to fulfil the government’s election manifesto by making preventive healthcare, health promotion and essential medical services easily accessible near people’s homes. Rural residents will also be connected to higher levels of healthcare when necessary.

Under the government’s new plan, each union in rural areas will have one PHC unit. Each union level center will be connected to three hubs.

In urban areas, the arrangement of units will depend on wards or population size and healthcare demands.

The centers and hubs will not perform the same functions. Hubs will serve as locations closer to communities for health promotion, prevention, initial contact and follow up services.

The centers, meanwhile, will provide relatively extensive medical services, basic diagnostic facilities, pharmacy services and referral coordination.

To implement these activities, the Health Services Division has proposed a project titled “Construction, Reconstruction, Upgrading, Renovation, Repair and Rehabilitation of Health Infrastructure at All Union and Ward Levels in Bangladesh.”

The project has an estimated cost of Tk 11,993 crore.

Following the completion of the processing and approval procedures, the Directorate General of Health Services (DGHS) and the Health Engineering Department (HED) will implement the project from December this year to November 2029.

A Project Evaluation Committee (PEC) meeting on the proposed project was held on October 28. Ehsanul Haque, member (Senior Secretary) of the Planning Commission, chaired the meeting.

At the PEC meeting, Chief Engineer of the Health Engineering Department Brigadier General Mohammad Jahangir Hossain said the primary healthcare hubs would be of two types.

Type A hubs will be designed for plain land, while Type B hubs will be constructed in relatively low-lying areas and locations where waterlogging is likely.

Type B hubs will be elevated on pillars and equipped with stairs and ramps.

The construction or reconstruction cost of each Type A hub will be Tk 42 lakh, while each Type B hub will cost Tk 51 lakh.

Each hub will cover 765 square feet. The estimated construction cost has been set at Tk 3,717 per square foot, including value added tax (VAT), advance income tax (AIT), profit and overhead costs.

Excluding VAT, AIT, profit and overhead costs, the construction cost has been estimated at Tk 2,434 per square foot.

The repair cost for each of the 8,348 hubs has been estimated at Tk 6 lakh.

A representative of the Directorate General of Health Services told the meeting that Bangladesh has a total of 4,586 unions and 41,274 wards.

If one hub is allocated for every three wards, the total number of hubs will stand at 13,758.

Of these, the proposed project will cover the construction of 350 new hubs, reconstruction of 5,936 PHC hubs and repair of 8,348 hubs.

The PEC meeting also suggested that the Health Engineering Department examine whether the usable infrastructure, medical equipment, other supplies and furniture of existing community clinics could be utilised under the proposed project.

This would also help reduce expenditure on the new project.

Asked about the proposed name change, Dr Enamul Haque, Director General of the Health Economics Unit under the Health Services Division, told Agamir Somoy, “It is true that the names of community clinics are being changed. However, these clinics will not be abolished. Rather, the scope of healthcare services will expand under the new initiative. At the same time, employees of different government agencies involved in health-related activities in rural areas will be brought together to work in a coordinated manner. This will prevent wastage of government funds and improve rural healthcare services.”