Community clinics and primary healthcare facilities utilization by reproductive age women in rural Bangladesh A systematic review of lessons learned from evidence-based studies

Abstract

In keeping with the “Alma-Ata Declaration” pledge to ensure “Health for All” by 2000 through Primary Health Care, the government of Bangladesh planned to establish one community clinic for every 6000 persons in 1996. The purpose of this literature review was to explore the extent of utilization of these community clinics as well as the associations between socioeconomic determinants, awareness of available services, and satisfaction with their service utilization. The literature was searched using appropriate search terms in PubMed and Ovid medline databases. The search resulted in 35 articles, of which 5 relevant full text articles were selected for review. The target population in the studies was women of reproductive age living in rural areas served by community clinics.

Community clinics (CCs) are one stop service centers for a variety of primary health care services in their catchment areas. Prominent services reported in some studies include family planning, immunization, tetanus, antenatal care, vitamin A, and general healthcare for children and child growth monitoring. However, the literature review showed that these establishments are being under-utilized. Reasons for under-utilization of CCs have been attributed to the distance of the facility from home, lack of awareness on the value of services, perceived poor quality of care, cultural and social belief systems, discrimination against those of low socio-economic status, and perceived high access costs. Very few studies are available on community clinics to establish its effectiveness. However, evidence suggests that an active involvement of community leaders is required in designing CCs. Policies targeting the improvement of education and poverty elimination among women are likely to improve awareness about community clinics. Media has a great role to play. Clients’ perception of the quality of services and satisfaction need to be explored in greater detail as they also play a vital role in the utilization of community clinics.