Strengthening Community Engagement and Local Government Support to Improve Community Health Care Programs

The project was implemented by the Improving Community Health Workers project, in collaboration with the Ministry of Health and Social Welfare, from 2016 to 2020. The project's main innovation was the Community Clinic-Centered Health Service Model (CCCHSM), which aimed to improve community health worker programs through optimal utilization of CHW potential, increased efficiency of CHW programming, and an improved supportive environment for CHWs through broader and deeper community engagement. The CCCHSM was implemented as a pilot in six Upazilas in the Barishal district, with support from the ICHW project to the local government to strengthen local systems for community-based health services. The model was designed to enable holistic support to community clinic service delivery, strengthen the systems and structures already being implemented through the public health system, and improve the quality, efficiency, and accountability of services at community clinics. The CCCHSM involved several interventions, including enhanced supervision and monitoring of CCs and CHWs, team-building and harmonization of CHW roles and responsibilities, collection of community health data and using it to make decisions and action plans, community engagement, local government support, and an accountability approach using the Community Score Card process. The Community Score Card process enabled community scoring of CHWs and overall CC services, and self-scoring by CHWs, which was jointly developed into an action plan, implemented and monitored between health service providers and community members. In addition to the CCCHSM, the ICHW project also activated all the latent Union Health, Education & Family Planning Standing Committees and Community Groups (CGs) and Community Support Groups (CSGs) responsible for CCs. The project reactivated the Committees by reaching out to the members through the Union Parishad (UP) Chairman, and then educating the Standing Committee members of their official functions regarding overseeing community health systems. Local government representatives actively engaged with CGs and CSGs in the Community Clinic-Centered Health Service Model areas. The project also used the Community Score Card process to influence the quality, efficiency, and accountability of services at CCs. In 13 CCs, the local government used the Community Score Card process to assess the CC services and their management, identify issues, action plan, implement, monitor, and evaluate the clinic performances. The process involved community members, CC service providers, and local government officials in identifying issues, action planning, implementation, monitoring, and evaluation of clinic performances. The CCCHSM and the Community Score Card process were designed to contribute to a more coherent and organized approach to CHW programs, leading to increased coverage, improved care-seeking, and increased referrals to higher levels of care. The project's findings and recommendations can inform discussions and decisions at the national and local levels in Bangladesh regarding why community and government support is essential to improve community health programming. The Community Clinic-Centered Health Service Model and the Community Score Card process have the potential to improve the quality, efficiency, and accountability of services at community clinics, and contribute to a more coherent and organized approach to CHW programs. The project's findings and recommendations can inform policy and program decisions at the national and local levels in Bangladesh, and contribute to the advancement of universal health coverage in the country.