Strengthening Community Clinics to improve nutrition outcomes in Bangladesh

Since its independence, Bangladesh has made considerable effort to strengthen its healthcare services. The establishment of the network of community clinics in Bangladesh has been a major milestone, especially in rural and marginalized areas . Of the nearly 15,000 clinics across, each is designed to serve approximately 6000 people with a basic package of essential health, nutrition, and family planning services. Developed as a unique public-private partnership model, and managed both by the community and the Government of Bangladesh, these clinics are an effective platform to deliver essential services, in a sustained manner.

The culmination of these efforts has led to considerable gains in maternal and child nutrition outcomes over the past decades. Recent years, however, have seen a stagnation of these gains. Stunting among children and anemia among women of childbearing age (15-49 years) remain notable public health challenges. Program experience suggests that integrating nutrition services which include vitamin supplementation and nutrition counselling during pregnancy and feeding counselling and growth monitoring for children into existing and accessible health programs can provide positive results. Based on these learnings, the World Bank financed Health Sector Support Project (HSSP) is focusing on mainstreaming the Government of Bangladesh’s nutrition agenda. The HSSP is implemented in the Sylhet and Chattogram divisions, utilizing the community clinics, to deliver evidence-based high-impact direct nutrition interventions.
 

In addition to financing the HSSP, the World Bank supports improvements to service delivery through community clinics. The project also promotes consistent monitoring and follow-up on the key nutrition indicators which include antennal care and nutrition counselling, among others, through the use of data and regular follow-up with the low-performing community clinics. 

How effective are health sector interventions in Community Clinics?

Using administrative data from 13,855 community clinics from across the country between 2018 and 2020, a recent study assessed the impact of HSSP on the delivery of essential nutrition services through community clinics – comparing trends across HSSP and non-HSSP divisions.  The study analyzed the impact on the provision of services to eligible pregnant women and children below two years of age from local community clinics.

What did our research reveal?

• The community clinics in the HSSP divisions were able to register 3.4 percent more eligible pregnant women than community clinics in the remaining divisions.
• An overall 2.7 percent increase in the proportion of pregnant women who received the three key nutrition services from community clinics, as compared to non-HSSP divisions. 
• 2.8 percent more women from HSSP areas were being weighed during a prenatal care visit than in non-HSSP areas.
• The proportion of women receiving at least 30 Iron and Folic Acid tablets and nutrition counselling was higher among the HSSP community clinics by 3.0 and 2.7 percent, respectively, than among the non-HSSP community clinics.
• Among the two age groups of 0-5 and 6-23 months, 5.9 and 4.6 percent more new children were registered for availing nutrition and health services as a result of HSSP respectively.
• In the case of child nutrition services, there was an 8.9 percent increase in the proportion of registered children who were provided age-appropriate nutrition services in HSSP community clinics as compared to the non-HSSP clinics.
• 1.5 percent more children of the age group 6-23 months received age-appropriate nutrition counselling in HSSP community clinics over control ones.

These findings on improved outreach and coverage of nutrition services are a testament to the fact that mainstreaming nutrition services within the wider health service delivery is an effective approach. Additionally, strengthening the delivery of services through a sustainable and grassroots platform such as community clinics is essential for improving access to healthcare services . It further highlights the value of added support in form of robust monitoring and follow-ups, and institutional capacity building which bolster further gains. These efforts have laid a strong programmatic foundation to deliver essential nutrition services and offer learnings for the potential next phase of the program to further improve nutrition outcomes towards a well-nourished Bangladesh.