Primary Health Care in The Tea Estates

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Primary Health Care in The Tea Estates

Primary Health Care (PHC) and health education/promotion has recently been introduced in a number of tea estates through the Tea Board. 

PHC components have been introduced vertically through individual tea estate initiatives. Tea Board sponsored STABEX/COMPLEX fund activities, Tea Labour Union health and welfare programme, Government health and population sector programme, Labour Directorate welfare programme and different NGO initiatives.

These include appointment and training of labour line health workers, keeping health and demographic data, conducting antenatal clinic days, water and sanitation programme, crèche facilities, dispensaries, labour welfare centre, training of crèche attendants, midwives, compounders, dressers, conducting work ships on maternal and child nutrition, distribution of equipment and essential drugs, expanded programme of immunization, vitamin “A” distribution, control of acute respiratory infections (ARI) programme, family planning satellite clinic, tuberculosis and leprosy control programme, etc.

But health workers in-charge of these programmes, work in isolation, without any professional support. There is need for supervisory support, continued education and on job training facilities for them.

Obviously vertical programmes are posing new opportunities as well as challenges for the management, health workers and the community as well. Tea estate community participation is an essential element, if a comprehensive integrated, sustainable PHC programme is to be installed in place. At the moment they are passive acceptors of whatever service is available. Tea estate management also need to be involved for such a sustainable PHC programme.

The objective of such a programme me should be improvement of health status of the tea estate community, in order to reduce curative medical care expenditure, to improve productivity, reduce sick leave payments and working day loss, reduce common causes of morbidity and mortality by introducing the concept of comprehensive primary health care programme and facilitating the tea estate management and the community in adopting such a programme.

Future goals of the programme should be

  • To priorities PHC components on the basis of community needs assessment, and integration of these components in the PHC programme.
  • Introduce the concept of community participation and ownership of programme (role of community in planning and implementing PHC programme, rather than passively accept services) through health education/promotion activities.
  • Involve owners and/or mangers in the PHC programme through lobbying and advocacy. They should be interested to receive reports from and give feedback to the health workers.
  • Provide continued education and on job training facilities to estate health workers; such training should be practical problem oriented on the basis of training needs assessment.
  • Introducing the concept of revolving funds for drugs, rather than indefinitely providing free medicines at least to the non-worker residents’.
  • Long term goal will be installation of a community based sustainable PHC programme in the tea estates.

To achieve these goals a workshop on “Primary Health Care in the tea estates” with emphasis on prioritization and integration of services and finding out ways of community participation, may be organized.

Participants should come from policy making ranks of the Tea board, Tea industry, Bangladesh Cha Sangsad, Tea labour union, Labour Directorate and various development partners.

It should select a central team of resource personnel for regular supervisory visits and also to monitor and evaluate steps already taken and future activities to be undertaken on the basis of the workshop outcome. This team should include people from Tea Board, owners, managers, estate medical officers and representatives from all agencies engaged or likely to be involved in the proposed PHC programme.

The purpose should be to provide continued education and on job training for health workers (through regular visits by members of the central of resource team). Preparation and use of a standard manual for management of common illness in the tea estates may be useful to reduce costs and risk to patients.

It is important to listen and record health workers real problems in the context of service delivery and try to solve these through dialogue, lobbying, networking and advocacy with relevant agencies and people within existing infrastructure and resource constraints. Coordination between different agencies should be highlighted to avoid duplication of efforts and wastage of resources.

Dissemination of information about positive steps already taken in one estate in the context of PHC could be useful.

Cost reducing exercise for the present curative Medicare may be arranged through consultation meetings for estate management, health workers and workers representatives.

Simple health and demographic data from existing data recording system may be collected, analyzed and provided as feedback to estate owners, managers, health workers and the community which will allow them the reflect on achievements or failures. Simplifying the present data collecting system may reduce work load of health workers.

Existing health education/promotion activities in the tea estates may be reviewed and realistic steps taken at the estate level.

A mechanism of community participation together with supervisory visits would monitor progress of such activities and give on the spot guidelines in the implementation of such initiatives.

Through these activities and industry-based supervisory support system for PHC programme should be installed.

Written by      —–Nurur Rahman Jahangir

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