To achieve Health MDGs: GK’s Experience in Rural Bangladesh

1. To achieve Health MDGs: GK’s Experience in Rural Bangladesh Dr. Zafrullah ChowdhuryGonoshasthaya Kendra (GK)*Email:gk@citechco.net, zaf.chowdhury@gmail.com Website: www.gkbd.org Gonoshasthaya Kendra (GK), established in 1972, is the largest rural healthprogramme outside Bangladesh Government health system. GK has pioneered the training of paramedics and initiated locally organised Cooperative Health Insurance. GK provides full preventive health care including EPI, Family Planning Services including Menstrual Regulation (MR), treatment for common diseases with supply of essential medicines, Antenatal and Postnatal Care of pregnant women, Community Physiotherapy for disabled and elderly people. GK trains rural women in various vocational trades such as Boiler and Generator Operation, Motor Driving, Welding, Carpentry, Electrical Wiring, Water Pump Operation, Textile and Pharmaceutical equipment operation etc. Presented at EURONGOs Conference on 8 November 2010, London, UK

2. Millennium Development Goals • 8 MDGs & 15 Targets to be achieved by 2015 was endorsed by 189 countries & 147 Heads of States during the UN Millennium Summit in September 2000 • Achievement of MDGs 7 & 8 are dependent on the commitment of developed countries & the IFIs (which are largely controlled by the rich countries). • Achievement of MDGs 1-6 depend on the political will of national governments, functional local democracy & international support. • Achievement of MDGs 4, 5 & 6 requires the development of local health workforce, including TBAs and a shift away from a doctor dependent approach to simple low cost interventions.

3. Problem of millions of deathsand Inequity • Every year, half a million maternal deaths and roughly 9.5 million maternal morbidities occur mostly in developing countries. Another 1.4 million survive through ‘near miss events’ constituting life threatening complications of pregnancy. • Globally, over 10 million children die every year of which 4 million are neonates, also poor.

4. Simple low cost interventions to overcome the big problem :Even a small mouse can release the entrapped lion.If the following simple (may be too simple) tasks are performed regularly by health workers, most deaths among pregnant women and under-5 children will be prevented. • Organise regular ANC & PNC camps in villages for poor pregnant women. - Record their Blood Group and Random Blood Sugar (RBS) level - Give at least 2 doses of Tetanus Toxoid, consult in case of danger signs; prompt referral to public hospitals if required. • Visit pregnant women and young children at home along with TBAs. • Regularly vaccinate young children for DPT, HIB and measles. • Treat anaemia and malaria and look for tuberculosis. • Stop smoking in front of pregnant women and children. Convince mothers-in-law to allow pregnant daughters-in-law to take mid day rest and allow her to eat first and make more food available. Also encourage her to eat more local citrus fruits and vegetables. Such generous motherly behavior will guarantee a healthy grand child.

5. Plant a fruit tree and prepare a clean delivery room. • Provide mosquito net for pregnant woman, & later on for new born as well. • Convince family and the community about the value of early (first) milk (colostrum) and exclusive breastfeeding; complementary feeding later on. • Water and sanitation for poor families. • Improve personal hygiene of family members and health care providers including TBAs; cut fingernails regularly. Wash hands with soap and plenty of water before and after the child birth. • Cut the umbilical cord 1-2 minutes after the birth and put the baby to mother’s breast immediately. • Visit newborn and mother frequently during first 4 weeks (neonatal period) • Vitamin-A and Zinc supplements for the newborn. • Provide Antibiotic Amoxicillin for pneumonia and sepsis. • Keep ORS ready at home and in case of diarrhoea continue breastfeeding. • Teach temperature management of newborn especially premature and LBW babies with kangaroo method i.e. baby to mother’s chest. • Resuscitate newborn with ‘mouth to mouth’ breathing and neonatal AMBO bag. • Examine both eyes at birth and during neonatal period for congenital glaucoma, congenital cataract, acute dacrocystitis, squint and opthalmia neo-natorum (to be treated with antibiotic eye drop) • Revive school health programme for eye sight testing (poor children will be more benefited) • Regular Community Health Audit improves accountability and health performances.

6. Low cost simple interventions can help achieve MDG 4 & 5

7. Health Infrastructure in Bangladesh: Unlike most developing countries, Bangladesh has good physical facilities which are under utilised. Public Hospitals have 30,317 beds. Beds in Army, Police, Para Military and Prison hospitals have not been included as these beds are not available for the public.

8. Unused Union Health and Family Welfare Centre is used as Police Outpost

9. Where do Rural People Get Health Care in Bangladesh ? 1 2 1 2 GK Field Observation

11. Translating Knowledge into action and practice: Paramedics & TBAs at Work

13. Skills Development of Rural Women in Traditional & Non-Traditional Occupation Men and Women Working Together in Carpentry Workshop Nari Kendra Women Stitching Clothes First Woman Welder in Gonoshasthaya Metal Workshop First female Boiler Operator of Bangladesh (1984), probably first in the sub-continent as well.

14. Women driving automobiles Women driving Power Tillers

15. GK’s achievement in MDG 4 & 5 is aided by-regular Community Health Audits of the causes and circumstances of every maternal and infant death. Whether such deaths could be prevented is discussed in a community health audit meeting. These audits make both the health service providers and the family members accountable for their actions/inactions and helps reduce IMR and MMR. Such audits are chaired by elected female UP members. Community Health Audit is a yard stick of Health Literacy.

16. Epilogue or Epitaph? Success of knowledge translation and knowledge transfer is dependent mainly on the political commitment and interest of physicians, politicians and policymakers. Their social class background often put blocks on the way to change.   Practice of commonsense low cost interventions are therefore not usually easy. Women trying to bring about a change face a greater challenge because of prevailing prejudice against women.

17. If Health MDGs are to be achieved sustainably- • Do not mislead common people with UN MDG Awards. Please be honest and truthful. • UN and international donor agencies must learn to identify “real” poor and destitute. • Invest more for Community Health Service Delivery and Community Health Audit. 4. Develop available Human Resources locally. Large numbers of Paramedics/ Health Workers need to be regularly trained. Continuing training of TBAs is essential. 5. The Developed Countries must compensate the Developing Countries for their supply of ready trained doctors and Health Workers. 6. OECD countries should implement their ODA commitments and compensate developing countries for the negative effects of CLIMATE CHANGE

19. I leave you to decide for yourselves who are our partners and friends in our struggle for health, and who are our foes.