Pattern and Effect of Community Participation in Health Care Delivery in Rural Bangladesh through the Community Clinic Approach

Abstract

Introduction: Community Clinics (CC) have played a crucial role in the remarkable achievements of health sector of Bangladesh and community participation is regarded as the key to this triumph. Comprehensive study on implementation, utilization and management of community clinic services is a time honoured issue. Objective: This cross-sectional study was designed to conduct in mixed method to assess the patterns and effects of community participation in health care delivery in rural Bangladesh through the community clinic approach. Methodology: Quantitative part of the study was concerned with pattern of community participation through community clinic approach while qualitative part dealt with key informant’s interview to determine the effects of community participation on health of rural communities. The study was conducted among 32 randomly selected community clinics, 63 health care providers, 2238 service users, 3285 community people and 597 key informants. Results: Most (96.9%) of the CCs were located in easy to reach area of the community. Lands of CCs were donated exclusively by the community members. Almost all the CCs had good infrastructure and security in most (93.7%) was maintained by community people and members of community groups. Availability of equipment was not encouraging as only 12.5% CCs were in the ‘Good’ while supply service was ‘Good’ in 40.6% CCs. Availability of logistics and furniture was ‘Good’ in 62.5% CCs. Provision of health care delivery was ‘Good’ in more than three fourth while health education services was ‘Good’ in 96.7% CCs. All the CCs showed increased trend of heath care utilization and normal delivery conduction in last five years. All the CCs performed referral service and 98.4% provided referral form to the referred patients. Community Groups (CG) of 88.9% and Community Support Group (CSG) of 96.8% CCs were active. UP chairman was the chief patron in more than half (58.7%) CCs. Most (92.1%) of the CG members were trained on training manual & trainer’s guide and 85.7% met once in a month. CC service users were predominantly female (71.2%) followed by male (20.0%) and children (8.9%). Most (99.2%) of the users knew about services available at the CCs. Users perceived benefits of CCs included free drugs (82.1%), free treatment (81.2%), easy access (76.3%), need based health services (75.0%) and immunization services (68.6%). More than three fourth of the users were satisfied with the services of CCs. Most (88.3%) of community people opined that CCs are located within the vicinity of their residing area. About 96.0% regarded that CCs remained open every working day and almost all (99.0%) opined that CGs were concerned about benefits of CCs and community participation in decision making for construction, further improvement, problem solving, local fund collection and referral services. Most (91.2%) of the key informants (KI) addressed that committees of CC were functional and 86.8% opined that the members of the committees were included following eligibility criteria. KI also mentioned that CG was involved in supervision of construction works (49.2%), management & maintenance (79.2%), cleanliness of premises (88.4%) and collection of money locally (22.9%). Collected money was spent to treat poor patients (59.5%), to treat children (49.2%), to repair infrastructure (43.7%) and to treat women (37.5%). More than three fourth (86.8%) of the KIs regarded the management of CCs as satisfactory. Average number of patients treated in CCs was significantly different by divisions (ANOVA, p<0.01). Availability of furniture/logistics was significantly different among the CCs (p<0.05) by division. Level of satisfaction about waiting room (χ , p<0.01), waiting time (p<0.01), quality of the service providers (p<0.01) was significantly varied by sex and occupation of the users. Knowledge about CC (p<0.05), CG (p<0.01), CSG (p<0.01) significantly varied by sex and occupation of the community members. Perceived impacts of community participation through community clinic approach included raised health awareness of the community, effective utilization of essential health care, reduction of communicable diseases, maternal and child morbidity and mortality. Major constraints noticed lack of specialist doctors (30.3%), inadequate service provider (30.9%), inadequate equipments (51.8%) and drug supply (51.8%), insufficient logistics supply (38.2%), financial constraint (34.3%), poor patronization of Government (20.1%) and lack of electricity supply (8.0%). Conclusion: Community clinics need more campaign and promotional activities through organizing more meetings with community people, expansion of space, resource mobilization, digital communication and easy transportation to ensure effective access to services. In order to improve community health, access of the community people to comprehensive health services and must be ensured. For this, the government, stakeholders and communities must extend their participation through community clinic approach to improve the health status of the people.