Coherent training for community health workers and paramedics in rural Bangladesh
Author: RTM International, Bangladesh
A disjointed approach to the provision of healthcare in Bangladesh has led to serious shortages of qualified healthcare workers in the country. Rural areas have suffered the brunt of this shortage, with 80% of those living in rural Bangladesh being served by unqualified healthcare providers. Apart from training for doctors and nurses, standard training programmes for other healthcare professionals have been largely absent. Public sector healthcare workers were in short supply due to a lack of recruitment and training by government for more than a decade. This has resulted in a demand for over 4,000 healthcare workers in Bangladesh. NGOs have attempted to fill some of this gap by developing short-term training courses. Later these were extended to one or two year training programs in paramedical subjects.
While the movement towards longer term training courses was a step in the right direction, the system suffered from a lack of standardization and coordination, with each NGO focusing on developing skills for their particular development initiative’s needs. There was a lack of coherence in training policies, no standardization or coordination in curricula or any regulation of quality in training courses.
Recognizing that the human resource crisis in healthcare in rural Bangladesh needed to be addressed in a more cohesive and systematic manner, RTM International focused on creating certification schemes for 2 sets of professionals: Community Health Workers and Community Paramedics. Both courses aimed to increase healthcare skills in remote areas of the country. The Community Healthcare Workers course focused on primary healthcare services while the Community Paramedics course focused on reproductive health, maternal health, child health and family planning. In collaboration with the Ministry of Health and Family Welfare, draft guidelines and curricula were developed and approved in 2008 in order to ensure that the courses were regulated under a single recognized body.
18 private training institutions are currently offering the Community Health Workers course, with 14 more undergoing the approval process. Nine private training institutions have applied to offer the Community Paramedics course and are undergoing the approval process. With 70% of students in training being female and most from disadvantaged economic backgrounds, the courses are helping to increase skills and employment opportunities for those who have previously had few opportunities available to them. They have also increased the supply of qualified healthcare providers in the country, particularly in rural areas whilst enhancing the capacity of regulatory bodies in the country.
The program has increased skills and job opportunities in rural areas whilst increasing the number of qualified healthcare providers available to these communities. A more coordinated approach to training has meant that the courses are appropriately designed to address the current skills shortages whilst ensuring that quality is standardized across training courses that are offered in the country.