Abul Hosen suffers from a heart condition in Pacha Sowdagor Para, a remote part of Cox’s Bazar, where access to healthcare is few and far between.
He is among a growing number of people in Bangladesh with noncommunicable diseases (NCDs) that the World Health Organization (WHO) warns are some of the most urgent and complex public health challenges in the country.
Cardiovascular diseases, diabetes, cancers and chronic respiratory diseases are responsible for 67% of all deaths in Bangladesh, many of which are premature, says WHO.
Abul Hosen used to to travel long distances to the Upazila Health Complex (UHC) as it was the only place that could give him proper treatment. But not anymore. With the support of Japan International Cooperation Agency (Jica), Sikder Para Community Clinic is able to offer the care he needs.
“I am suffering from a heart condition and a respiratory condition. The UHC was my only option for checkups but now the community clinic is able to provide the treatment I need. I don’t have to travel so far,” he said.
Jica’s Shasto 1 project is at community clinics, upazila health complexes, and district hospitals at Sadar, Chakaria, and Ramu upazila.
Jica is providing technical support to this community clinic and patients also get 29 types of medicine free of cost there.
To spread awareness regarding NCDs and functions of the community clinic, Jica also has a strong structural and organized community. One of Jica's notable initiatives, the Shasto project, launched in 2017, characterizes its commitment to public health by raising awareness and arranging treatment for non-communicable diseases (NCDs).
In Bangladesh, nearly 70% of all deaths are due to NCDs, according to the WHO NCDs Progress Monitor 2022.
Noncommunicable diseases are caused by a poor lifestyle or a genetic predisposition, but they are not contagious. Diabetes, cancer, chronic respiratory diseases, and heart disease, etc., are major NCDs.
To combat NCDs, Jica provides technical support to 344 NCD corners across the country where people get treatment and diagnosis for high blood pressure, diabetes and other NDC’s free of cost.
Health assistants, community groups, and community support groups conduct the community engagement and mobilization sessions after training by Jica.
Ayesha Siddika is a member of the support group at Sikder Para and also leads the community engagement sessions. She has worked at the hospital for several years and Jica provided her with training on how to lead these sessions.
She also suffers from high blood pressure and now works to educate her community about noncommunicable disease (NCD) symptoms and preventative actions.
“People usually treat the symptoms with paracetamol or other pain killers without realizing they might have high blood pressure,” she said. “I try to build awareness and tell them to visit the community clinic to get their blood pressure checked.”
“If needed, the community clinics will refer them to a bigger hospital like the UHC for further treatment.”
Jica also provides technical support to the UHC with NCD diagnosis and medical equipment, such as modern blood pressure machines and adequate medicines.
Dr Shovon Dutta, upazila health officer of Chakaria Cox’s Bazar, said because of the Jica-supported NDC corner, they are able to treat more people and the word has got around, with the number of patients increasing daily.
“We get patients from our neighbouring upazilas too, like Maheshkhali. At our UHC, adequate NCD drugs are available along with free regular checkups, which is why more and more people are coming in,” he said.
Jica’s support has also been extended to the 250-bed Cox’s Bazar Sadar Hospital where a Coronary Care Unit (CCU) has been established.
Jica established 10 CCU beds at the hospitals in collaboration with the government and every CCU is packed with patients.
Dr Lutfun Nahar Begum at Sadar Hospital said that with support from Jica, the hospital has started providing services in a small room with a capacity to admit six patients.
“However, as demand grew over time, they moved the CCU to its present dedicated location and increased the number of beds from six to ten with more assistance from Jica,” she added.
The hospital has also expanded its Post Coronary Care Unit (PCCU) by adding ten more beds. The hospital can now serve even more patients with Jica's assistance.
Jica provided modern blood pressure machines which take only a few seconds to assess blood pressure. It increases the hospital's service capacity by enabling them to process patients more quickly. Moreover, Jica also provides the hospital with staff training and quality monitoring.
As part of the projects, the international organization is supporting the government in establishing a healthcare system to provide NCD services at primary healthcare facilities and promoting NCD prevention activity in the community.
Jica has been assisting Bangladesh's health sector since 1974 in different ways, such as grants, loans, technical cooperation, training, etc.
The introduction of the Shasto 2 project emphasizes promoting community-based interventions for NCD prevention by strengthening the existing community healthcare system.
The project will last between September 2023 to September 2028 in dedicated areas in Cox's Bazar, Comilla, and Narsingdi.
Jica’s contribution is felt in the health sectors all around Cox's Bazar.
U Cha Prue Marma, senior health education officer of the Civil Surgeon’s Office of Cox's Bazar, said that the teams in the districts and upazilas visit the community clinics and observe whether the patients receive appropriate care to combat NCDs to determine whether Jica's assistance has had an impact.
“The residents of the three upazilas that Jica's project has reached are far more aware of NCDs than residents of other districts,” he added.
Dr Mahfuzur Rahman Bhuiyan, country lead and quality improvement consultant of Shasto 2, Jica said that according to reports, approximately one in five adults in Bangladesh has high blood pressure.
“Along with the elderly, the young are also at the risk of NCDs as 19% of premature deaths occur due to major NCDs,” he added.
Rie Ozaki, chief advisor at SHASTO2 of Jica, said that Bangladesh has implemented policies against NCDs with amazing success during the last five years.
The government set up a primary healthcare system to offer NCD services and was assisted in establishing this system in cooperation with other stakeholders under the SHASTO Phase 1 project (2017–2022) of Jica.
Currently, there are more than 300 NCD corners in UHCs across the country which offer medical services following standardized national procedures, considerably enhancing the community's access to care.