Community clinics on verge of becoming ‘clinically dead’
Graphics: Agamir Somoy
Most of the nearly 14,500 community clinics are plagued by risky buildings, staff shortages, or irregularities and deficits in medicine supply and they are on the verge of becoming “clinically dead”.
Community clinics were established to bring healthcare services to the doorsteps of marginal people across the country. Since its inception, the initiative has played a significant role in providing healthcare to marginal communities while earning international praise and recognition.
Across the country, there are 14,475 community clinics. According to government records, around 50,000 people receive primary medical treatment and advice at these centers every day.
However, nearly 35 percent of the buildings require renovation or replacement in some way. Among these, reinforcement rods have become exposed in the roofs of more than 5,000 buildings. Plaster has fallen off from some, with cement and sand crumbling down.
Others have broken windows, allowing rainwater to enter, while some have broken fans, and others have cracks in the walls. Some community clinics lie completely abandoned.
The condition of the Uttar Madinabad Community Clinic in Koyra Sadar Union, Khulna, is also similar, where cracks have developed in the roof and walls, plaster is falling off, and garbage has accumulated inside.
As the building became unusable, Community Health Care Provider (CHCP) Prakriti Gain has been seeing patients while sitting on the veranda of a house for a year. Even there, measuring blood pressure is impossible due to a broken BP machine, and she also faces difficulties in storing medicine.
Community Clinic Health Assistance Trust Managing Director AKM Fazlul Zoha said, “Many buildings of the community clinics are dilapidated, and these buildings have been listed. As part of this process, around 6,000 buildings will be reconstructed and repaired. In places where buildings are entirely unusable, clinic activities are being conducted elsewhere under temporary arrangements.”
Discussions regarding the dire state of the buildings have also reached the National Parliament. In response to a query in Parliament on June, Health Minister Sardar Md Sakhawat Husain said plans to construct 540 new community clinics in disadvantaged areas, subject to land availability and necessary budget allocation.
The community clinic buildings were constructed between 1998 and 2002. Based on that calculation, their maximum age is 24-28 years. However, as the buildings became “unusable” within this timeframe, questions have arisen regarding irregularities during their construction.
Mehedi Ahmed Ansary of the Civil Engineering Department at Bangladesh University of Engineering and Technology (BUET) said, “If building construction rules are followed, these should remain usable for at least 50 years. The buildings should not become abandoned so quickly. However, if quality control of materials is not maintained during construction and proper maintenance is not carried out later, they will deteriorate, collapse, or sink”.
Although construction work began in 1998, community clinic operations were officially launched on 26 April 2000. The clinics were initially operated through the Community-Based Health Care (CBHC) program.
In 2018, the Community Clinic Health Assistance Trust Act was enacted to make its operations sustainable. Since 15 December 2024, community clinics have been managed through the Community Clinic Health Assistance Trust.
On paper, community clinics are supposed to remain open from 9 am to 3 pm. However, the real picture is different. Some community clinics open after 10 am and close before 12 pm. Others remain open from 11 am to 1 pm.
Overall, community clinic activities run for only one to two hours. Although they are supposed to be open six days a week, many community clinics do not open for more than two to three days.
A community clinic in Beanibazar municipal town, Sylhet, operates for only two to three hours, two to three days a week. As a result, people are being deprived of healthcare services.
Bilkis Begum, a local living near this clinic, alleged, “The doctor does not come to the clinic regularly. Even if he comes at 11 am, he leaves before 1 pm.”
However, Zoha said steps are being taken to address this situation. He said, “We are conducting sudden inspections to ensure the attendance of service providers and the delivery of service in community clinics. The situation is satisfactory in most places. If irregularities are found anywhere, salary deduction, suspension, and temporary dismissal are carried out.”
Although strict measures are being taken regarding the attendance of service providers in community clinics, in reality, the available manpower is significantly lower compared to the total number of community clinics. Against 14,475 community clinics, there are 13,878 personnel.
Out of these, 40 people have been temporarily suspended over allegations of irregularities. Yet according to regulations, one community health care provider is supposed to provide services six days a week in each community clinic.
Moreover, one health assistant and one family welfare assistant are supposed to provide services two days a week. When asked how operations can run with lower manpower relative to the number of community clinics, Zoha said, “No trust meeting has taken place since 2024. As a result, new manpower cannot be recruited.”
An average of 30-40 people receive services at each community clinic daily. 80 percent of service recipients are women and children. There is a supply of 22 types of medicines at community clinics, which are provided free of cost to patients.
However, the primary complaint from patients is that no more than two to three items of medicines are available from the clinics, which is inadequate for poor patients. Most of the time, the response is, “There is no supply of medicine.”
Sanowar Kha, a local of Gangni Upazila in Meherpur, said, “I came to get medicine, but I am not getting any. Those in charge of this clinic said there is no medicine. I used to get good service from here, but now I do not.”
However, according to Zoha, “There is now an adequate supply of medicines. During inspections, I noticed higher demand for a few types of medicines. We are taking that into consideration and working on it.”
He informed that for the 2026-27 fiscal year, there is a budget of Tk 440 crore for salary support and Tk 220 crore for goods support, totaling a budget of Tk 660 crore.
Meanwhile, Prime Minister’s Special Assistant Ziauddin Haider said the government is working to overhaul the country’s primary healthcare system.
He said, “There will be one healthcare unit in every union in rural areas and in every ward in urban areas. Under this healthcare unit, there will be three community hubs each. The existing community clinics will be converted into community hubs. Then, services can be ensured from community clinics according to people’s needs.”
