Programme description

Title: Multidisciplinary HIV/AIDS programme in Chittagong, Rajshahi, Khulna and Sylhet
Commissioned by: German Federal Ministry of Economic Cooperation and Development (BMZ)
Country: Bangladesh
Lead executing agency: Ministry of Health and Family Welfare (MHFW)
Overall term: 2004 to 2011

Context

As the national infection rate is still less than one per cent, it is not too late to curb the spread of HIV in Bangladesh. With rapid the rate of urbanisation, it is in Bangladesh's rapidly growing cities that the further spread of HIV and other infectious diseases must be contained. Today just 27% of the people live in cities and towns, but Bangladesh has one of the fastest rates of urban population growth in the world. Demand for public services, including health care, is already placing enormous pressure on overstretched municipalities and that pressure can only increase. Estimates suggest that nearly 40% of the nation will live in its urban areas by 2030. As such, access to services and the quality of services remain below standard.

In response, the Ministry of Health and Family Welfare and GIZ are together supporting the Multidisciplinary HIV/AIDS Programme, which works with the city corporations of Chittagong, Rajshahi, Sylhet, and Khulna. The aim of this programme is to improve the standard of healthcare provided in the respective urban areas and increase access to it, particularly for vulnerable groups who have a higher risk of contracting HIV/AIDS, STIs, and tuberculosis.

Objective

Prevention, diagnosis, consultation and treatment of STIs and HIV/AIDS have improved in Chittagong, Sylhet, Rajshahi and Khulna.

Approach

The programme supports the further development of urban health systems. It is helping the city corporations, which are responsible for health within their areas of jurisdiction, to plan and act more effectively for the management and improvement of health services, and to respond to HIV/AIDS, STIs and tuberculosis in their cities. In doing so, the programme works with the corporations' health departments, as well as the Ministry of Health and Family Welfare, and the Ministry of Local Government, Rural Development and Cooperatives, to facilitate dialogue between the decision makers at national and city level. In the cities, the programme cooperates with the local health departments and service providers to expand and improve the services available.

In the current phase, the programme is following commonly formed operational plans that focus on improving decision making processes, as well as concepts and planning related to STIs, HIV/AIDS and TB. The quality of primary health care services is being enhanced, and access to health services is being made more equitable for vulnerable groups.

Quality assurance systems are being piloted by the Sylhet City Corporation, and joint assessments of facilities have been made in collaboration with primary health care service providers. The outcomes of the pilot system will serve as a basis for introducing quality standards elsewhere in Bangladesh.

The programme has entered into three development partnerships with the private sector, with the aim of improving the health of specific population groups, and developing health education, social protection and occupational health and safety models for the different sectors. Two of these partnerships are tripartite, involving private sector actors, the Government of Bangladesh (city corporations or ministries), and GIZ.

Results achieved so far

Concepts for city health management information systems have been jointly developed and institutionalised by stakeholders in the two cities where the approach is currently being piloted. These are essential to enable decision makers to act on proper evidence.

Urban primary health care standards, which are essential for raising the quality of patient care, including prevention and treatment, have been jointly developed. Those providing health care in pilot facilities are now working according to the new standards.

Vulnerable groups, such as rickshaw pullers, migrant workers and young people, now have access to information and educational materials on HIV/AIDS.

Informal educational approaches led by students' groups are now in place in the universities. These groups have helped to create awareness and prompt discussions about HIV/AIDS among young people, and have promoted prevention measures which did not previously exist.

HIV/AIDS training has been integrated into the packages of training offered to outgoing migrant workers by the government and NGOs.

Rickshaw pullers who have been trained as peer educators are disseminating basic information about HIV/AIDS risks and prevention among their colleagues.

Sustainable, targeted interventions have been established in order to reduce the vulnerability to HIV/AIDS infection in certain vulnerable groups.

Specific local approaches that enhance access to health care services for economically vulnerable groups have been improved, and linkages with the private sector strengthened. In Chittagong, for example, safety policies and guidelines at the shipyard have been introduced, and the workers have gained access to basic health care services and facilities.

In each of the four city corporations it works with, the programme has helped to develop HIV/AIDS coordination committees. These are bring together representatives of the health, education and business sectors, as well as governmental and non-governmental organisations and people living with HIV. The coordination committees are now well established and meet regularly to plan and coordinate activities to improve health care at the city level.

Multidisciplinary HIV/AIDS Programme at World Aids Day 2006 in Chittagong