At the Savar center, primary health care (PHC) evolves with the health conditions

Chirac, P.

Developpement et Sante Revue de Perfectionnement Medical et Sanitaire en Pays Tropical 82: 28-30


ISSN/ISBN: 0396-8014
PMID: 12282818
Document Number: 366992
A war hospital installed close to the front by a group of young Bangladeshi doctors during the 1971 war of liberation from Pakistan was the origin of the new "Gonoshasthaya Kendra" (GK), or people's health center, 40 km north of Dhaka in Savar. At the new center, as in the hospital, trained paramedics furnish basic health care for the population. The center at Savar was applying the principles of primary health care 6 years before they were recognized at the Alma Ata conference. Today, GK has integrated programs to fight poverty into its health activities, with educational, nutrition, and employment programs. The paramedics have a long training course, working under the supervision of a senior paramedic for a year and receiving theoretical training in the evenings. They do not become senior paramedics for several years. The work of the paramedics is oriented toward health education, prevention, and demoepidemiologic surveillance and registration. Each paramedic is responsible for 2 or 3 villages with about 3 thousand inhabitants. The paramedics visit and motivate the population, register births and deaths, identify and care for pregnant women, and vaccinate children and pregnant women. They provide health and nutrition education, treat diarrhea and instruct mothers in use of oral rehydration therapy, and provide family planning information and supplies. Persons in need are referred to "clinic days" held regularly in the larger villages. The paramedics maintain records for each family which allow calculation of vital rates and epidemiologic data. In the region of Savar served by the paramedics, the rates of general mortality and infant mortality are 12/1000 and 85/1000 respectively, vs. 17 and 124/1000 in Bangladesh as a whole. The GK has a new goal of reducing infant mortality to 60/1000. The paramedics have been taught to recognize 2 new symptoms, convulsions and respiratory distress, and to refer infants showing these symptoms to doctors. The GK doctors believe that reducing infant mortality below 60/1000 will require improving the physical condition of mothers by delaying the age at 1st birth, providing education for girls, and improving the nutrition of women. A recent study shows certain limitations in the role of the paramedics. Demand for their services is somewhat limited by their purely preventive role, and they feel undervalued because of their low pay. Their attrition rate is high, and they now sign 3-year contracts at the outset of training. The center is studying the possibility of allowing junior paramedics to prescribe antibiotics to increase demand for their services and improve their professional image.

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