Since 2006, we have worked on establishing arsenic free drinking water supplies and developed protocols for the identification, diagnosis and treatment of arsenicosis in the Munshiganj district. However, access to safe water and to symptomatic treatment of arsenicosis will not be effective without broader health improvements. In 2013, we completed the construction of a clinic (at the sub-district level) with support from the Japan Government. Its purpose is to help address gaps in existing primary health care services. The establishment of Community Based Organizations (CBOs) forms the basis of our approach. We have started working with CBOs towards the implementation of the following activities in one union (currently the smallest administrative area). A union is divided in 9 wards (each generally covering one village):
- Extend the reach of our clinic (static clinic at the sub-district level) by establishing a satellite clinic at union-level, 9 ward-level health camps and a paramedic program at the community level (see Figure above).
- Provide affordable and accessible primary health care services through the development of a referral system that links local paramedic care, health camps, physician care at satellite clinic, static clinic and tertiary partner hospital in Dhaka (see video explanation here).
- Raise community awareness regarding nutrition, hygiene and reproductive health in collaboration with CBOs (particularly for women as domestic care-givers) by organizing training sessions (e.g. food gardens, first aid, hygiene and child feeding) and by establishing a resource center at the satellite center.
- Improve local management of the health care system by engaging CBO members in a trial to establish a non-profit, mutual, community-based health insurance scheme.