Three-month-old Sulaiman beats pneumonia
A new clinic model is offsetting the burden of health care costs in the slums of Bangladesh
Three-month-old Sulaiman was born at home in Shyampur, a slum in Dhaka, with a neighbour – a former nurse – assisting his mother to bring him into the world. He and his parents share an apartment with two other families, each with one private room but sharing the bathroom and the kitchen.
Shyampur is a fusion of big factory buildings, apartment blocks and cramped tin houses. It is a busy industrial town with shoe factories, steel mills, furniture shops, welding shops and garment factories on one hand and typical slum houses with narrow paths on the other.
Sulaiman had been fighting pneumonia for several days. His breathing was fast, and he made harsh sounds as he struggled to get air into his lungs. He cried and coughed through the night, unable to sleep. His parents brought him to a UNICEF-supported Aalo clinic near their home where he received medical care.
Dr Moumita Sarker and another general physician run the morning shift at the Shyampur Aalo clinic along with a team of nurses and lab assistants. She says children with pneumonia can quickly deteriorate from healthy and playing to very bad, difficult breathing.
“Young children need close monitoring during treatment,” she adds.
Every day, for seven days, Sulaiman’s parents brought him to the clinic for his treatment including some minutes under a nebulizer to get medicine directly to his lungs.
“The Aalo clinic is close to our home so it’s easy for us to bring our son here. Other hospitals are far, and it costs so much money to get treatment there. First, we have to pay for transport, then we pay for consultation, treatment and medicines. We can’t afford this. At the Aalo clinic everything is free,” explains Sulaiman’s father Mintu.
A struggling health care system
In the urban slums of Bangladesh, around 40 per cent of the children are stunted, meaning they are too short for their age due to malnutrition. This is much higher than the national stunting prevalence of 28 per cent which is already unacceptably high. In addition, only 56 per cent of deliveries in slums are supported by skilled birth attendants, compared to 74 per cent in non-slum urban areas.
While the Government of Bangladesh has impressively expanded health care services in rural communities, the urban health care system is largely uncoordinated and fragmented. Low government expenditure on health care means that Bangladesh’s health care system is mostly funded by those who are sick and who have no option but to pay high charges for care and medicines.
For Sulaiman’s family and other families like them, the consequences of high and unpredictable costs, especially for medicines and diagnostic tests, are inadequate treatment, no treatment at all or impoverishment from the high burden of expenses. Bangladesh has the highest rate of catastrophic health expenditure in South Asia, leaving about 11.3 million people impoverished by health care costs.
Solutions towards affordable primary health care
The Shyampur Aalo Clinic is one of six urban clinics opened in Bangladesh as a model for primary health care provision in urban areas. Through this model, UNICEF, supported by Government of Sweden and in partnership with the Government of Bangladesh, is delivering an essential package of common health services such as maternal and newborn care, child health and immunization, adolescent health, family planning, and treatment for tuberculosis, malaria, hypertension and diabetes. Complicated cases are referred to nearby public hospitals.
Strategically located to make them easily accessible to under-served communities including garment workers, rickshaw pullers, construction workers and domestic workers, the Aalo clinics are open six days a week from 8.30 a.m. to 9 p.m. with both male and female doctors on each shift. Regular clinics are only open five days a week and close already at 2 p.m. if not earlier.
When a patient comes in, they register their name and phone number before moving on to get their vital signs checked. The results are immediately updated to an online system which the doctor on duty accesses. Any lab tests, scans and prescriptions are also added to the patient’s file. This digital filing system helps to track patient information and treatment history and ensures a smooth, efficient administrative process to reduce the waiting time while maximizing on the consultation time.
Data on the number of patients treated and the range of services provided is uploaded real time to the government’s digital health information system. This helps in day-to-day monitoring, planning, resource allocation and auditing doctors’ prescriptions to ensure rational use of drugs. After treatment, patients provide feedback which is regularly analyzed to improve the quality of services in Aalo clinics.
The clinics also run mobile services in surrounding slums with teams of two paramedics going out into the community to provide health services and information.
The Aalo clinics are helping children like Sulaiman beat common childhood illnesses which could be fatal if untreated. If he had been born just a year and a half earlier, Sulaiman may not have had access to the same quality treatment he is getting now and without his parents forced to pay high treatment costs.
“Investing in health matters enormously for children. These urban clinics demonstrate the importance of accessible and affordable primary health care as a pathway for universal health coverage. Our goal is to see this model scaled up, with increased and efficient public spending on health care,” says Maya Vandenent, Chief of Health for UNICEF Bangladesh.