Our Health Our Responsibility:
Char Dakatia's Own Safety Net
What do poor villagers have but each other? When people in need of help start to figure out ways to help themselves in an organized manner, they create new avenues of social development. This is exactly what villagers of Char Dakatia of Bagerhat have done. Together, they have created their own health safety net where a very small contribution fee from everyone ensures access to medical services to all villagers. With the help of Voluntary Services Overseas (VSO) and Renaissance, a NGO based in Chitolmari, Bagerhat, these villagers have developed a social model to greatly improve access to health care services. If we look at where Bangladesh was right after independence and then at where the country is now, we will notice that people who say we haven't achieved much don't have all the information. There have been both positive and negative changes and there has been a lot of development in Bangladesh indeed.
There is a lot of negativity in Bangladesh. We suffer from a perennial image crisis, and the positive sides and the achievements of Bangladesh often get sidetracked. There have been a lot of achievements in health care, evident by increase in life expectancy and other health indicators. The Khulna division, where the Sundarbans lie, is a district where some of the most underdeveloped village is located. Villages that are in immediate need for development, especially in matters of transport and communication. A trip to Khulna, Bagerhat and Mongla was in order as the people at Voluntary Services Overseas invited me to witness their projects which aimed to help remote villagers of Bangladesh.
Throughout the journey VSO's Programme Development Officer Mohammad Rashid accompanied me, and we discussed all the different NGOs in our land as well as the steady stream of aid money entering our country. These organizations change our country for the better, but there remain many areas that need to be addressed. Without NGOs, people would not know about their rights, about what they can do to make their lives better.
There was a lot of talk regarding change - such as freshwater shrimp farming – an idea which brought forth massive economic change, but even with this change a lot of problems arose – every acre of land that is used for shrimp farming refuses to yield any other fruits or vegetables. A large majority of Khulna is heavily reliant on shrimp farming, and while this is a great source of income, it is also something they are heavily dependent on. On one hand, this means that they are specializing, but on the other, if something goes wrong, then millions of people will be left without an alternative source of income. In the village of Char Dakatia from the Baniyari union of Bagerhat district in the Chitolmari Upazila, we sat down to have a meeting with the villagers to hear what they had to say. Also present in the meeting was Evelynn Ekisa, an Environmental Health and Research Advisor from Kenya, working as a Volunteer, who specializes in community based help finance. Kenya has had a lot of success in the past in this area of work. Evelynn Ekisa has a lot of expertise in this field and so she came down to Char Dakatia to see if her skills could be put to good use.
Evelyn had explained her ideas to the villagers, based on what the villagers heard at the meeting, they formed a “Citizens' Committee”, which consisted of 74 members. Every month each member deposits fees ranging from 10 to 25 taka, in order to form a fund. To help the committee VSO made a generous deposit of 10,000 taka. All posts in the committee are delegated to its members, in doing so the committee does not involve any outside individual or organization, making it entirely self-reliant. The committee also signed a 'Memorandum of Understanding' with the Upazila Health Complex, in case any of its members faces any health problem - any expenses that are incurred for treatment will be paid from the fund. Thus the risk one faces in the event of a medical need is pooled together amongst the villagers. And the benefits are extended to not just the 74 members, but also their extended families. Since the formation of the committee - the villagers feel empowered; they get a feeling of self respect because it isn't like it was before, when they would just complain about things not happening. Now they feel better about themselves, they have found a way to address their needs and solve their own problems. They are beginning to develop leadership and organizational skills.
Renaissance and VSO took up another initiative with the committee. In this initiative, ten farmers who were in desperate need of help were picked by the committee. Ten cows were given to them on the condition that the first born calf of the cows will be returned to the committee. This way the committee will be able to give out ten more cows to ten other farmers with the same condition, and in doing so creating a never-ending cycle of food and agriculture. Sustainability has been built into the heart of the programme. Similar to the health fund and the cows, the Citizens' Committee plans to take up more initiatives in order to better themselves and their village.
Lao Tzu had once said, “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” VSO and Renaissance didn't just give the villagers food and money, they didn't come to Bagerhat with handouts. Rather, they taught them to take care of themselves through sustainable programmes. These are the kind of initiatives the NGOs need to plan and carry out, enable people of Bangladesh who are in need of help to help themselves.
This is a small step. But every journey, no matter how long, starts with small steps.
Evelyn (Left) with the villagers
Working in Bangladesh on Health and Climate Change
Working in Bangladesh for the last 9 months has had almost an equal measure of positive and negative outcomes. But, the experience has been particularly enriching and fulfilling since I have been able to achieve my objectives and conduct sustainable development in a different context in terms of culture and a language I don't speak and understand.
Chiltalmari sub-district is among the poorest communities in Bangladesh with undeveloped infrastructure; poor roads, lack of safe water, lack of electricity in most parts, ill-equipped health facilities that are facing an acute shortage of professionally trained health workers and an area prone to climate change related disasters. These issues present a host of challenges for the delivery of health care services to the poor masses who are not able to afford quality health care, hence end suffering and dyeing from preventable and treatable diseases.
It is in this context that the “Our Health Our Responsibility” campaign was started to ensure the delivery of primary health care in order to improve community access to health care services.
I facilitated the development of the community based health financing scheme. It is an initiative that has mobilized the community members to pool their resources together through the payment of monthly premiums of as little as 20 taka per member.
Members who are not able to pay money are encouraged to pay in kind by bringing items like eggs, chicken, rice e.tc to the health management committee who in turn sell the items. We have also managed to boost the fund through sourcing for support from well wishers and stakeholders like CBOs and VSO.
Through the collective fund, the committee is able to facilitate a sick member of the scheme to seek prompt outpatient treatment from the Upazilla Health Complex or support transportation in-case of referral to another hospital.
Through the project we are training community health volunteers on basic health care that will enable them to support the professionally trained health workers to promote health and deliver primary health care to the community, through conducting household visits and offering health education.
For mitigation of the impacts of climate change, I have facilitated the establishment of an alternative livelihood project, using “Pass the Gift Concept”. The project has supported 10 first beneficiary farmers with dairy cows after they each contributed a third of the cost of purchasing a cow.
The farmers subsequently pass the gift to the next farmer when the cow calves. Each participating farmer also saves a minimum of 50 taka as shares in the project which we hope will become a farmers' cooperative in the near future.
These projects have ensured increased community participation and gender main streaming in development and has resulted in more women taking part in the leadership of the management committees. My next steps are to strengthen the management committees, conduct more resource mobilization for scaling-up and ensuring sustainability of the initiatives.
High levels of poverty and a huge language barrier have been the main challenges for me, but all in all I am glad that I came to Bangladesh. It was also a good chance to explore the rich culture, different delicacies, and make friends with very friendly and hospitable people.
Evelynn Ekisa is Environmental Health and Research Advisor (Volunteer) of Voluntary Services Overseas (VSO)
Cover art by Ujjal Ghose
(R) thedailystar.net 2012