Improving SRHR-services of SKS hospital and its Satellite Clinics in Bangladesh

Last month, Consiglieri Private Limited, SERAC and CINOP facilitated a co-creation session with the staff of the SKS Foundation for the development of a SRHR (Sexual and Reproductive Health and Rights) training course that matches the challenges and needs of communities in Northern Bangladesh.

SKS foundation is a Bangladeshi NGO that facilitates development programs for the most marginalized regions in Bangladesh. Women and children are often at the heart of its projects. SKS Foundation established a hospital in Gaibandha in 2008 with the aim to increase people’s access to basic quality health care. SKS also works with Satellite Clinics, to ensure that medical services also reach the rural communities such as the communities living in the Saghata sub-district.

Saghata is a complex area, because of its location alongside the riverbanks. The communities living here are called ‘chars’, these communities belong to the most marginalized of the country, the region is prone to floods and communities get disconnected from the mainland every year during the monsoon.

SRHR is one of the topics of basic health services that are provided in the SKS hospital and its Satellite Clinics. A focus is on services for mothers, adolescent girls at a reproductive age and children. Through this project, SKS aims to further strengthen its capacity and skills in addressing and tackling challenges specific to SRHR in the communities they serve. In this way, SKS will be able to contribute to improved equitable access to and utilization of quality health services, with a specific emphasis on SRHR services.

During its visit to SKS, the project consortium visited a community in the Saghata sub-disctrict, shared the results of the training needs assessment with the staff of SKS, and facilitated several co-creation sessions with the SKS staff to come up with the main topics that will need to be covered in the training course. In the coming months, the next step will be to develop a curriculum that can tested in the communities.

Results training needs analysis

During the first phase of the project, a training needs assessment (TNA) was carried out in order to identify the major challenges the target group (local communities in the Saghata Upzilla district in Gaibandha) faces around SRHR. A total of 54 people were interviewed as part of this assessment, including community members of different age groups as well as staff members of SKS. The purpose of the TNA is to identify the topics of SRHR that should be incorporated in the curriculum.

The major challenges identified by the communities were menstrual health management problems, lack of knowledge on SRHR, stigma on topics related to SRHR, domestic violence, eve-teasing, extreme gender discrimination, child marriage, dowry, lack of affordability in prenatal care, illegal and unsafe abortion practices and infertility issues.

Child marriage and dowry were seen as two of the most important problems in the district. Child marriage could clearly be linked to girls dropping out of school: girls that get married before the age of 18 are less likely to be in school than their peers and girls who drop out of school are more likely to get married. Furthermore, child marriage was seen as a root cause of divorce and was described to have a great impact on the children’s and mother’s health.

The community members believe that the challenges should be tackled by creating awareness (for example through campaigns or through school programs), sex education (at the family level) effective law enforcement and SRHR training for the community. They also pointed out that social dialogue should be facilitated in the community. Social leaders in the communities were specifically mentioned as having to be part of such awareness building activities.

In terms of health care, most of the respondents indicated that they do not have decent access to health services related to SRHR. The community members listed safe sex practices, appropriate referral system developments, sex education and bodily anatomy as important services related to SRHR that they would like to have access to in a community environment. They also mentioned that they would like to have facilities where men and women will be sensitized together rather than separately. Regarding such awareness raising sessions, the community members want to include the medical staff as well.

From the perspective of the staff of SKS, a major challenge that was brought up was the shyness of the community, especially among the women. They explained that women are often not comfortable in sharing their problems with male staff. Other challenges include late involvement of medical staff (for example during childbirth) which makes it more difficult to provide adequate medical assistance. The staff indicated that leadership on SRHR cooperation initiatives should be improved, as should be the knowledge level of the staff, funding, staffing and regional cooperation and coordination.