1.
Presented By: 151115

2.
 What is Community Health?
 Community Health Covers
 Population Health
 History of Community Health
 Types of Community Health Care
 Factors Affecting Community Health
 Why Community Healthcare Services are required?
 Community Health Care in Bangladesh
 Community clinics: background and the present scenario
 Services provided in community clinics
 Community clinic as health related data bank
 Health Problems in Bangladesh
 What is BDHS?
 Challenge for the Health System in Bangladesh
 Major Health Problems Solution
 Conclusion

3.
A community is a group of people who might have different characteristics but
share geographical location, settings, goals, or social interest. Examples of
communities include people living in the same town, members of a church, or
members of a sports team. Community health is a field of public health that
focuses on studying, protecting, or improving health within a community. It does
not focus on a group of people with the same shared characteristics, like age or
diagnosis, but on all people within a geographical location or involved in specific
activity.

4.
Community health covers a wide range of healthcare interventions,
including
 health promotion,
 disease prevention,
 and treatment.
It also involves management and administration of care. Community health
workers (CHWs) are often frontline health professionals with knowledge of
specific characteristics and developments of the community. They are often
members of the community themselves and play an important role in the
functioning of community care.
Example: The health status of the people living in a particular town, and the
actions taken to protect and improve the health of these residents.

5.
Population health differs from community health only in the scope of people it
might address. People who are not organized or have no identity as a group or
locality may constitute a population.
Example: Women over fifty, adult male etc.
Population health is an approach to health that aims to improve the health of
the entire population and to reduce health inequities among population
groups. In order to reach these objectives, it looks at and acts upon the broad
range of factors and conditions that have a strong influence on our health.

6.
The earliest recorded evidence of community health is from 25,000 BCE.
Murals on the walls of Spanish caves show physical deformities. These murals
tells us that someone noticed and documented differences in the physical state
or appearance of community members. Later murals in China show a group of
people digging a well for drinking, giving us evidence that the 21,000 BCE
community members understood the importance of clean water for their
health.
In the Middle Ages, many diseases and cures were considered to be spiritual,
and sciences like medicine were thought to be evil. That could be the reason
why so many communities suffered from diseases like plague and leprosy. In
the 19th century, the focus on community health increased. A Commonwealth
of Massachusetts paper by Lemuel Shattuck in 1850 outlined public health
needs in the state, and the work of Dr. John Snow, who removed the handle of
the drinking water pump on Brad Street in 1854 to fight the cholera epidemic,
showed that community interventions are indeed very important.

7.
 Physical factors like the geographical and environmental position of a
community, which affect disease prevalence, community size (overcrowding),
industrial development, and levels of pollution.
 Socio-cultural factors like beliefs, norms and traditions, define attitudes
toward health and influence practices that are either beneficial or harmful to
health. Economic and political community of a health status affect the
affordability and availability of care.
 Community organization can play an important role in the presence of
healthcare options as well as the extent to which members know the
priorities and participate in lobbying and promotion of community health
care.
 Providing proper facilities for preventing diseases.
 Imparting health education and promoting public awareness.

8.
 Assure an adequate local public health infrastructure.
 Promote healthy communities and healthy behaviors.
 Prevent the spread of infectious disease.
 Protect against environmental health hazards.
 Prepare for and respond to disasters, and assist communities in
recovery.
 Assure the quality and accessibility of health services.
 Increase each patient's quality of life by effectively treating
their long term conditions

9.
 Bangladesh is one among the few countries of
the world that provides free medical services to
the people at the community
 Bangladesh government has taken initiatives in
2009 to revitalize the community clinics
 Title of the project was “Revitalization of
Community Health Care Initiatives in
Bangladesh”
 community clinics become functional from 1st
july 2009
Bangladesh was one of the countries who signed the “Alma-Ata Declaration” in
1978 with a pledge to ensure “Health for All” (HFA) by 2000 through Primary
Health Care (PHC). But in 1996 it has been observed that we were far behind the
destination as per the set indicators. Unavailability & inaccessibility of PHC to the
rural community of Bangladesh (about three fourths of national population) with
lacking in community participation were the important reasons.

10.
The government of Bangladesh, in 1996-2001, planned to establish community
clinics (CCs) for provision of primary health care services to rural people. The
government decided to establish 18000 community clinics .

11.
Following the decision, 10723 community clinics were constructed, of which
8000 were made functional by the period from 1998 to 2003
However, due to the change of the government in 2001, the community
clinics were closed until 2008.
With full manpower and necessary logistics, the project office is now fully
functional.
Recruitment of 12991 community health care providers is completed and
recruitment of rest 509 is in progress. (at the end of 2011)

12.
“Revitalization” project undertaken by the government aimed at
the followings:
Making functional 10624 existing community clinics
Recruiting 13500 community health care providers (CHCPs)-one for each
community clinic.
Revitalizing and establishing 18000 community clinics.
Constructing 2876 new community clinics (which included 99 previously
constructed but non-functional community clinics).
Starting operation of community clinic units at 4500 upazila and union health
facilities.

13.
A mini laptop computer with internet connection to every community clinic
All necessary medicines
25 items at initial stage
Depending on the need and reality, the no. of items has extended to have 30.
It is planned that community clinics will be developed as a local health
related data bank containing quantitative data on
community clinics itself,
 community group,
 support group,
 health,
 nutrition,
 family planning and
 general information.

14.
COMMON HEALTH PROBLEMS
IN BANGLADESH - RURAL
 Malnutrition
 Worm Infestation
 Skin Infections
 Diarrhoea
 Acute Respiratory Infections (ARIs)
 Anaemia
 Uberculosis
 Malaria
 Leprosy, etc
 Lack Of Health Care Services
 Poor Housing
 Poor Sanitation
COMMON HEALTH PROBLEMS
IN BANGLADESH – URBAN
 Hypertension
 Air Pollution
 Sound Pollution
 Heart Diseases
 Diabetes
 Cancer
 Dengue Fever
 Drug Addiction
 STD ( Sexually Transmitted
 Diseases , etc )

15.
Communicable diseases are still the major diseases in Bangladesh.
Mortality & morbidity due to these disease are very high. Infectious
diseases like cholera, typhoid, tuberculosis, leprosy, tetanus, measles,
rabies, venereal diseases and parasitic diseases like malaria, filariasis,
worm infestations are responsible for major morbidity.
An expanded immunization programme against nine major disease (TB,
Tetanus, Diphtheria, Whooping cough, Polio, Hepatitis B, Haemophilus
influenza type B, Measles, Rubella) was undertaken for
implementation.

16.
Non-communicable diseases (NCD), defined as medical conditions that
cannot be transmitted from person-to-person, are a growing public
health problem in Bangladesh as well as in the rest of the world. Major
non communicable diseases include high blood pressure, diabetes,
cancer and asthma.
Cardiovascular (heart) disease is now considered to be a leading cause
of death in Bangladesh. About one in three women and about one in
five men age 35 and older has elevated blood pressure and roughly one
in ten women and men age 35 and older has elevated blood glucose, an
indication of diabetes.

17.
“Malnutrition is a broad term commonly used as an alternative to under
nutrition but technically it also refers to over nutrition. People are
malnourished if their diet does not provide adequate calories and protein for
growth and maintenance or they are unable to fully utilize the food they eat
due to illness (under nutrition). They are also malnourished if they consume
too many calories (over nutrition).” -UNISEF

18.
Drug addiction is a complex brain disease. It is characterized by habitual, a
times uncontrollable, drug desire, seeking and use that even in the face of
extremely negative consequences . In Bangladesh it is a growing national
concern .There are million of drug addicted people in Bangladesh and they
are from all level of the society.

19.
Bangladesh suffers from some of the most severe malnutrition problems.
The present per capita intake is only 1850 kilo calorie which is by any
standard, much below the required need.
Malnutrition results from the convergence of poverty, inequitable food
distribution, disease, illiteracy, rapid population growth and environmental
risks, cultural and social inequities etc.
Severe under-nutrition exists mainly among families of landless agricultural
labors and farmers with small holding.

20.
Specific nutritional problems in the country are—
Protein-Energy Malnutrition (PEM): The chief cause of it is
insufficient food intake.
Nutritional anaemia: The most frequent cause is iron deficiency and
less frequently follate and vitamin B12 deficiency.
Xerophthalmia (dryness of eyes): The chief cause is nutritional
deficiency of Vit-A.
Iodine Deficiency Disorders: Goiter and other iodine deficiency
disorders.
Others: Lathyrism, endemic fluorosis etc.

21.
The most difficult problem to tackle in this country is perhaps the
environmental sanitation problem which is multi-faceted and multi-
factorial.
The two major problems of environmental sanitation are—
a)Lack of safe drinking water in many areas of the country.
b)Preventive methods of excreta disposal.

22.
Demographic and Health Surveys (DHS) are nationally-
representative household surveys that provide data for a wide
range of monitoring and impact evaluation indicators in the areas
of population, health, and nutrition.
Conducted By---
1.National Institute of Population Research and
Training (NIPORT)
2.Mitra and Associates, Dhaka, Bangladesh
3.MEASURE DHS, ICF International,
Calverton, Maryland, USA

23.
Percentages
of married
women age
15-49 who
wish to spare
or limit births
but are not
using
contraception
Unmet Need for Family Planning

24.
IYCF Practices
Percent of children age 6-23 months

25.
Trends in Knowledge of AIDS
Percentage of Ever-Married Women and
Men Who Have Heard of AIDS

26.
Source: BDHS 2011
Progress -> Several indicators
Fertility and Family Planning: High
Maternal Health: Satisfactory
Child Survival and Health: Very High
Nutrition : Satisfactory
Knowledge of HIV/AIDS : High

27.
 Limited public facilities
 Lack of essential commodities
 Unavailability of health workforce
 Lack of devolution
 Lack of local level planning
 Misuse of resources
 Lack of community empowerment at a local level
 Lack of Public Health and Management Expertise at the District
and Upazila Levels
 Growing and Continuing Inequity within the Health System
 Inadequate Financial Resources
 Political Instability and Lack of Commitment
 Weak Health Information System

28.
 Poor drinking water quality-install drinking water treatment plant and
drinking water distribution pipe work to every property.
 lack of proper sewage and sanitation- get rid of open drains and sewers -
install sewage treatment works and full sewage pipe work to every
property.
 Infant mortality - introduce a program of mass immunization of babies
against major diseases.
 Polluted air & water courses-introduce a strict regime of strong penalties
for business and industry that pay little attention to air and water
pollution.
 Preventing epidemic and the spread of diseases.
 Promoting healthy behaviors.
 Assure the quality and accessibility of health services.
 Educating people about the health problems

29.
The challenges faced by the health system are multifarious and varied. Bangladesh
has a severe shortage of physicians, nurses, midwives, and health technicians of
various kinds. The deficit will keep on rising as the population increases.
Inadequate number of appropriately trained human resources for health in
Bangladesh is a strong limiting factor for population health. In terms of health
technicians of various kinds (from laboratory technicians to physiotherapists) the
deficit is almost half a million. Midwives and community health workers are also in
short supply. The gap between what the government has assessed (sanctioned) as
requirement for providing healthcare services and the positions vacant clearly
shows that Bangladesh has to make much greater efforts in ensuring accessibility
to essential health care services. Moreover, the human health resources are
heavily concentrated in urban centers, depriving rural areas of much needed
human resources for health.