In order to achieve the objectives of GK has been implementing Comprehensive Primary Health Care (CPHC). The CPHC program is providing services for over a million populations in the GK operational areas. As an outcome of the various inputs, the health condition of the people has improved over time. Major improvements have been observed in the GK catchment area for the following health indices, such as IMR (Infant Mortality Rate) came down to 18.30 /1000 live births, MMR (Maternal Mortality Ratio) 153.15/100,000 live birth, CBR 10.57 and CDR 2.06. Over the years GK has acquired capacities to mobilize a large number of health workers, local NGOs, CBOs and local volunteers in post-disaster medical relief and recovery activities. Thus GK has contributed in attaining some of the health-related targets of the Millennium Development Goals (MDGs) of Bangladesh.
GK provides health services including reproductive health and family planning, referral cases at the village/community level through a cadre of village-based, trained health workers, known as paramedics. Most paramedics are females who have passed SSC (Secondary School Certificate) examination in science. Initially, paramedics receive 6 months of foundation training in basic anatomy, physiology and components of primary health care. On successful completion, they receive 12 months’ practical field training, during which time a qualified and experienced paramedic accompanies them while they deliver health care in the villages. New paramedics are mostly recruited through national-level advertisements. After formal training, the health workers are posted at GK’s Union level Health centers. They work in close collaboration with the Traditional Birth Attendants (TBAs), known as dais, in each village.
The characteristics of socioeconomic based health insurance are that the premium is fixed on the basis of socioeconomic status of the people. The destitute and poor people are to pay no or less premium than other groups of people. But all the members of all classes will get equal quality health services. There are six types of social class according to their socio-economic condition as given below ;
1. Destitute and Ultra-poor;
3. Lower middle class;
4. Middle class;
5. Upper middle class; and
6. Upper class or Rich.
However, non-smoker client is to pay less premium compared to smoker groups in all respects. In whatever case, GK never refused any patient whether they could pay or not.
The following services offered by the Paramedics in the rural areas through 31Health Canters in 17districts.
(i) Registration and follow-up of pregnant women and the provision of various ANC related services such as:
– Measurement of height and weight, including measurement of the circumference of the ankle and lower leg, 2-3 inches (5-8 centimeters) above the ankle, to check for edema,
– Measurement of blood pressure, and checking for jaundice and anemia,
– Testing of urine for sugar and albumin,
– Examining eyes, ears and teeth, and
– Examining abdomen for fundal height, foetal movement and foetal heart sound;
(ii) Distribution of iron and calcium tablets amongst pregnant women;
(iii) Immunization of pregnant women against tetanus, and children under age one year against six deadly diseases: diphtheria, whooping cough, tetanus, polio, tuberculosis and measles;
(iv) Identification and regular follow-up of high-risk mothers to ensure their timely referral, when needed, to appropriate medical professionals for treatment;
(v) Promotion of additional nutrients and a balanced diet for pregnant and/or lactating women and new-borns with family members;
(vi) Organization of follow-up meetings with family members and villagers to discuss the possible cause(s) of maternal death and how any maternal death could have been prevented;
(vii) Promotion and delivery of family planning services, and
(viii) Organization of special camps to treat pregnant women.
A GK village health worker, who is known as Paramedics often visits each village in the health center catchment area once per month. The health workers carry simple medications with them. The frequency of visits depends to a great extent on the severity of the health situation prevailing in the community at a particular time. GK health workers immediately upon their arrival in a community, ascertain the major health problems faced by the community, including information on the number of (a) pregnant women, (b) ill people ill and (c) frail elderly, etc., through informal discussion mostly through TBAs with whom. Grounded on this data, a GK health worker visits seriously affected families who require prompt medical care.
They work under close supervision and monitoring of senior-level GK field staff as well as headquarter staff and village level health committee. In this endeavor to assure accountability, health worker visits every death in the community regardless of age, gender, class and faith. Paramedic records verbal autopsy of the death and later on, a senior paramedic and/or a supervised visit the family and check the result. Later on, a doctor verifies the cause of death recorded. GK health workers are answerable for each maternal death, the deaths of a new-born and infant in the village and arranged death meetings where a good number of family members, teachers, Imam (priest) and local elected representatives are present. Paramedics are primarily answerable to the local Gonoshasthaya Health Committee as well as to their field level and central level supervisors. GK field-level health personnel, especially paramedics, attend the funeral ceremony of the deceased child or woman and discuss the matter with the family members.
Paramedics organize a meeting in the presence of the Chairperson and members of the Village Health Committee to discuss possible causes of maternal/neonatal death and explore whether or not this death could have been avoided by overcoming lapses of the health worker and/or of the family of the deceased person, and if so, how? This has a huge social awakening impact. No such rigorous social auditing of maternal and infant deaths is performed at the national level. Beyond this village-level social-auditing, all GK field-level health workers, ranging from village level paramedics to their immediate supervisors, have to independently prepare a detailed case history. This report submitted to their respective Manager/Director, preferably within 24 hours, but not exceeding 72 hours, explaining why the maternal and neonatal/infant death could not have been prevented. Health–in-charge or Manager of the concerned GK Health Sub-center will verify the reports submitted by GK paramedic.His/her supervisor will visit again and share his/her interpretations with the field workers and submit the investigation report within the next seven days to a higher authority. A GK doctor attached to its Union level Health Sub-center also investigates the death reports submitted by GK field staff on a randomly selected basis.
The activities of health workers are also monitored through a monthly report on vital events. Each village level GK health worker is required to submit a monthly report on births and deaths, including neonatal/infant and maternal deaths taking place in his/her operational villages. If there are any unusually low and high reporting of births and deaths, these are verified through independent field investigation. In this way, GK management monitors the performance of the health workers as well as checks the reliability of their reports. GK’s monitoring team also visits village graveyard(s) and talks to the Imam of the local mosque and local Hindu priest (if there is one) to verify births and deaths in the community. Imams and Priests are important sources of information on the human deaths in the community as they are invariably called on to preside over funeral services.
There is an acute shortage of trained birth attendants in rural areas. GK decided to involve the existing Traditional Birth Attendants (TBAs) in safe delivery by enhancing their skills and handling of normal delivery. TBAs were trained to deliver the baby at home without the supervision of GK health paramedics, except in difficult cases.
GK Hospital at Savar is a referral hospital for integrated community-based health care services. It is a 250-bed hospital. It is also known as Gonoshasthaya Kendra Medical College Hospital.
All indoor facilities including burn, Ayurveda, Yoga, Acupuncture, Leprosy, PHC services and 24 hours diagnostic service. Emergency obstetric cares including cesarean section, blood bank and two well-equipped Operation Theatre.
In the outpatient, there is provision for preventive services of anti-natal care, post-natal care, EPI, family planning referral, health information and treatment of common diseases. Only the cases beyond her or his capacity referred to the doctor.
In addition, every month more than one specialized health-camp is arranged within or outside of GK catchment areas.
Emergency services are also available round the clock in this hospital. This hospital is located alongside the national highway towards the Dhaka-Arichabus route run through Dhaka Export-Processing Zone (EPZ) and many small & big factories. Unfortunately, this route is very much known for road accidents. The road accident patients, get admitted to this hospital as the first choice and receive emergency treatment. Most of the EPZ workers belong to the poor socio-economic status category; this hospital has its special category payment system for them so that they can afford the services from GK at a low cost. There are two (2) ambulances are always ready to serve the patients.
4. Surgery, Burn unit, Neuro Surgery
5. Obstetric and Gynae
6. Child and neonate
7. Children surgery
8. Skin and sexual disease
11. Radiology and Imaging
14. Blood Transfusion
Services available in Nagar Hospital, Dhaka City
It is a secondary and tertiary health care hospital. It is a 250-bed referral hospital located at Dhanmondi, Road # 06, House # 14E, Dhaka. Facilities including burn and plastic surgery unit, cardiac unit, surgery unit, dental unit, general unit, obstetrics care unit, extended outpatient department, modern diagnostic facilities, physiotherapy, counseling, Ayurveda, Yoga, primary and preventive essential services, and emergency services are also available round the clock.
1. Emergency Unit
2. Out-Patient Department
3. General Medicine
6. General surgery
7. Burn & Plastic Surgery
8. Pediatric surgery
9. Obstetrics Gynaecology
12. Radiology & Imaging
Health camps commonly understood as treating patients with a group of health professionals outside of clinics and hospitals. Health camps are organized traditionally in rural areas. The Specialized Health Camp (SHC) was conducted in two ways:
(a) Base camp, which integrated medical services with minor and major
operations throughout (2-8 days) the camp and
(b) Outside the camp which incorporated medical services with the only
minor operation for a day.
GK has reformed the concept of Health Camp by demonstrating SHC by integrating Medicine, Cardiology, Surgery, Gynae, and Obstetrics, Pediatrics, Orthopedics, Ophthalmology, ENT, Dental, Physiotherapy, ECG, Ultra-sonography, Pathology and Drugstore by setting up of temporary hospital in remote rural areas. Surgery includes general surgery, pediatrics, surgery, eye operation, gynecology, and obstetrics operation, orthopedics. Surgical operations were performed by the Professors and Senior Physicians of GonoshasthayaSumajVittick Medical College and Hospital (GSMCH). Moreover, blood transfusion also performed if needed. The referral rate is very few and the casualty rate is almost nil.
GK is trying to achieve its aims of health and population through working with the disadvantaged and deserving poor people. SHC need basic health care facilities for the hard to reach areas of Bangladesh. GK acts as complementary to Government health efforts at the grassroots level. As a result, the deprived and vulnerable population receives health services at a minimum cost.
The SHC mostly set in educational institutions, Cyclone Shelter, Community Building, Gonoshasthaya sub- Centre and Union Council Complex. Available spaces readily converted into a temporary field hospital. The required number of rooms equipped with the necessary instruments to act as consultation, diagnostic, pharmacy and operation theatre to conduct minor and major surgical operations. SHCs were conducted remote areas of Galachipa in Potuakhali district, Charfashion in Bhola district, Bishwanath in Sylhet district.
The participatory approach adopted in implementing SHC by involving local partner NGOs, local government, educational institutions and host community for effective health service delivery. More specifically GK has undertaken to establish facilities like Generator for electricity supply, Autoclave, Operation Theater, Cardiac monitor, Diathermy, Spinal and General Anesthesia Machine. Special measures had been taken to transform the camp environment for women and child friendly. Privacy, dignity for every patient, especially for women, children and elderly people are upheld. SHC ensured health care support for vulnerable people by providing appropriate and efficient service delivery.