Sustainable Health Services for Isolated Populations in Bangladesh

Riki Chakma, 28, has been working at Pathfinder’s clinic in Kutukchari for 2 years. Before that she was at home with her children, but says she came to the clinic so she could provide for her family, learn about her health, and serve her community.

At a rural clinic, Reasly Chakma receives a prenatal exam from Urmi Chakma, a Pathfinder-trained paramedic. Without the local clinic Reasly might have to forego care; the faraway city hospital is too expensive and difficult to reach.

Because of the Pathfinder clinics, Sadhana has had regular prenatal exams—unlike during her first pregnancy when the only care she received was from a pharmacist.

At a rural clinic, Reasly Chakma receives a prenatal exam from a Pathfinder-trained paramedic, Urmi Chakma. Reasly is grateful for the local clinic—without it, she could have to forego care; the faraway city hospital is too expensive and difficult to reach.

Health outreach works like Supria Chakma (L) and Mina Chakma (R) travel to distant villages by bus, foot, and rowboat to bring women and families essential health information and contraceptives.

Started in March 2010 with funding from the RiverStyx Foundation, Pathfinder's Sustainable Health Services for Isolated Populations in Bangladesh aims to improve access to health services in the Rangamati Hill district of southeast Bangladesh. The region is home to a large tribal population, which lives in remote, rural areas where people are geographically, culturally, and linguistically isolated. Additionally, tribal communities tend to be impoverished. As a result, they can neither access nor afford proper nutrition, health care, or sanitation services.

Funded for three years, the project is led by Pathfinder Bangladesh, working in concert with Green Hill, a local NGO. The project's objective is to help the region's poor, isolated population access modern health services by training health providers, setting-up clinics, and raising community awareness about available health services.

To achieve this goal, Pathfinder is executing two long-term strategies:

1. Providing services from static and satellite clinics
2. Training local women as paramedics

Thus far, Pathfinder and Green Hill have setup five clinics in three subdistricts (or upazilas) of the Rangamati district. Led by a paramedic, clinic aide, and depot holder, each clinic is responsible for addressing the health care needs of a catchment population of approximately 8,000-10,000 people. Services provided by the clinics include maternal and newborn care*, family planning**, management of sexually transmitted infections and reproductive tract infections, general health care***, and diagnostic and lab work. For emergency cases, the clinics refer clients to nearby public and private health facilities.

At the same time, Pathfinder has arranged for a two-year training course for paramedics, which will prepare locally-recruited women to serve their own communities and take leadership over the clinics, ensuring long-term sustainability for the overall efforts.

In order to restock the clinic and cover staff and administrative expenses, the clinics charge a small fee for services. By the end of the project, Pathfinder expects that each team of paramedics will be able to run their clinic without external funding or support, when trainee paramedics return after completing their training.

* Antenatal care, postnatal care, immunizations and referral for safe delivery, and emergency obstetric care

** Oral contraceptives and condoms, IUD insertion and removal, referrals for other methods

*** Related to common illnesses, scabies and malaria