Field Visit to Savar UHC

Column 2

Interactive Discussion with Government Officials at Savar Upazial Health Complex

Voices of Health Workers

Column 2

Outcomes of FGDs with Front line Health Workers at Union Levels and Ward Levels

Requested Training Proposed By Group A

  • Management Training

  • Community Clinic (CC) Management Training

  • Awareness raising training on specific program

  • Increasing Usage of Appropriate Technology

  • Refresher Training for Skills Development

  • Increasing Social Acceptability of a modern health technology in low income settings

  • Coping Strategy with a Disaster/Climate Change

Who needs these training

  • Community Health Care Provider (CHCP)

  • Health Assistant (HA)

  • Family Welfare Assistant (FWA)

Requested Training Proposed By Group B

  • Social Behaviour Change Communication or Communication for Development (C4D)

  • Improving Maternal and Child Health

  • Background Knowledge and Implications of Health Services Provided by a CC

  • Strengthening Public Private Partnership through CG and CSG

  • Accountability of duty bearers at union/village/community level (e.g. CHCP, HA, FWA)

  • Critical needs for capacity building training on supervising activities of CHCP at a CC

  • Basic pharmaceutical training on usage of different medicine prescribed at CC and their effectiveness

  • Usage of antibiotics and consequence

Who needs these training

  • Community Health Care Provider (CHCP)

  • Health Assistant (HA)

  • Health Inspector (HI)

  • Assistant Health Inspector (AHI)

  • Family Welfare Assistant (FWA) and Family Welfare (FW)

Requested Training Proposed By Group C

  • Comprehensive training for HI, AHI, FPI, FWV to inspect CC

  • Comprehensive management training for HA, FWA to properly manage all activities at CC

  • Health Promotion and disease prevention training for MHV

  • Skills development training for CHCP to administer a CC more efficiently

  • Training for First Line Inspector, EPI and Sanitary Inspector at the field level to perform their job more efficiently

Who needs these training

  • Community Health Care Provider (CHCP)

  • Health Assistant (HA)

  • Health Inspector (HI)

  • Assistant Health Inspector (AHI)

  • Family Welfare Assistant (FWA) and Family Welfare (FW)

  • Family Planning Inspector (FPI)

  • Multipurpose Health Volunteer (MHV)

  • Family Welfare Visitor (FWV)

Requested Training Proposed By Group D

  • Basic management training to operate a CC

  • Training for pregnant women to take good care for safe birth

  • Basic training on family planning

  • Capacity building training for Community Support Group (CSG) members on preventive care

  • Reproductive health training for adolescent boys and girls

  • Organize training/workshop for Imam of a mosque, muezzin of a mosque, Union

  • Parishod (UP) Member, Teacher, Village Doctors, Community Leaders

  • Environmental management training especially around CC

Who needs these training

  • All field level members and CSG members

Requested Training Proposed By Group E

  • Monitoring and follow up training for First Line of Supervisors so that they could supervise their respective subordinates

  • Management training for operating a CC more efficiently

  • Training for First Line of Supervisors so that they could assist Community Group (CG) and Community Support Group (CSG)

  • Comprehensive training for Inspectors on specific task to be performed smoothly

  • Climate and disaster management training to take instant measure

Who needs these training

  • Sanitary Inspector (SI)

  • Health Inspector (HI)

  • Family Planning Inspector (FPI)

BHW WG Members Interviewed

Column 2

Outcome of Interview with BHW WG Members

Working Group Member-1

Alignment of short course and Sida’s development goal - short course theme was proposed in the proposal based on Sida’s development goal as it focuses on democracy, human rights, gender equality, health, climate and environment.

  • Voice and participation

  • Equity

  • Good governance

  • Transparency and accountability

  • Using a framework would be useful to delineate

Sustainability of the short course

  • Charging fees and its advantage and disadvantages

  • Quality of course contents and willingness to pay

  • Quantifying opportunity cost of training participants due to training

  • Scholarship offering equivalent to training/short course fee

  • If scholarship, what would be scholarship offering criteria

Reaching out participants (who have policy decision making power)

  • DG Health

  • DG Family Planning

  • Assistant Secretary

  • Senior secretary

  • Public Health Institute (Institute of Public Health (IPH), Lead training organization -National Institute of Preventive and Social Medicine (NIPSOM), Bangladesh College of Physicians and Surgeons (BCPS), Institute of Epidemiology, Disease Control and Research (IEDCR), Institute of Child and Mother Health (ICMH), National Institute of Kidney Diseases & Urology (NIKDU), Center for Medical Education (CME)

  • Explore the private sector whether they are interested in this course. Otherwise don’t waste time

  • NGO will be interested

Coverage of short course

  • Not mutually exclusive: same set of participants may participate subsequent courses but coverage will be limited to 25 and some courses are not required for some participants

  • Mutually exclusive: different set of participants may participants different courses - coverage will be 25*4 = 100 end of four courses but participant would miss some topic of courses

  • So, we will see after running first two courses

Specific feedback of short course contents

  • Course overall objectives and objectives by theme are okay but need to work on session objectives and session contents

  • Currently, session contents are too broad and need to be more specific and clearer specially Theme-2 & 3

  • So, specify the session objective and design session content accordingly as session contents would depend on session objectives

  • Incorporate session objective and corresponding contents, and proposed experiential learning activities

  • Write somewhere how each session will be conducted such as first lecture/background and then exercise based on session objectives

  • Theme-2 would be: Good Governance including transparency and accountability in Health Sector

Experiential learning activities

  • Regarding experiential learning activities, first, propose tentative tools aligned with session objectives followed by session contents through brainstorming, existing literature/conventions etc.

  • Then, expert member would suggest best alternatives/give comments on it

Working Group Member-2

What would you like promote through this course/Ideal position

  • To show them their their mistakes

  • Support government activities or be in favour of the government

  • Course content should aligned with your ideal theme or so

Suggestions on designing overall course contents

  • Arrange training needs assessment workshop with government representatives to understand the needs of these course

  • Curriculum Development Expert will be needed to design the course contents Organize a virtual or in-person meeting with all experts rather than taking individual opinions. Because what is right for me might not for others. So a common meeting would be beneficial

Suggestions by Course Theme

  • Theme-1 (Pandemic and GoB Response)

    • Start with govt failure to contain COVID-19

    • Why there is no coordination between DGHS and MOHFW

    • Why did GoB delay in response to COVID-19

    • Contact teaching and testing are insufficient, charging price

    • Why govt did not listen expert opinion

    • Why govt prioritize economic impact than health

    • Why anyone goes against govt should end up with jain due to security act

    • No voice from common people

  • Theme-2 (Voice & Participation of Stakeholders in Service Delivery)

    • Follow Community Engagement Involvement (CEI) steps to empower community and delegation of power
    • Narrow down balancing power relation through PPP which broad topic itself

  • Theme-3 (Equity for accessing healthcare services)

    • Read through relevant literature of Prof Dr Mushtaque Raja Chowdhury in context of Bangladesh
    • Access, coverage, quality of services–UHC

  • Theme-4 (Good Governance in Health Sector)

    • Should we point govt mistakes or in favour of government

Working Group Member-3

Facilitators and others

  • Who will be the facilitator?

  • Facilitator should have in-depth knowledge and interest on the topic

  • Ask Daniel’s (Donor representative) suggestions about the short courses

Working Group Member-4&5

Potential participants

  • Include participants from BHW Regional Chapters (RC)

  • If 1-2 persons participate from each RC, there will be at least 12-24 RC participants in 12 short courses in the end

  • Journalists are encouraged to participate in the short course

  • Private Sectors are also encouraged to include as without them UHC cannot be achieved. Additionally, they should be accountable for their actions/inactions

  • Govt Sectors will dominate the course in terms of number of participants

  • A mixed or heterogeneous participation would be useful

  • Asking suggestions from participant how to improve certain situation or thing rather than pointing failure of the GoB

Alumni meeting after 6 months of each course

  • Participants will be told about the alumni meeting after six month of the course they participated

  • There will be 12 alumni meeting to follow up participants

  • One alumni meeting for each course

  • In the meeting participant would share how they had implemented the skills they acquired during the training, what were the barriers etc.

  • It will be good document for the future as well as assess the overall outcome of the short course

  • Dr Zahirul Islam would be present from Sida during Alumni Meeting

  • Dr Zahirul Islam may be facilitator of Equity Session of the short course as suggested by Dr Daniel Novak as he is experienced in that area

Health workers and their roles

Column 2

The duties and responsibilities of health service providers

At village/ward/union level:

The duties and responsibilities of Community Health Care Provider (CHCP), Health Assistant (HA), Family Welfare Assistant (FWA) at Community Clinic (CC), Union Sub Center (USC) and Health & Family Welfare Center (HFWC)

Administrative/management

  • Managing Community Clinic (CC) under field service unit

  • Listing activities of Community Clinic (CC)

  • Making working days and times of CC in discussion with Community Group (CG) about

  • Taking all initiative to successfully/effectively deliver Essential Service Package (ESP)

  • Registration of all patients especially pregnant women who visit community clinic (CC)

  • Collecting data for updating Management Information Systems (MIS) to be sent to Union Health and Family Welfare Center (UHFWC) for necessary action

  • Managing logistic and record keeping

  • Timely requisition for medicine and essential materials

  • Ensuring safe removal of medical waste (e.g. disposable syringe, needles) from community clinic (CC)

General services

  • Providing quality OPD services to patients

  • Provide medicine and treatment for certain diseases and/or symptoms: diarrhoea, goitre/iodine deficiency, worm infestations, Acute Respiratory Infection(ARI), measles (rubella), Tuberculosis (including DOTS), Leprosy with Multi-Drug Treatment (MDT)

  • Screening of Chronic non_communicable Diseases (NCDs)

Maternal and child services

  • Distribution of Vitamin A Capsule (VAC) to pregnant women, lactating mothers, and children especially with suffering from acute malnutrition, infected by measles

  • Identifying child night blindness cases and ensure treatment accordingly

  • Child Immunization/vaccination against Measles, Whooping cough , Tetanus, Polio

  • Record keeping of expected due date (EDD) of all pregnant women in catchment area to provide emergency care for danger sign (if any)

  • Providing Post natal care (PNC) to mothers and neonatal care to newborns

  • Identifying Anemia among women and adolescent girls and give necessary treatment

  • Providing Reproductive and Family Planning (FP) services (e.g. distribution of condoms, contraceptive pills)

  • Providing necessary support to Family Welfare Visitor (FWV) during her visit at CC for an Intrauterine Device (IUD), Norplant to interested women visiting CC.

Domiciliary services

  • Awareness raising about epidemic of an infectious diseases such as COVID-19, Kalajor (Black Fever)

  • Visit hard to reach area to provide services to those who are unable to visit CC

  • Personal communication with pregnant women to visit CC to receive ANC services including tetanus immunization

Referral services

  • Complicated patients who visited CC are referred to higher level health facility such as Union Health and Family Planning Center (UHFPC) after giving primary treatment

  • Interested women who want to receive menstrual regulation (MR) services and post abortion are referred to higher level health facilities

Behavior Change Communication (BCC)

  • Health education and counselling such as reproductive tract infection (RTI), sexually transmitted diseases (STD), and HIV/AIDS

  • Nutritional education such as eating balanced diet, avoid unhealthy food, diet for adolescent girls and women

  • Safe sexual relationship, reproductive health awareness to adolescent girls and women

Sub-district level:

The Duties and Responsibilities of Health Inspector/ Assistant Health Inspector at Upazila Health Complex (UHC):

  • Ensuring successful implementation of Essential Service Packages (ESP) at union and ward/community level diseases control and prevention, behavior change communication (BCC) and coordination with NGOs

  • Supervising and assessing effectiveness of CC intervention such as vaccination/immunization activities at community level through door to door visit- diseases control and prevention, ARI, diarrhoea, disease due to lack of Vitamin-A

  • Supervising measures undertaking control and prevention of epidemics

  • Participation in health awareness activities such as cleaning, sanitation, food habit

  • Investigation of stock of medicine and other essential materials and take initiative to ensure smooth supply of medicine at CC level

  • Coordination with NGOs, CBOs, Volunteer organization, private organizations to help responsible persons

  • Submit monthly work plan including field inspection to supervisor in advance

  • Any other responsibilities given by supervisor

The duties and responsibilities of Upazila Health & Family Planning Officer (UH&FPO) at Upazila Health Complex (UHC):

  • In coordination with Upazila Nirbahi Officer (UNO), executing all activities under the guidance of Upazila Porishod (UZP)

  • Supervising all health staff at Upazila (sub-district) and below level

  • Budget allocation for both health and family planning department and ensuring proper utilization allocated money

  • Management and Implementation of Upazila Health Projects

  • Ensuring family planning initiatives especially permanent method of family planning

  • Ensuring all types of health and family welfare training

  • Distribution of duties and responsibilities among Medical Officers for clinical, and health and family planning operations

  • Distribution of duties and responsibilities and duty station among field staff

  • Maintaining all information and statistics of Upazila Health Projects and report to higher authority

  • Paying regular visit to Union and Village to learn challenges on health family planning activities

  • Ensuring that subordinate officer and supervisors keep regular communications with Schools at Union level and representative team

  • Resource mobilization and distribution

  • Controlling of communicable diseases to implement primary health and family planning activities

Guiding Principles of HS in Bangladesh

Column 2

Guiding Principles of Health System in Bangladesh

Governance and health service architecture in Bangladesh


Timeline of relevant policies to Primary Health Care (PHC)


Source: Adapted from Primary Health Care Systems (PRIMASYS) Case study from Bangladesh

Constitution :

  • Article 15(a) : Ensure basic necessities of life (Including medical care) to its citizens.

  • Article 18(1) : Raise the level of nutritional status and improve public health.

Sustainable Development Goals (SDGs):

  • SDG-3: Ensure healthy lives and promote well being for all at all ages by 2030
  • 13 Targets
  • 28 Indicators

Health Population and Nutrition Program (1998-2021) :

  • Sustainable improvement in health, nutrition and family welfare.

National Health Policy (NHP)-2011:

  • 15 Principles. Ensure quality health, nutrition and family welfare services which are affordable, attainable and acceptable to its citizens.

Bangladesh National Population Policy-2012:

  • Lower the Total Fertility Rate (TFR) to 2.1, achieve NRR = 1 to achieve a stable population by 2060.

Vision 2021:

  • Digital Bangladesh and improving Human Development Index.

  • National Nutrition Policy 2015

  • Healthcare Financing Strategy 2012-2032: Expanding Social Protection for Health Towards Universal Health Coverage (UHC)

  • Bangladesh Health Workforce Strategy 2016–2021

Agreement on International Declarations:

  • The Alma Ata Declaration (1978)

  • The World Summit for Children (1990)

  • International Conference on Population and Development (1994)

  • Beijing Women’s Conference (1995)

  • The Alma Ata Declaration on Primary Health Care (2008)

---
title: "Training Needs Assessment for BHW Short Courses"
date: '1 - 25 March 2021'
output: 
  flexdashboard::flex_dashboard:
      source_code: embed
      social: menu
      
---
```{css}
body > div.navbar.navbar-inverse.navbar-fixed-top > div > div.navbar-header > span.navbar-brand {
    font-size: 30px;
    color: white;
}
```

```{r setup, include=FALSE}
library(flexdashboard)
library(knitr)
```

# Field Visit to Savar UHC {data-navmenu="TNA"} 

## Column 1 {data-width=350, .sidebar}


Field Visit to Savar *Upazila* Health Complex (UHC)

Following the Training Needs Assessment (TNA) work plan, the JPGSPH Team (Lead Facilitator Kazi Hasan Imam, Dr Proloy Barua, and Munirul Islam) went to Upazila Health Complex (UHC), Savar, Dhaka on 2 March 2021. The purpose of this field visit was to interview health providers at upazila hospital (sub-district level) and focus group discussions (FGDs) with frontline health workers at Community Clinic (CC) at union level/ward level/community level (Figure 1). As such, we used TNA tools to identify skill gaps at health providers levels while we used the FGD method to identify required training to deliver quality services to community people. Pictorial views of the TNA activities are presented in the Annex. We first identified duties and responsibilities of health providers at upazila levels and below followed by the requested training as presented in the following sections. 


## Column 2 {data-width=4350}

Interactive Discussion with Government Officials at Savar Upazial Health Complex

```{r, echo = FALSE, out.width="50%"}
myimages<-list.files("F:/BHW Dcuments/Photo_FGD_Final/", pattern = ".jpg", full.names = TRUE)
include_graphics(myimages)
```

# Voices of Health Workers {data-navmenu="TNA"} 

## Column 1 {data-width=350, .sidebar}

Focus Group Discussions (FGDs) GROUPS

  - Group A: Group A is composed of five members including one Sanitary Inspector (SI), one Health Inspector (HI), three Family Planning Inspector (FPI)
  
  - Group B: Group B is composed of nine members including one eight Assistant Health Inspector (AHI)
  
  - Group C: Group C is composed of four members including three Assistant Health Inspector (AHI) and one Family Planning Inspector (FPI)
  
  - Group D: Group D is composed of five members and all are Family Planning Inspector (FPI)
  
  - Group E: Group E is composed of five members including one Sanitary Inspector (SI), one Health Inspector (HI), and three Family Planning Inspector (FPI)

## Column 2 {data-width=350}

Outcomes of FGDs with Front line Health Workers at Union Levels and Ward Levels 

Requested Training Proposed By Group A

  - Management Training
  
  - Community Clinic (CC) Management Training 
  
  - Awareness raising training on specific program 
  
  - Increasing Usage of Appropriate Technology 
  
  - Refresher Training for Skills Development 
  
  - Increasing Social Acceptability of a modern health technology in low income settings 
  
  - Coping Strategy with a Disaster/Climate Change  

Who needs these training

  - Community Health Care Provider (CHCP)
  
  - Health Assistant (HA)
  
  - Family Welfare Assistant (FWA)

Requested Training Proposed By Group B

  - Social Behaviour Change Communication or Communication for Development (C4D) 
  - Improving Maternal and Child Health 
  
  - Background Knowledge and Implications of Health Services Provided by a CC
  
  - Strengthening Public Private Partnership through CG and CSG
  
  - Accountability of duty bearers at union/village/community level (e.g. CHCP, HA, FWA)
  
  - Critical needs for capacity building training on supervising activities of CHCP at a CC
  
  - Basic pharmaceutical training on usage of different medicine prescribed at CC and their effectiveness
  
  - Usage of antibiotics and consequence    

Who needs these training

  - Community Health Care Provider (CHCP)
  
  - Health Assistant (HA)
  
  - Health Inspector (HI)
  
  - Assistant Health Inspector (AHI)
  
  - Family Welfare Assistant (FWA) and Family Welfare (FW)

Requested Training Proposed By Group C

  - Comprehensive training for HI, AHI, FPI, FWV to inspect CC
  
  - Comprehensive management training for HA, FWA to properly manage all activities at CC
  
  - Health Promotion and disease prevention training for MHV 
  
  - Skills development training for CHCP to administer a CC more efficiently 
  
  - Training for First Line Inspector, EPI and Sanitary Inspector at the field level to perform their job more efficiently


Who needs these training

  - Community Health Care Provider (CHCP)
  
  - Health Assistant (HA)
  
  - Health Inspector (HI)
  
  - Assistant Health Inspector (AHI)
  
  - Family Welfare Assistant (FWA) and Family Welfare (FW)
  
  - Family Planning Inspector (FPI)
  
  - Multipurpose Health Volunteer (MHV)
    
  - Family Welfare Visitor (FWV)


Requested Training Proposed By Group D

  - Basic management training to operate a CC
  
  - Training for pregnant women to take good care for safe birth 
  
  - Basic training on family planning 
  
  - Capacity building training for Community Support Group (CSG) members on preventive care 
  
  - Reproductive health training for adolescent boys and girls 
  
  - Organize training/workshop for Imam of a mosque, muezzin of a mosque, Union
  
  - Parishod (UP) Member, Teacher, Village Doctors, Community Leaders
  
  - Environmental management training especially around CC

Who needs these training

  - All field level members and CSG members 

Requested Training Proposed By Group E

  - Monitoring and follow up training for First Line of Supervisors so that they could supervise their respective subordinates 
  
  - Management training for operating a CC more efficiently 
  
  - Training for First Line of Supervisors so that they could assist Community Group (CG) and Community Support Group (CSG)
  
  - Comprehensive training for Inspectors on specific task to be performed smoothly 
  
  - Climate and disaster management training to take instant measure 


Who needs these training

  - Sanitary Inspector (SI)
  
  - Health Inspector (HI)
  
  - Family Planning Inspector (FPI)
 

# BHW WG Members Interviewed {data-navmenu="TNA"} 

## Column 1 {data-width=350, .sidebar}


BHW WG Members Interviewed

Dr. Yasmin H Ahmed
 
Adviser
 
Bangladesh Health Watch (BHW)

Interview Date: 11AM-12:25PM, Sunday, 21 March 2021 
 
Professor Dr. Syed Masud Ahmed 
 
Director
 
The Centre of Excellence for Health Systems and Universal Health Coverage(CoE HS&UHC), BRAC JPGSPH

Interview Date: 12-1PM, Monday, 22 March 2021 
 
Prof Dr. AMR Chowdhury
 
Convener

Bangladesh Health Watch (BHW)

Interview Date: 11AM, Thursday, 24 March 2021

Dr. A M Zakir Hussain

Former Director

Primary Health Care and Disease Control, Government of Bangladesh

and former Regional Advisor for Regional Office for South-East Asia (SEARO), World Health Organisation (WHO)

Interview Date: 12PM, Tuesday, 24 March 2021


Dr. Daniel Novak

First secretary/Program Specialist Health Sector

Embassy of Sweden,  Dhaka-1212, Bangladesh

Interview Date: 11AM, Thursday, 25 March 2021

Dr. Mohammad Zahirul Islam
Senior Programme Officer/Health Advisor

Development Cooperation Section

Embassy of Sweden,  Dhaka-1212, Bangladesh

Interview Date: 11AM, Thursday, 25 March 2021

## Column 2 {data-width=350}

Outcome of Interview with BHW WG Members

Working Group Member-1

Alignment of short course and Sida’s development goal - short course theme was proposed in the proposal based on Sida’s development goal as it focuses on democracy, human rights, gender equality, health, climate and environment. 

  - Voice and participation
  
  - Equity 
  
  - Good governance
  
  - Transparency and accountability
  
  - Using a framework would be useful to delineate  
  
Sustainability of the short course

  - Charging fees and its advantage and disadvantages
  
  - Quality of course contents and willingness to pay
  
  - Quantifying opportunity cost of training participants due to training
  
  - Scholarship offering equivalent to training/short course fee
  
  - If scholarship, what would be scholarship offering criteria 

Reaching out participants (who have policy decision making power)

  - DG Health 
  
  - DG Family Planning
  
  - Assistant Secretary
  
  - Senior secretary  
  
  - Public Health Institute (Institute of Public Health (IPH), Lead training organization -National Institute of Preventive and Social Medicine (NIPSOM), Bangladesh College of Physicians and Surgeons (BCPS), Institute of Epidemiology, Disease Control and Research (IEDCR), Institute of Child and Mother Health (ICMH), National Institute of Kidney Diseases & Urology (NIKDU), Center for Medical Education (CME)  
  
  - Explore the private sector whether they are interested in this course. Otherwise don't waste time  
  
  - NGO will be interested 
  
Coverage of short course

  - Not mutually exclusive: same set of participants may participate subsequent courses but coverage will be limited to 25 and some courses are not required for some participants 
  
  - Mutually exclusive: different set of participants may participants different courses - coverage will be 25*4 = 100 end of four courses but participant would miss some topic of courses 
  
  - So, we will see after running first two courses 

Specific feedback of short course contents

  - Course overall objectives and objectives by theme are okay but need to work on session objectives and session contents 
  
  - Currently, session contents are too broad and need to be more specific and clearer specially Theme-2 & 3
  
  - So, specify the session objective and design session content accordingly as session contents would depend on session objectives
  
  - Incorporate session objective and corresponding contents, and proposed experiential learning activities
  
  - Write somewhere how each session will be conducted  such as first lecture/background and then exercise based on session objectives
  
  - Theme-2 would be: Good Governance including transparency and accountability in Health Sector  

Experiential learning activities

  - Regarding experiential learning activities, first, propose tentative tools aligned with session objectives followed by session contents through brainstorming, existing literature/conventions etc.
  
  - Then, expert member would suggest best alternatives/give comments on it   
  
Working Group Member-2

What would you like promote through this course/Ideal position

  - To show them their their mistakes 
  
  - Support government activities or be in favour of the government
  
  - Course content should aligned with your ideal theme or so
  
Suggestions on designing overall course contents

  - Arrange training needs assessment workshop with government representatives to understand the needs of these course
  
  - Curriculum Development Expert will be needed to design the course contents
Organize a virtual or in-person meeting with all experts rather than taking individual opinions. Because what is right for me might not for others. So a common meeting would be beneficial 

Suggestions by Course Theme

  - Theme-1 (Pandemic and GoB Response) 
  
    - Start with govt failure to contain COVID-19
    
    - Why there is no coordination between DGHS and MOHFW
    
    - Why did GoB delay in response to COVID-19
    
    - Contact teaching and testing are insufficient, charging price
    
    - Why govt did not listen expert opinion
    
    - Why govt prioritize economic impact than health 
    
    - Why anyone goes against govt should end up with jain due to security act
    
    - No voice from common people 

  - Theme-2 (Voice & Participation of Stakeholders in Service Delivery) 
  
    - Follow Community Engagement Involvement (CEI) steps to empower community and delegation of power 
    - Narrow down balancing power relation through PPP which broad topic itself 

  - Theme-3 (Equity for accessing healthcare services) 
    - Read through relevant literature of Prof Dr Mushtaque Raja Chowdhury in context of Bangladesh 
    - Access, coverage, quality of services--UHC 

  - Theme-4 (Good Governance in Health Sector)
    - Should we  point govt mistakes or in favour of government  

Working Group Member-3

Facilitators and others 

  - Who will be the facilitator?
  
  - Facilitator should have in-depth knowledge and interest on the topic   
  
  - Ask Daniel’s (Donor representative) suggestions about the short courses 

Working Group Member-4&5

Potential participants

  - Include participants from BHW Regional Chapters (RC) 
  
  - If 1-2 persons participate from each RC, there will be at least 12-24 RC participants in 12 short courses in the end  
  
  - Journalists are encouraged to participate in the short course
  
  - Private Sectors are also encouraged to include as without them UHC cannot be achieved. Additionally, they should be accountable for their actions/inactions  
  
  - Govt Sectors will dominate the course in terms of number of participants 
  
  - A  mixed or heterogeneous participation would be useful 
  
  - Asking suggestions from participant how to improve certain situation or thing  rather than pointing failure of the GoB

Alumni meeting after 6 months of each course 

  - Participants will be told about the alumni meeting after six month of the course they participated
  
  - There will be 12 alumni meeting to follow up participants
  
  - One alumni meeting for each course 
  
  - In the meeting participant would share how they had implemented the skills they acquired during the training, what were the barriers etc.
  
  - It will be good document for the future as well as assess the overall outcome of the short course  
  
  - Dr Zahirul Islam would be present from Sida during Alumni Meeting
  
  - Dr Zahirul Islam may be facilitator of Equity Session of the short course  as suggested by Dr Daniel Novak as he is experienced in that area 


# Health workers and their roles {data-navmenu="TNA"} 

## Column 1 {data-width=350, .sidebar}

Training Needs Assessment (TNA)

List of Health Staff Working at *Upazila*, Union and Ward Levels

***Who are working at Upazila Health Complex Level***

**Health Service Provider**

  - *Upazila* Health & Family Planning Officer (UH&FPO)
  
  - Resident Medical Officer
  
  - Consultant
  
  - Medical Officer (Disease Control)
  
  - Medical Officer 
  
  - Supervisor Nurse 
  
  - Senior Staff Nurse
  
  - Health Inspector In-charge
  
  - Health Inspector
  
  - Medical Technologist (Sanitary Inspector)

**Family Planning Service Provider**

  - *Upazila* Family Planning Officer
  
  - Medical Officer (MCH-FP) 
  
  - Assistant Family Planning Officer
  
  - Senior Family Welfare Visitor
  
  - Family Welfare Visitor
  
  - Ayea

## Column 2 {data-width=350}


The duties and responsibilities of health service providers 

**At village/ward/union level:**

The duties and responsibilities of Community Health Care Provider (CHCP), Health Assistant (HA), Family Welfare Assistant (FWA) at Community Clinic (CC), Union Sub Center (USC) and Health & Family Welfare Center (HFWC)



Administrative/management


  - Managing Community Clinic (CC) under field service unit 
  
  - Listing activities of Community Clinic (CC)
  
  - Making working days and times of CC  in discussion with Community Group (CG) about 
  
  - Taking all initiative to successfully/effectively deliver Essential Service Package (ESP) 
  
  - Registration of all patients especially pregnant women who visit community clinic (CC)
  
  - Collecting data for updating Management Information Systems (MIS) to be sent to Union Health and Family Welfare Center (UHFWC) for necessary action
  
  - Managing logistic and record keeping 
  
  - Timely requisition for medicine and essential materials
  
  - Ensuring safe removal of medical waste (e.g. disposable syringe, needles) from community clinic (CC) 
  

General services


  - Providing quality OPD services  to patients 
  
  - Provide medicine and treatment for certain diseases and/or symptoms: diarrhoea, goitre/iodine deficiency, worm infestations, Acute Respiratory Infection(ARI), measles (rubella), Tuberculosis (including DOTS), Leprosy with Multi-Drug Treatment (MDT)
 
  - Screening of Chronic non_communicable Diseases (NCDs)


Maternal and child services


  - Distribution of Vitamin A Capsule (VAC) to pregnant women, lactating mothers, and children especially with suffering from acute malnutrition, infected by measles 
  
  - Identifying child night blindness cases and ensure treatment accordingly
  
  - Child Immunization/vaccination against Measles, Whooping cough , Tetanus, Polio
  
  - Record keeping of expected due date (EDD) of all pregnant women in catchment area to provide emergency care for danger sign (if any)
  
  - Providing Post natal care (PNC) to mothers and neonatal care to newborns 
  
  - Identifying Anemia among women and adolescent girls and give necessary treatment 
  
  - Providing Reproductive and Family Planning (FP) services (e.g. distribution of condoms, contraceptive pills)
  
  - Providing necessary support to Family Welfare Visitor (FWV) during her visit at CC for an Intrauterine Device (IUD), Norplant to interested women visiting CC.

Domiciliary services

  - Awareness raising about epidemic of an infectious diseases such as COVID-19, Kalajor (Black Fever)
  
  - Visit hard to reach area to provide services to those who are unable to visit CC
  
  - Personal communication with pregnant women to visit CC to receive ANC services including tetanus immunization   

Referral services

  - Complicated patients who visited CC are referred to higher level health facility such as Union Health and Family Planning Center (UHFPC) after giving primary treatment
  
  - Interested women who want to receive  menstrual regulation (MR) services and post abortion are referred to higher level health facilities  

Behavior Change Communication (BCC)

  - Health education and counselling such as reproductive tract infection (RTI), sexually transmitted diseases (STD), and HIV/AIDS 
  
  - Nutritional education such as eating balanced diet, avoid unhealthy food, diet for adolescent girls and women 
  
  - Safe sexual relationship, reproductive health awareness to adolescent girls and women  

**Sub-district level:**

The Duties and Responsibilities of Health Inspector/ Assistant Health Inspector at Upazila Health Complex (UHC):

  - Ensuring successful implementation of Essential Service Packages (ESP) at union and ward/community level diseases control and prevention, behavior change communication (BCC) and coordination with NGOs
  
  - Supervising and assessing effectiveness of CC intervention such as vaccination/immunization activities at community level through door to door visit- diseases control and prevention, ARI, diarrhoea, disease due to lack of Vitamin-A  
  
  - Supervising measures undertaking control and prevention of epidemics 
  
  - Participation in health awareness activities such as cleaning, sanitation, food habit
  
  - Investigation of stock of medicine and  other essential materials and take initiative to ensure smooth supply of medicine at CC level
  
  - Coordination with NGOs, CBOs, Volunteer organization, private organizations to help responsible persons 
  
  - Submit monthly work plan including field inspection to supervisor in advance 
  - Any other responsibilities given by supervisor


The duties and responsibilities of Upazila Health & Family Planning Officer (UH&FPO) at Upazila Health Complex (UHC):


  - In coordination with Upazila Nirbahi Officer (UNO), executing all activities under the guidance of Upazila Porishod (UZP)
  
  - Supervising all health staff at *Upazila* (sub-district) and below level 
  
  - Budget allocation for both health and family planning department and ensuring proper utilization allocated money 
  
  - Management and Implementation of *Upazila* Health Projects 
  
  - Ensuring family planning initiatives especially permanent method of family planning 
  
  - Ensuring all types of health and family welfare training 
  
  - Distribution of duties and responsibilities among Medical Officers for clinical, and health and family planning operations
  
  - Distribution of duties and responsibilities and duty station among field staff 
  
  - Maintaining all information and statistics of Upazila Health Projects and report to higher authority 
  
  - Paying regular visit to Union and Village to learn challenges on health family planning activities 
  
  - Ensuring that subordinate officer and supervisors keep regular communications with Schools at Union level and representative team 
  
  - Resource mobilization and distribution 
  
  - Controlling of communicable diseases to implement primary health and family planning activities  

# Guiding Principles of HS in Bangladesh {data-navmenu="TNA"} 

## Column 1 {data-width=350, .sidebar}

Guiding Principles of Health System in Bangladesh

The Constitution of Bangladesh


  - Ensure basic necessities of life (including medical care) to its citizens.

  - Raise the level of nutritional status and improve public health.

Sustainable Development Goals (SDGs)

  - SDG-3: Ensure healthy lives and promote wellbeing for all at all ages by 2030
  
Health Population and Nutrition Program (1998-2021):

  - Sustainable improvement in health, nutrition and family welfare.
  
**National Health Policy (NHP)-2011:**

**Bangladesh National Population Policy-2012:**

**Vision 2021:**

  - Healthcare Financing Strategy 2012-2032: Expanding Social Protection for Health Towards Universal Health Coverage (UHC)

**Agreement on International Declarations:**

  - The Alma Ata Declaration on Primary Health Care (Almaty 2008)

## Column 2 {data-width=350}

Guiding Principles of Health System in Bangladesh



Governance and health service architecture in Bangladesh 


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```

 

Timeline of relevant policies to Primary Health Care (PHC)


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```


Source: Adapted from [Primary Health Care Systems (PRIMASYS) Case study from Bangladesh](https://www.who.int/alliance-hpsr/projects/alliancehpsr_bangladeshabridgedprimasys.pdf?ua=1)



Constitution :

  - Article 15(a) : Ensure basic necessities of life (Including medical care) to its citizens.
  
  - Article 18(1) : Raise the level of nutritional status and improve public health.

Sustainable Development Goals (SDGs):

  - SDG-3: Ensure healthy lives and promote well being for all at all ages by 2030
   - 13 Targets 
   - 28 Indicators

Health Population and Nutrition Program (1998-2021) :

  - Sustainable improvement in health, nutrition and family welfare.

National Health Policy (NHP)-2011:

  - 15 Principles. Ensure quality health, nutrition and family welfare services which are affordable, attainable and acceptable to its citizens.

Bangladesh National Population Policy-2012:

  - Lower the Total Fertility Rate (TFR) to 2.1, achieve NRR = 1 to achieve a stable population by 2060.

Vision 2021:

  - Digital Bangladesh and improving Human Development Index.

  - National Nutrition Policy 2015

  - Healthcare Financing Strategy 2012-2032: Expanding Social Protection for Health Towards Universal Health Coverage (UHC)
  
  - Bangladesh Health Workforce Strategy 2016–2021
  
Agreement on International Declarations:

  - The Alma Ata Declaration (1978)
  
  - The World Summit for Children (1990)
  
  - International Conference on Population and Development (1994)
  
  - Beijing Women’s Conference (1995)
  
  - The Alma Ata Declaration on Primary Health Care (2008)