In October of this year, I had the opportunity to visit the Khulna office of Eminence. I was struck by the stark facilities: a bare office, minimum materials, a remote location – and one staff member, with big arms, a welcoming smile, and a heart of gold. He is an extension worker of sorts. He provides support to a community clinic, helping the staff learn how to manage the facilities, providing services for the patients, and encouraging the community to use the clinic’s services and help with its upkeep. Eminence is working to make a difference to the community–and to the well-being of its members–through the community clinic approach.
In Bangladesh, community clinics are managed by Community Groups that consist of 9 to 11 members from local elites including land donors, teachers, women’s groups, and landless peasants. These community groups focus on accumulating resources for the clinics and on mobilizing health care at the community level. Eminence provides training, technical support and advocacy for these Community Groups to ensure that health service delivery is reaching the most vulnerable, particularly the poor.
In order to better understand Eminence’s role, I visited the Khulna community clinic together with one technical staff member and the extension worker. There, we met the community health care providers who were administering to the community’s needs. In addition to services such as antenatal and postnatal care, immunization, and dietary counseling, they were providing counseling and distributing family planning materials and contraceptives including injectables for which they were trained. The providers revealed that they work steadily, with regular attendance by community members. They showed us the supplies that they had in stock (they mentioned that stock outs were generally not a problem for this clinic); shared with us their records of patient visits; and discussed the different types of reproductive health services they provide. When talking about family planning, they remarked that condoms and the pill were in high demand.
Even though it was toward the end of the day, there were about 12 women gathered in the waiting area. They were chatting among themselves, and entertaining the children who were with them. When I asked them why they came to the clinic, several of them mentioned minor ailments, and the easy accessibility of services that were immediate and free. They were forthcoming in talking about the clinic and the services that they provided.
After some initial blushing and giggling, however, they shared that they also come to the clinic for their reproductive health needs. Several of them talked about accessing family planning to space to limit the number of children they would have, and a couple women even mentioned that their husbands would join them in these visits. When I asked them why they came to the clinic and what they thought about it, they gave three general reasons: First, it was easy to walk to the clinic on their own; second, they could bring their children with them; and third, they liked that the health providers were from their community and they could trust them.
As we continued talking, one elderly woman, looked up at me and said, “Okay, enough talking now, is it time for my examination?” She thought that I was a doctor! I took that as my cue that it was time to leave. And as the women gathered on the staircase to bid us farewell, I was pleased to see a young Bangladeshi woman smiling back at me, confident in her ability to access the services provided at this clinic.