Bangladesh faces significant challenges as one of the world’s most disaster-prone countries, given its location in flood plains and high population vulnerability. Particularly, communities in hard-to-reach riverine and coastal areas struggle with limited access to basic services, including healthcare. Friendship, a non-governmental organization with a social purpose, has been dedicated to aiding underserved populations in remote Bangladeshi communities. Drawing on 20 years of experience, Friendship has developed the capacity to operate Floating hospital ships and implement community-based primary healthcare programs. These initiatives target remote rural areas in the northern riverine regions and southern coastal belt, addressing issues of accessibility, affordability, availability, acceptability, and awareness in healthcare delivery.
The King Abdullah bin Abdulaziz Program for Charity Works (KAAP) of IsDB funded by the King Abdullah Foundation acted through a generous donation to address the still unmet need to make quality healthcare accessible for reaching out to people in different remote regions of Bangladesh. For this purpose, an agreement was signed between the Government of the Peoples Republic of Bangladesh and the Islamic Development Bank on May 17, 2015.
On March 16, 2017, Friendship and the Islamic Development Bank (IsDB) signed an agreement to jointly implement five units of Floating Mobile Medical Units (FMMUs) along with community-based outreach healthcare.
Five FMMUs of Friendship
For five years from the commencement of each Mobile Medical Unit (MMU) operation, Friendship will manage the Five FMMUs, registered under the Directorate General of Health Services, Ministry of Health & Family Welfare, overseeing 220 satellite clinic sessions monthly and coordinating with 220 community health workers.
Following this period, Friendship will transfer each FMMU, along with its associated satellite clinics and community health workers, to the Government of the People’s Republic of Bangladesh. (i.e., to DGHS, unless otherwise instructed by the Government of the People’s Republic of Bangladesh) for keeping those functional. The floating hospitals are proposed for the following regions:
FMMU- 1 (medium-sized primary care ship): Barisal, Patuakhali, Borguna
FMMU- 2 (medium-sized primary care ship): Sunamganj, Habiganj
FMMU- 3 medium size (small primary care ship): Khulna, Bagerhat
FMMU- 4 (medium-size primary care ship): Kushtia, Pabna
FMMU- 5 (large secondary care ship): Chandpur, Laxmipur, Bhola.
Floating Mobile Medical Units (FMMUs) no 1, 2, 3, and 4, each will be medium size primary care ships (25-meter length) and no 5 will be a large (31-meter length) secondary care ship.
Three-Tier Health Care System:
We will ensure access to quality healthcare services for beneficiaries in the envisaged project intervention areas by implementing a three-tier healthcare system within Friendship’s existing intervention areas. The three tiers are as follows.
Tier 1- Ship Hospitals (FMMUs)
Tier 2- Satellite Clinic Sessions
Tier 3- Community Health Workers Aka Friendship Community Medic Aides.
Catchment Area and Population Dynamics
The catchment area of the five FMMUs along with their outreach component spans 53 unions in 13 sub-districts (Upazilas) of 12 districts in North & South Bangladesh
The catchment population will be over 1.5 million considering on average around 30,000 population in each union.
The project will reach through the 3-tier healthcare system, with around 500,000 beneficiaries.
Medical Service Provided by the Ships:
Each of the five ships will be operational for an average of 330-340 days each year.
Each of the five ships will provide the following services 7 days a week.
Outdoor service will be provided from 9 AM to 5 PM
Emergency service will be provided 24/7
During the weekly and Government holidays medical service will be provided on demand, however, emergency cases will be catered.
Each ship will have the capacity to serve an average of 120 patients per operational day.
There will be provision for periodical secondary health camps in MMU-5
The five ships altogether will cover 53 unions in 13 sub-districts (Upazilas) of 12 districts. 25 anchoring locations are expected to be reached throughout the mentioned geographical locations each year by these five ships. As envisaged, each ship will reach 5 anchoring locations each year. However, all five ships combined may touch up to 30 anchoring locations each year which will entirely need basis and depending on adequate navigation conditions of the river channel and availability of safe & suitable anchoring locations. In each location, one MMU will stay and provide service for approximately two months.
Each of the ship hospitals has medical & fleet staff. Medical staff are responsible for providing and managing health services on the ships. The fleet staff is responsible for running, maintenance, safety security, cleanliness, cooking, and logistics support including assistance during day-to-day medical service as and when required.
Medical services provided by small size (25 meters) primary care ships (ship hospital no’s: 1, 2, 3, 4):
General treatment and primary health care:
Treatment and management of common illnesses, and seasonal and tropical ailments of men, women, and children.
Management of communicable and non-communicable diseases. Services will include general treatment, investigation, referral, and follow-up.
Childcare including acute respiratory tract infection, diarrhea, and limited curative care
Adolescent healthcare and awareness for personal hygiene and behavioral change communication.
Maternal and women’s health care including ANC/PNC, nutrition supplementation, and gynecological services.
Family planning,
Management of sexually transmitted and reproductive tract infection
Primary Eye and Dental Care
Emergency health care for basic first aid and further referral
Emergency care and minor surgery:
Treatment of minor injury and surgery
Emergency care and referral.
Lab Services:
Limited pathology and Lab Services and imaging
Referral Services:
Referral Services to government healthcare facilities.
Counseling and nutrition services:
Providing health education for nutrition, supplementation, family planning, disease prevention, etc.
Medical services provided by the large secondary care ship (ship hospital no. 5)
The large (31 Meters) ship (floating hospital no.5) will provide all the above-mentioned primary healthcare services alike the small ships. In addition, the following secondary healthcare services will be provided through special camps:
Cataract Surgery
Reconstructive Surgery (burn contracture repair, cleft lip, and palate surgery, etc.)
Pediatric Consultation and surgery
Orthopedic Surgery
Physiotherapy
Minor surgery
ENT consultation
Gynecological consultation and surgery
Dental care and surgery
Specialist Consultation
Referral Services
Healthcare services provided by outreach component (Satellite Clinic Sessions and Community Health Workers):
To bolster Ship Hospital operations, we will implement an outreach component that includes Satellite Clinic Sessions and Community Health Workers.
Snapshot of the component:
13 sub-districts of 12 districts
220 Satellite Clinic Sessions per month, by Medical Assistants, at the doorsteps of the community people, in areas identified in collaboration with the local health authorities, to
Provide primary health care, limited curative care, and family planning services.
Provide ANC & PNC
Provide first aid in emergencies and quick referral.
860 Courtyard session to disseminate Health education & information.
220 CHWs working at the doorstep of 44,000 households to provide services like Awareness, Health education, mobilization for EPI, Demand generation, Nutrition (screening & referral) referring ANC, PNC & FP clients, etc.
Note:
The number of satellite clinic sessions in a particular project area corresponds with the number of CHWs in the specific area.
Each satellite clinic session serves 50 beneficiaries/ session.
Each CHW covers 200 households. Thus, directly serving 1000 beneficiaries/month (household size- 5 members/household). Moreover, around 5000 beneficiaries are served indirectly.
There will be a total of 220 community health workers within the project intervention area.
Around 220 satellite clinic sessions are envisaged to be held per month throughout the project intervention area.
In conclusion, Friendship, in collaboration with the King Abdullah bin Abdulaziz Program for Charity Works (KAAP) and the Islamic Development Bank, has implemented a comprehensive healthcare initiative in Bangladesh. Through the operation of Floating Mobile Medical Units (FMMUs) and a three-tier healthcare system, the project aims to provide essential medical services to over 1.5 million people in remote riverine and coastal areas. The partnership between Friendship and KAAP underscores a commitment to improving the well-being of vulnerable populations in disaster-prone regions of Bangladesh.
