It was 2 am. Aklima (pseudonym), a 22-year-old female from Sunamganj Sadar just broke her water. She was to be a mother for the first time. Her husband, Sohel, was also young, a 26-year-old man. Neither had any idea what to do next. Sohel remembered that his wife had the cellphone number of the Clinic Manager of the local Surjer Hashi Network Clinic (SHNC).
Aklima used to visit the local SHNC for her antenatal care visits regularly. Therefore, her husband called the clinic manager without thinking twice. At that time of the night, the clinic manager, a 45-year-old woman and an employee of SHNC for almost 20 years, did not hesitate to help, and she had her plans ready almost immediately. She called her colleagues and prepared for the delivery instantly. Why?
Because she made a few context-wise tailor-made innovations. She ensured that all her colleagues resided near the clinic so that she could tackle any emergency. She also ensured that the people could directly access “the manager” who was responsible for organizing any medical needs.
We can find a similar example in SHNC’s Aftabnagar branch. The clinic manager there, a 42-year-old male, designed the system of the clinic in such a way that the service seekers can seek all medical needs – consultation, diagnostics, and medicines in a single pathway. Like the manager of Sunamganj, he also ensured barrier-free access for the service seekers.
There are also several instances where health managers of government primary-level healthcare facilities demonstrated context-based innovations. For example, the Chowgacha Upazila Health Complex (UHC) model is well-known. The Government of Bangladesh awarded Chowgacha UHC 12 times as the best-performing UHC. The managers of Chowgacha UHC ensured the merging of community participation and systemic service delivery systems to their fullest extent.
These clinics are part of the primary healthcare level (PHL) – the base of the medical referral system. A stronger PHL only strengthens the overall health system of a country. However, in most cases, the facilities within the PHL do not receive proper resources, such as technical human resources, technological and inventory resources, and financial abundance. Therefore, often, primary healthcare facilities must come up with coping mechanisms or innovative adaptation methods (like the examples mentioned before) to compensate for the lack of operational resources.
In this context, PHL managers hold, probably, the most importance. They are to execute decisions at the root level of the health system. Their insights on the local population and governance system are prerequisites to establishing all national-level policies, strategies, and action plans. Moreover, they are the ones to perform as the universal access point for health seekers at the primary level, and responsible for reaching out to the people at the grassroots. They directly deal with patient complaints as well as the grievances of the facility workers. They are the decision-makers as well as responsible for overall management. If there are any innovative ideas from the grassroots, they are the ones to implement them first. Therefore, their leadership is of indispensable value for a strong national health system. They need to be provided with ample freedom and support to execute their ideas (always with consultation from the higher-ups).
Therefore, the policymakers above must interact with the PHL managers before constituting national policies. We must document such innovative efforts of PHL managers, from all public and private institutions. We should not consider PHL managers only as the executioners of decisions. They need to play the health leaders and for that, we must groom them accordingly.
Empowering PHL managers will not only introduce us to effective innovations at PHL but also help to lessen the burden on the tertiary health facilities, at a time when we are considering decentralization and an effective referral system. Therefore, acknowledgment and recognition of the PHL managers innovations need to be institutionalized.
Syed Hassan Imtiaz is an Associate in the Gender and Basic Services Portfolio at Innovision Consulting Private Limited.