Stepping Up to Community Health: Key to Universal Health Care in Bangladesh

To achieve this goal, the government has committed to Universal Health Coverage (UHC) by 2032, which includes financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines. Bangladesh recognizes that integrating Community Health (C.H.) is a key component of addressing major trends in the nation's growth and development. The country has a population of 163 million people, with a high population density of over 1,000 individuals per kilometer. Rapid urbanization and an epidemiological transition have led to an increase in non-communicable diseases (NCDs), which account for 25% of deaths. Cancer and respiratory diseases are among the leading causes of death, along with heart disease, strokes, tuberculosis, diabetes, and cirrhosis. To address these challenges, Bangladesh is refocusing attention on primary health care at the community level. The government is strengthening Community Health by revitalizing village-level Community Clinics (C.C.s) and engaging communities in their oversight. The role of Community Health Workers (CHWs) is being strengthened through the development of a National Strategy for CHWs, supported by the Integrating Community Health Program. The program is a catalytic partnership supported by USAID, UNICEF, and the Bill & Melinda Gates Foundation. The government has multiple and successive policies to address stewardship of the whole health system. The 2011 National Health Policy asserts universal availability of free comprehensive primary health care services for all reproductive, maternal, child, and adolescent health (RMNCAH) needs, as well as the most prevalent communicable and non-communicable diseases. The policy recognizes the epidemiological transition of NCDs and the need to test out and implement private insurance and social safety nets for the extremely poor and vulnerable segments of the population. Bangladesh faces challenges in human resources for health (HRH), including provider shortages, skill mix imbalance, geographic and location maldistribution, migration, gender imbalance, and financing. Less than 20% of health workers provide services to 70% of the population in rural areas. There remains a general shortage of healthcare professionals, and sanctioned positions often go unfilled for long periods. The government has recognized the need for a comprehensive review of HRH issues to maximize the utilization of human resources in health and family planning. Community Health Workers and their evolving role are critical components of the health system in Bangladesh. Formal CHWs include Family Welfare Assistants (FWA), Health Assistants (HA), and Community Health Care Providers (CHCP). Currently, it is estimated that there are more than 185,000 formal CHWs, with roughly 38% supported through government programs and the remaining 62% in the NGO sector. The government has developed a National Strategy for Community Health Workers, which aims to strengthen the role of CHWs in promoting and delivering essential services at the community level.