Health
Literacy
of
the
community and the role of
Physicians,
Politicians
and
Policy makers to achieve health
related MDGs and beyond
Zafrullah Chowdhury
Gonoshasthaya Kendra (GK)
House 14 E, Road 6, Dhanmondi
Dhaka-1205, Bangladesh
Email:gk@citechco.net
Problem of millions of deaths and Inequity
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•
Every year, half a million maternal deaths and roughly 9.5 million
maternal morbidities occur mostly in developing countries.
Another 1.4 million survive through ‘near miss events’
constituting life threatening complications of pregnancy.
Globally, over 10 million children die every year of which 4 million
are neonates, also poor.
Simple low cost interventions to overcome the big problem :
Even a small mouse can release the entrapped lion.
If the following simple (may be too simple) tasks are performed regularly by health
workers most deaths among pregnant women and under-5 children will be prevented.
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Visit pregnant women and young children at home along with TBAs.
Organise regular ANC & PNC camps.
Give at least 2 doses of Tetanus Toxoid, consult in case of danger
signs; prompt referral to public hospitals if required.
Check blood pressure and nutritional status.
Record Blood Group and Random Blood Sugar (RBS)
Regularly vaccinate young children DPT, HIV and measles.
Stop smoking in front of pregnant women and children.
Treat anaemia and malaria and look for tuberculosis.
Convince mothers-in-law to allow pregnant daughters-in-law to take
mid day rest and allow her eat first and make more food available,.
Also encourage her to eat more local citrus fruits and vegetables. Such
generous motherly behaviour will guarantee a healthy grand child.
Mosquito net for pregnant woman. Later on, for new born as well.
Value of early (first) milk (colostrum) and exclusive breastfeeding;
complementary feeding later on.
Plant a fruit tree and prepare a clean delivery room.
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Water and sanitation for poor families.
Improve personal hygiene of family members and health care providers
including TBAs; cut fingernails regularly. Wash hands with soap and
plenty of water before and after the child birth.
Cut the umbilical cord 1-2 minutes after the birth and put the baby to
mother’s breast immediately.
Visit newborn and mother frequently during first 4 weeks (neonatal
period)
Vitamin-A and Zinc supplements for the newborn.
Provide Antibiotic Amoxicillin for pneumonia and sepsis.
Keep ORS ready at home and in case of diarrhoea also continue
breastfeeding.
Teach temperature management of newborn especially premature and
LBW babies with kangaroo method i.e. baby to mother’s chest.
Resuscitate newborn with ‘mouth to mouth’ breathing and neonatal
AMBO bag.
Examine both eyes at birth and during neonatal period for congenital
glaucoma, congenital cataract, acute dacrocystitis, squint and
opthalmia neonatorum (to be treated with antibiotic eye drop)
Revive school health program for eye sight testing (poor children will
be more benefited)
Regular Community Health Audit improves accountability and health
performances.
Low cost simple interventions help achieving MDG- 4 & 5
Simple low cost interventions to overcome the big problem :
Did little mouse succeeded to release the entrapped Lion?
Translating Knowledge into action and practice
Individual Health Literacy is not enough:
Strong national actions are required
Gonoshasthaya Kendra (GK)
Promotes community health literacy
Since 1972, Gonoshasthaya Kendra (GK) a
public charitable foundation developed
integrated Primary health Care (PHC) in
rural Bangladesh. Presently GK provides
full preventive, nutritional and basic
curative care among 1.2 million people in
17 disadvantaged rural areas mainly with
trained Community Health Workers (over
75% are females), paramedics, TBAs and a
small number of qualified physicians.
Every
programme
has
a
Local
Management Committee which is chaired
by an elected female member of Union
Parishad (Local Council).
Poor families get all services almost free of charges while middle class and
rich families pay user fees and full price of essential medicines. Home
delivery and frequent visit during first 4 weeks are promoted, supervised
and followed.
Community Health Audit of the causes and circumstances of every
maternal and infant death are regularly organised. Whether such deaths
could be prevented is also discussed in a community health audit. These
audits make both the health service providers and the family members
accountable for their actions/inactions and helps reduction of IMR and
MMR. Such audits are chaired by elected female UP members.
Community
Health
Audit
is
a
yard
stick
of
Health
Literacy.
Epilogue or Epitaph?
Success of knowledge translation and knowledge transfer is dependent mainly on the
political commitment and interest of politicians and policymakers.
Their social class background often put blocks on the way to change.
Practice of commonsense low cost interventions is not usually easy.
Even then, the change shall follow as Health literacy of the community creates
demands and builds waves to overcome blocks to changes.
GK Workers Reach them Regularly