Strengthening Health- Applying Research Evidence (SHARE)

Background:

Last few months icddr,b researchers and team members of European Union supported SHARE (Strengthening Health, Applying research Evidence) project travelled all around in Jhenaidah and Monpura of Bangladesh to talk to champion health managers and people in their own locality. SHARE team is working alongside Directorate General of Health Services (DGHS) to ensure putting peoples’ voices right at the centre of the health conversations through public engagement initiative. This initiative aims to learn what support the local community needs to improve its health and how to help connect people to local resources that can help them.

Looking at the concept of ‘Public Engagement’, it is generally defined as “a two-way process, involving interaction and listening, with the goal of generating mutual benefit”. In public engagement initiatives, two-way communication can effectively shape health issues and set priority policy agenda. Engagement of health scientists and researchers with public is getting prominence now-a-days. Public engagement helps scientists and researchers to increase the timeliness and relevance of their research, and also contributes significantly to generate insights for policy and practice. Thus public engagement becomes important for health managers and policy makers, since intrinsic link among healthcare, health policy and research is undeniable.

Spirit comes from learning Chowgacha Health Model:

Professor Michael Marmot, Chair of the ‘WHO Commission on Social Determinants of Health’ said, ‘Inequalities in the amount of control people have over decisions that impact on their lives creates inequalities in people’s health and wellbeing. Individuals having greater control over their lives have been shown to improve health.’ Health Consultant Dr. Emdadul Haque knew what it means to win trust of these underserved people for whom hospital services and resources are inadequate to serve their health needs. He also knew how to minimize this inequality gap through local participation. His leadership during 1996 to 2012 helped to develop Upazila level standard services in Chowgacha Health Complex of Jessore (southwestern district of Bangladesh) and mobilized 46 additional workers from community. Chowgacha Health complex was awarded for best performance in emergency obstetric care in the administrative division consecutively during 2005 to 2014. As Senior Consultant, later he introduced community participation in hospital service improvement in Sadar Hospital of Jhenaidah (southwestern district of Bangladesh). In response to his initiative, Member of Parliament of Jhenaidah, doctors of the hospital and Jhenaidah town are providing substantial manpower support. Mayor of Jhenaidah is also playing an important role in hospital cleanliness, security and wastage management. Support of different segments of society has been found tremendous and created such value that Jhenaidah Sadar Hospital became the highest revenue generation hospital in Khulna Division in 2014.

Though initial challenges of Jhenaidah Sadar Hospital was shortage of manpower, inadequate services especially emergency obstetric care, dire problem in cleanliness, inadequate coordination with local administration and community leaders, poor documentation and reporting system. Champion health manager like Dr. Md. Emdadul Haque shows the way how community participation can make a difference in health service delivery. 'Chowgacha Health Model' introduced by this Senior Consultant of Jhenaidah Sadar Hospital has got national and global recognition. Dr Margaret Chan Director-General of WHO visited Chowgacha Health Complex in 2010 and highly appreciated this model to ensure benchmark health services.  At that time, Dr. Haque was working there as Junior Consultant. Dr. Haque has started working as National Resource Person for Quality Control Secretariat under Health Economics Unit of Ministry of Health and Family Welfare to promote this model. Government is planning to scale up his Chowgacha Model in ten district hospitals. These are all positive sides of capitalizing local support in health services.

In course of time, SHARE team started coordination with health champions like Dr. Emdadul Haque to promote benchmark success stories of health managers in triggering local support.  In July 2016, SHARE team led by Dr. Iqbal Anwar began public engagement initiative through an exchange meeting with community support group in Jhenaidah to learn effectiveness and factors behind local resource mobilization for health service delivery.  Lessons learned from the public engagement meeting at Jhenaidah were, firstly, effective health service and hospital management require local support and participation, and secondly, health personnel, specially the local health manager should take the role of catalyst. Local support can be attracted through improved services, and visible efforts and leadership of the health managers like Dr. Emdadul Haque. Dr. Iqbal Anwar and his team took initiative to disseminate local support model of Chowgacha and Jhenaidah in hard-to-reach areas like Monpura- one of the remotest islands of Bangladesh.

On 3 October, 2016, SHARE project held a public health conversation in the name of ‘Health Dialogue for the People’ event at Monpura Health Complex auditorium in Monpura of Bhola- southern district of Bangladesh. Representatives of health managers, researchers, local leaders, media, policy makers, stakeholders and mass people attended the event. This event has built practical understanding of existing health service situation in hard-to-reach areas of Bangladesh and led the unique process of engaging health managers, researchers, local leaders, media, policy makers, stakeholders and mass people towards developing better health service delivery model in low resource-settings.

How Health Dialogue looks like:

Listening to the views of local people on health issues is a vital part of this health dialogue event which is fluent conversational in style and local residents are urged to join in health conversation by sharing their views on health services of their locality. This is also about understanding what the community perception about health, finding the challenges they face and exploring ways for responsive health service delivery. Eventually, this positions local people in charge of the health agenda to address their needs in front of health managers and stakeholders.

Why Health Dialogue matters in Bangladesh:

This public engagement initiative is far more profound when looking at the role of local people. The Government of Bangladesh is implementing its health sector programme where priority institutional and policy reforms in local level health planning and increasing incentives for service providers in hard-to-reach areas have been included in sector-specific strategies. Under this backdrop, public engagement health dialogue can give underserved people a real say over how health services can be developed through local participation and complement health sector programme. From health dialogue in Monpura, severe shortage of doctors, nurses and medicine has become evident. A gross imbalance between urban and rural areas in distribution of health workforce exists in Bangladesh. Situation of hard-to-reach areas like Monpura is more depressing. It has become urgent to revamp health workforce and hospital services that reflect the health needs of their populations in hard-to-reach areas.

From the health dialogue in Monpura, some strong appealing messages emerged that has connected people to local resources that can help them. Just after public engagement dialogue event, a community support group for Monpura Upazila Health Complex was formed chaired by elected Upazila Chairman along with members from local administration, media and different professionals.  Professor Dr Abul Kalam Azad, Director General of DGHS applauded the initiative and emphasized on scaling up best practices and health champions through such public engagement dialogue in other areas where required. 

This health dialogue allows people to unfold their community strength and initiate constructive conversations around health with health managers, government representatives and stakeholders. For researchers, it paves the way to learn how to communicate health study findings among local people and what matters to people and what supports people in hard-to-reach areas like Monpura. Monpura event has been very warmly received by local people, media, health managers and local stakeholders. Health manager who is continually striving to improve the health of local people, is very willing to help people feel connected to local health service network and get them involved with mobilizing local support improve health service. This reciprocity of roles can inevitably create real sense of ownership and accountability in health service, and goes well with the goal of public engagement in ‘generating mutual benefit’.