Health/gk

Rapid urbanization has created an urban health crisis, characterised by economic inequality, environmental destruction, and a lack of people-friendly investments in the rural areas. Densely-populated urban slums are inhabited by generations of rural people lacking physical security. Oftentimes, gangs harass these people and illicit drug use is epidemic. Many women and children are forced into prostitution. They can be arrested, beaten and murdered without enforcement by the legal system. Women and girls can be detained “for their own protection” and subjected to harassment and rape. Trauma from traffic and industrial accidents, and violence are major health problems in the urban areas. Clean water and sanitation services are still not available, leading to intestinal and vector diseases. Dhaka, the capital, has the worst air pollution in the world. In response to this urban health crisis, GK has instituted an urban health program with a fully-equipped modern hospital and 11 community sub-centers near major urban slums.

The harsh realities of urban Dhaka, however, forced a change in GK's program policy. At one site, slum dwellers were evicted. At several other sites, the NGOs involved there were forced to discontinue working. Urban gangs, involved in protection rackets, selling drugs and other illicit activities, continuously harassed GK workers. It became clear that a change in approach was required.

Therefore, beginning in April 1999, the urban program changed to mobile clinics providing primary and school health care. GK also provides health services for garment workers. The 150-bed hospital provides a wide range of medical services for patients covered by GK's income-based health insurance program and the general public.

Gonoshasthaya Kendra Hospital and Village Health Program

Health management is not an isolated problem of society in Bangladesh. Therefore, health care development relies on addressing other related problems. Gonoshasthaya Kendra strongly believes that in order to develop health care, services must be integrated with other development activities. Therefore, GK works to gradually incorporate the following programs into the activities of each health center: To develop people-oriented health management, and to make people aware of different health issues. To provide basic education, particularly to women and children of poor families. To organize women, particularly from land-less populations, and to provide financial assistance to alleviate poverty. To make women aware and self-conscious of their rights and to encourage them to reach their full potential. To promote the mother language of Bangla, and the spirit of the Liberation War, establishing its importance in national life. To play an advocacy role for the well-being of poor people in Bangladesh and internationally. To create social awareness about fundamentalist and communal violence, and to protect the interests of minority communities. To undertake natural and man-made disaster-mitigation relief and rehabilitation programs and to conduct disaster preparedness programs. To be a self-reliant organization. Gonoshasthaya Kendra has continued to develop a program primarily focused on people-oriented health care service delivery, integrating programs in women's development, education, agriculture extension, poverty alleviation, and conservation of the environment in each of its operational areas. Gonoshasthaya Kendra has faced many challenges and even has lost lives in its effort to establish its objectives of sustainability. Three workers have lost their lives to people opposed to GK's work. GK has established the following health centers around Bangladesh: BHATSALA HEALTH CENTER SREEPUR HEALTH CENTER SATURIA HEALTH CENTER SHIBGONJ HEALTH CENTER SORAJGONG HEALTH CENTER SONAGAZI HEALTH CENTER PARBATIPUR HEALTH CENTER KASHINATHPUR HEALTH CENTER COXS BAZAR HEALTH CENTER CHARFASHION HEALTH CENTER

Gonoshasthaya Urban Hospita
Rapid urbanization has created an urban health crisis, characterised by economic inequality, environmental destruction, and a lack of people-friendly investments in the rural areas. Densely-populated urban slums are inhabited by generations of rural people lacking physical security. Oftentimes, gangs harass these people and illicit drug use is epidemic. Many women and children are forced into prostitution. They can be arrested, beaten and murdered without enforcement by the legal system. Women and girls can be detained “for their own protection” and subjected to harassment and rape. Trauma from traffic and industrial accidents, and violence are major health problems in the urban areas. Clean water and sanitation services are still not available, leading to intestinal and vector diseases. Dhaka, the capital, has the worst air pollution in the world. In response to this urban health crisis, GK has instituted an urban health program with a fully-equipped modern hospital and 11 community sub-centers near major urban slums. The harsh realities of urban Dhaka, however, forced a change in GK's program policy. At one site, slum dwellers were evicted. At several other sites, the NGOs involved there were forced to discontinue working. Urban gangs, involved in protection rackets, selling drugs and other illicit activities, continuously harassed GK workers. It became clear that a change in approach was required. Therefore, beginning in April 1999, the urban program changed to mobile clinics providing primary and school health care. GK also provides health services for garment workers. The 150-bed hospital provides a wide range of medical services for patients covered by GK's income-based health insurance program and the general public.
Primary Health Care and Paramedics
The use of paramedics ensures the delivery of health services to poor people living in rural areas. In addition to providing health care, employing paramedics enables women to find new and satisfying employment opportunities.
Mini Laparotomy
Paramedics are also trained to perform surgical procedures that previously were only performed by doctors. Remarkably, their performance and infection control exceeds that of trained medical doctors. A full discussion and analysis of their performance was published in the leading medical journal, The Lancet .
Health Insurance
Gonoshasthaya Kendra introduced its Health Insurance Scheme to provide sustainable health care services. Insured persons or families pay for a health insurance subscription according to their socio-economic status; but all people get essential and appropriate health care. The Health Insurance Scheme classifies four different groups by reviewing the socio-economic status of the people living in project areas. Group A represents distressed women and poor people. Group B represents marginal farmers who face insufficiency and even starvation. Group C represents those who can afford to eat twice a day and have some surplus; and Group D represents those who do not have enough surplus but are sufficient.
Reducing Maternal Mortality and Infant Mortality

During the last three decades, GK has made significant improvements in its coverage of health services, especially in regards to reproductive health services and child health. In particular, GK has made noteworthy progress in achieving some of the Millennium Development Goals that are related to maternal and child health. The purpose of the two presentations on Maternal Mortality and Infant Mortality is to highlight these achievements and its underlying factors. These presentations use panel data to address the issue of reducing maternal mortality and infant mortality, and discuss the lessons learned by GK. This can be done by GK's own village level trained paramedics, as well as through improved birth weight, food security and overall reduction of poverty.