Increasing Access to Markets & Services: Improving Access to Health & Education
Students at Kaziar Char Shishu Shikkha Kendra a CLP Learning Centre in Kurigram
The Chars Livelihoods Programme (CLP) recognises the importance of improved health and education services in lifting and keeping poor households out of poverty. Without access to low-cost healthcare, health shocks can have devastating consequences for extreme poor households. Furthermore, many char dwellers do not attend school due to limited household resources to fund education, or lack of schools in their locality.
Health & Education during CLP-1
Much of the CLP's work focuses on reducing the need for medical treatment through prevention. However, in recognition of the fact that illness is inevitable from time to time, in July 2007 CLP began a pilot of the Primary Health Care and Family Planning project (PHC-FP). PHC-FP was implemented via three levels: Char Shasthya Karmi (CSK), Satellite Clinic (SC) and referrals. By the end of CLP-1 PHC-FP was running in 15 Upazilas with about 400 CSK's and 50 paramedics, 15,585 SCs had been held and 706,627 consultations took place.
The Non-Formal Education project began in late 2007 to provide six years of education to children from the neediest households . Under CLP-1, 150 learning centres were set up, 18 of which run double shifts, to deliver education to 4,976 children.
Health & Education during CLP-2
Under CLP-2 the pilot health project has been expanded to cover all districts and a direct nutrition intervention project is scheduled to start in March 2012, covering all 67,000 CLP-2 targeted households. A new partnership with the LAMB Hospital as Technical Assistance provider has improved health care on the chars. Looking towards future sustainability, the CLP is working with local NGOs to examine the options for ongoing health service delivery after the end of the CLP.
The Non-Formal Education project continues unchanged, and will end when the current cohort of children graduate from Class V in December 2012.
Primary Health Care and Family Planning Project (PHC-FP)
PHC-FP operates fortnightly satellite clinics to provide primary health care and family planning services to all char dwellers. Qualified paramedics offer basic consultancy services and refer complex cases to designated referral centres at Upazila and District levels.
Char Shasthya Karmis (community health workers)
In addition to satellite clinics, the CLP provides funding for CSKs, who live within the community and can see patients at home at any time. CSKs provide simple healthcare services and family-planning materials, health commodities and some medicines. The Family Planning component of the project is affiliated with the Directorate General of Family Planning, ensuring supply of the pill, condoms and contraceptive implants from GoB.
The Voucher System
The CLP places emphasis on maternal and neo-natal health, and as such ante-natal and post-natal check ups are free for all. Other healthcare services are not free: a consultation fee of Tk 10 (about £0.10) is charged for each service. However, CLP core participants are provided with vouchers which cover the cost of consultations and medicines.
Direct Nutrition Intervention (DNI) Project
This will be a new project and will run alongside the PHC-FP. The DNI aims to improve nutritional status of children, adolescent girls and pregnant or breastfeeding women through direct provision of inputs such as micronutrients and deworming tablets. Counselling on breastfeeding and complementary feeding will also be offered. Female Char Pusti Karmis (Char Nutrition Workers) will be selected from the community and trained to provide these services.
The CLP Learning Centres: Non-Formal Primary Education
In 2007 the CLP responded to limited education on the chars by piloting an education project. To ensure high quality services, the CLP established continuous training and technical support to the implementing organisations. Classes are currently held 3.5 hours a day, six days a week. Access was prioritised to the neediest households, especially older children between (6-8 years) who may not be offered another chance to receive any education. A key factor in the lack of char education services is the unwillingness of teachers to live and work on the chars. The CLP addresses this by selecting and training teachers from within the local community. The CLP also provides students with uniforms and academic materials, which may be prohibitively expensive for extreme poor families.