Funding Model Helps Bangladesh Expand Primary Health Care

Decision makers like Habiganj Municipality Mayor Ataur Rahman Selim are charting fresh territory in primary health care. For the first time, municipalities like Habiganj are allocating funding from their own resources to support primary health care services in urban areas of Bangladesh. “We want to show that basic primary care is a rising priority for our municipality,” Selim said in announcing new efforts to make it easier for residents to access and afford services.

High-quality, community-based primary health care is the backbone of healthy families and stable communities and a vital safeguard against public health threats. Yet in Bangladesh, rapid urbanization combined with poor financing for public primary health care services have led to major health inequities and gaps in coverage. If public services aren’t available in times of need, most city dwellers resort to expensive private facilities they can barely afford.

Reducing out-of-pocket health care expenditures for low-income residents

To address this mounting challenge, USAID’s Abt Global-led Local Health System Sustainability (LHSS) Project partnered with local government officials in Bangladesh’s Sylhet and Rajshahi Divisions, where millions of people lack reliable access to public primary health care.

Central to our approach was an effort to revitalize health standing committees within the local government institutions (LGIs). These committees would plan, execute, and monitor primary health care services within each LGI. Abt worked with LGI authorities to engage a diverse and influential group of local stakeholders to serve on the committees. Using a collaborative funding model, Abt helped the committees develop other resources to bolster municipal commitments.

Mobilizing resources for primary health centers in Habiganj municipality

In Habiganj municipality, Abt worked with the committee to conduct a comprehensive mapping of zones that lacked functional primary health care sites. They discovered that a population of over 100,000 from five contiguous wards had no access to a primary health care facility. Filling this urgent need became the committee’s highest priority.

Lacking a ready source of financing for a new health facility, the committee focused on mobilizing resources from an array of collaborators. First, they located an unused building owned by the municipality and undertook a nine-month renovation project to transform it into a health center. The municipality invested over two million Taka — or about $18,000 — from its own development budget to complete the renovations.

The health standing committee then turned to other pressing issues of equipment, medicine, and service providers to operationalize the center. The Civil Surgeon’s Office extended its support by committing human resources to provide five days of treatment services per week through three specialized doctors, free-of-cost to the new health center. The Office of Family Planning provided two family welfare visitors for maternal and child services to work at the center three days a week.

The mayor of Habiganj, meanwhile, used his influence to collaborate with private sector entities like the pharmaceutical representatives’ association to source essential medicines for the center. The Habiganj Diabetes Hospital contributed three medical beds, and the municipality recruited a full-time nurse and cleaning and support staff for consistent service to the poor.

Finally, Abt supported the health standing committee in forming a management committee to monitor the service quality and operations of the center. Members include elected ward councilors, the chair of the Habiganj Chamber of Commerce, and other individuals capable of providing financial, technical, or political support.