Health Dialogue for Citizens: community participation in healthcare in Monpura
The European Union supported SHARE (Strengthening Health, Applying Research Evidence) project is working alongside the Government of Bangladesh to make sure that health-requirement and views of the mass population are at the centre of discussions about health policy in this country. The objective of the SHARE project is to build capacity of evidence-informed health policy making. This project also strives to study and evaluate local community needs to improve healthcare facilities both in urban and rural settings.
SHARE project takes up these initiatives, so that the local communities could empower themselves and take lead to cater to their own health requirements, letting them to connect beneficially with local health workers and doctors. Health dialogue at community levels can and should be established as a model for coordinating community level health planning in rural settings, where there is a basic lack of resources.
In continuation of similar public engagement event previously hosted by SHARE, a community support group for Monpura Upazila Health Complex was formed in 2016. The support group is led by the elected Upazilla Chairman, working alongside members from the local administration and the mass population.
The second participatory health dialogue in Monpura, “Health Dialogue for Citizens” was organized on 23 January, 2018, involving the local people, health service managers, stakeholders, government officials, elected representatives, social elites and local media. In this event, people from all occupations met in Monpura Upazila Health Complex and shared their views on needs, expectations and situation around health service delivery in hard-to-reach areas like Monpura.
Dr. Mahbubur Rahman, Director (Health), Barisal Division; Shelina Akhter Chowdhury, Chairman, Monpura Upazilla; Dr. Iqbal Anwar, Project Director, SHARE; and Dr. Selim Reza, Professor, Shaheed Suhrawardy Medical College; Dr. Abdul Majid, Deputy Programme Manager, Maternal Health, DGHS; Dr. Mushtuq Ahmed, Consultant, icddr,b; Shishir Morol, Special Correspondence, Prothom Alo, were among the notable attendees of this event.
The dialogue in Monpura exposed a stark scarcity of doctors, nurses and basic medicines. An unpleasant disparity in the allocation of healthcare workers between urban and rural areas exists in Bangladesh. This is worsened in particularly hard-to-reach areas like Monpura, and there is a crucial need for more healthcare providers and better medical facilities in such areas throughout Bangladesh.
The initial challenges of Monpura Health Complex was lack of medical manpower, inadequate services in emergency obstetric care, cleanliness, security, lack of coordination between local administration and community leaders and inefficient documentation and reporting system. Detailed discussions on these issues also took place at the event.

This health dialogue event in Monpura is expected to create further awareness on health issues, a sense of ownership and accountability among the community caregivers and advance the learning agenda on health services from development partners, service providers and government representatives.
Similar public engagement programmes will mutually benefit all parties involved in the healthcare system. By considering the observations of the local people on health issues, the SHARE project will help strengthen the understanding of the hurdles faced by the medical system in remote areas.
Dr. Iqbal Anwar, Project Director, SHARE, mentioned, “Through these dialogues, we can achieve a clearer perception of community participation in public health, which in turn will help us to adapt and modify medical service delivery according to the requirements of local population. This will also help to create a sense of responsibility and shared ownership among community caregivers. The researchers working with icddr,b and other similar organizations can also share and communicate their findings and outcomes among the members of the local population and get a better understanding of healthcare-needs in the hard-to-reach area in Bangladesh.”
The importance of community financing in improving health care was also highlighted when two sizeable donations worth of BDT 1,00,000 were handed over to the Chairman, to improve the existing health facilities in Monpura Upazila Health Complex. Chairman of Dhokkhin Shako Porishod, Monpura, also promised a sanction of a further BDT 15,00,00 for the development of the health complex.
The attendees applauded these initiatives. The attendee journalists also promised to write and report on this issue, so more community financing could be arranged in the months ahead.
In conclusion, this health dialogue will permit people to reveal their communal power and start productive discussions and sharing of knowledge among healthcare providers, representatives of the Government of Bangladesh and local population. For researchers, such discussions help create a platform to learn, perceive and evaluate study findings regarding community-based healthcare facilities. This event will further strengthen the platform for the local communities, doctors, nurses, policy makers, researchers and relevant stakeholders in Monpura to share their opinions towards a more robust health service delivery model in their localities and other rural settings and develop a successful health management system.
Major recommendations:

• The government of Bangladesh should take steps and provide incentives for doctors posted in remote areas throughout the country.
• Dedicated doctors working in heard to reach areas should be given national recognition, which will end up boosting their motivation and inspire others.
• Training should be given to local caregivers on how to use medical technologies, such as, Ultra-sonogram, ECG, and X-ray.
• For purchasing expensive medical instruments, a future collaboration with UNICEF would be financially beneficial.
• Usage of additional solar-powered instruments should be promoted since the locality lacks access to the national power grid.
• A diabetic card with information on NCD awareness should be developed and distributed among the local population.