The core elements of the health services provision by CHDP are:
- A network of Village Health Volunteers involved primarily in health promotion and case finding, (identifying especially women and children at high risk).
- 28 community clinics with satellite clinics (including 18 safe delivery units)
- Assisting with activation of Government Health Service facilities through training of staff and developing community capacity for oversight and accountability.
- Specialised training and service capabilities
The Village Health Volunteers, the Community Clinics, and the Hospital provide a continuum of care which is a key feature of the LAMB model of an integrated health system for the poor.
Village Health Volunteers
VHVs are the first line caregivers of the community health programs. There are currently 480 Village Health Volunteers providing health services in CHDP target unions. Each VHV is responsible for 150-300 households.
VHVs are selected by their own community. LAMB provides initial training in primary health care, following up with bi-monthly refresher training. These women also are key mobilizers as they are also trained to gather neighborhood women into action groups.
Most of the VHVs are semi-literate and from poor communities. They are not paid a salary but can earn some money through providing health services, such as distributing contraceptives, oral rehydration solutions and simple medicines, as well as receiving community incentives when acting as ‘companions’ to accompany women to clinic for maternity care. VHVs perform the following tasks:
- Providing simple health education at the household level and encouraging women to have antenatal check-ups, vaccinations, curative care at Heath Care Centers and to use family planning methods
- Distributing contraceptives, ORS and worm medicine
- Encouraging facility deliveries, acting as women’s advocates during labor and delivery (especially if complications) and providing postnatal care
- Linking villagers to clinics
Community Health Workers are more educated paid staff covering a wider area. In addition to providing higher-level health training to communities, they help mobilize groups (women, children, adolescents, informal local leaders) through facilitating discussions to prioritize local health issues, and then design and implement local initiatives to address them.
Clinics and Safe Delivery Units
LAMB has 28 community clinics including 18 Safe Delivery Units spread over an area 80 km in length.
The general clinics are staffed by Community Health Assistants, (paramedics), who receive 4 months’ supervised clinical training at LAMB. Safe Delivery Units are open 24 hours per day, 7 days per week, and have midwives who have additionally gone through LAMB’s Community Midwifery Course of 6 months duration. They provide ante-natal as well as delivery and post-partum care.
The ability of the clinics to refer relevant patients to LAMB (or other tertiary care institutions), is a key value of the clinics. LAMB Medical Assistants and Nurse Midwives visit the clinics regularly for ongoing technical quality assurance, and the standards monitored by LAMB at the clinics and SDUs support good acceptance by the communities.
Clinics are typically located on land donated by the community, and their operating costs are covered by a combination of patient fees, local donations, and donor (or LAMB) contributions.
Specialised Training and Services
Adolescent Health: Adolescent health is a specialized program within CHDP. It not only monitors their health, but seeks to strengthen their awareness of reproductive health issues. It increases the capacity for self-advocacy on the issues, especially in girls, who by societal practice are often married at 13-17 years of age.
Maternity High-Risk Observation: a low-dependency unit in LAMB Hospital is used for the observation of high-risk pregnant mothers referred by community clinics.
Tuberculosis: This continues to be a grave problem in Bangladesh, and LAMB’s program is part of the National TB Program. The CHDP unit identifies cases, initiates treatment either in hospital (if necessary) or community, following DOTS (directly-observed treatment, short-course) methodology in on-going community follow-up.
Rehabilitation of disabled: The disabled population of rural Bangladesh are underserved. LAMB provides home-based and clinic-based therapy, primarily to children. Severe or newly-identified children are also referred to LAMB Hospital Rehabilitation Centre with their mothers for intensive residential therapy, or corrective surgery if needed.
Emotional and Spiritual Health
Emotional and spiritual health is recognized as a key to total health. Mission-Vision-Values Counselors (formerly called community chaplains) ensure Biblically-based justice and wholistic health principles are part of field staff and community training and meeting discussions. They sometimes function as peacebuilders in the event of conflict. Each LAMB staff member, regardless of religious background, knows that prayer is used as a counseling tool and fear-reduction approach.