Though the Urban Primary Health care Centre (UPHCC) is supposed to promote community primary health care through awareness creation and implementing health support activities in urban areas, such centres are being found facing dearth of delivering services to the people.
Thirty–year-old Nasima Akhtar was one of those who often was deprived of getting medicare from UPHCCs, contradicting the government’s vision to focus on wellness instead of sickness, on preventive education rather than reactive treatment.
Nasima Akter, who lives in capital's Jurain area, suffered from fever for three days in mid-August.
Although there was an Urban Primary Health Care Centre (UPHCC) next to her doorstep, considering the centre ineffective, Nasima and her family avoided it.
To test if her fever was dengue, she could not go to any remote hospital in her husband's absence.
When her husband Dulal Hossain returned from Chattogram, on the fourth day of her sickness, he took Nasima to the Dhaka Medical College Hospital (DMCH). She had been tested for dengue.
His family members wanted to take medical treatment from that medical care centre, said Dulal.
"The treatment facilities of the centre failed to serve us. It is even getting worse. So, we now go to hospitals like Dhaka Medical College Hospital," Dulal said.
His neighbours also shared similar experiences about the health care centre. Before the dengue outbreak, people of the area largely ignored this health care centre.
Aklima Khatun, grandmother of a newborn baby at Boro Moghbazar Maternal Health Care Centre, said she did not get the required services from doctors and nurses.
People of Jurain, Gandaria, Sutrapur, Jatrabari, Matuail, Moghbazar, and many more areas have expressed similar frustration about the services of Urban Primary Health Care Services Delivery Project-run health centres. Even the centres do not have any dengue-testing kits, they complained. The officials of the centers also admitted it.
Preferring anonymity officials of those centers said, they were not getting salaries regularly for the last one year, considered as one of the main reasons about the dysfunctional condition of the centres.
Salaries and other facilities are being curtailed by NGOs who have gotten the responsibility through bidding.
Within an hour in the morning, seven to eight patients, all of whom were women and children, came for treatment and saw similar scene prevailing in one of the health care centres in the city's Sutrapur on Thursday.
The patients said they do not get any free medicine and health services like pathological tests from the centre.
Dr Shanaz Nasreen, chief medical officer of the centre, said they have limitations to give free medicines to poor patients.
There are about 2,000 red card holders– enlisted to take free treatment and medicines from the centres– but only 200 patients seek the service now.
The Urban Primary Health Care Services Delivery Project has health care centres in city corporations across the country.
There are 57 primary health care centres and 10 maternal health care centres in Dhaka's two city corporations.
Improving access, equity, and quality of urban primary health care services– namely for the poor, women and children– are the targets of the Asian Development Bank-funded project.
Since its inception in 2000, the NGOs have been running these projects through bidding, in every five-year phase.
Many urban poor people are red card holders. They get all the treatment facilities from these centres completely free including cesarean child delivery service.
Mismanagement and lack of proper monitoring have gripped these promising health care centres for the urban poor, patients and experts said.
The structural facilities of the urban health care centres had the great promise to become a model for health care services.
"The urban primary health care system, designed for the lower-income people, have failed due to negligence," Dr Mozaherul Haque, former advisor of World Health Organisation (WHO) told The Bangladesh Post.
The government needs to have a clear vision to take the health care sector to the next level. It also needs to ensure proper monitoring in urban medical facilities, suggested Mozaherul.
To give complete health care services to the urban poor, he said, the city corporations and the LGRD ministry should adopt the right kind of referral system.
The urban health care centres should refer poor patients, needing specialised treatment, to any public hospital, Mozaherul commented.
Md Asadul Islam, Secretary, Health and Family Planning Ministry, told the Bangladesh Post they have a plan to sit with the LGRD Ministry to extend primary health care services in local areas and introduce the right-kind-of referral system.
When contacted, LGRD Minister Md Tajul Islam said he would take necessary actions after making an in-depth study.
The worsening condition of urban health care centres has become a threat to urban health. Many patients are now rushing to public hospitals, avoiding these health care centres, said Adil Mohammad Khan, general secretary, Bangladesh Institute of Planners.
Failures of the local urban medical facilities are forcing too many patients to crowd the Bangabandhu Sheikh Mujib Medical University, DMCH and other public hospitals every day.
All of these patients, struggling in the queues of hospital outdoors, are not getting to see doctors finally.
"I have the responsibility to get the project done by the employees. But the project director, working under the ministry, has the management responsibilities," said Brigadier General Sharif Ahmed, Chief Health Officer, Dhaka South City Corporation.
"We are trying hard," said Dhaka North City Corporation Chief Health Officer Brigadier General Mominur Rahman Mamun, "to make the primary health care facilities functional."
Abdul Hakim Majumder, the project director, said: "It cannot be denied that the health care services for the urban poor have become inefficient. But we are trying to make it work."
He said, NGOs who got the bid have responsibilities to make the centers more workable. The local monitoring bodies comprising with ward councilors should give more attention to make those centers functional.
