JICA sets a template on fighting noncommunicable diseases

"Dizziness, headache, breathing problems—" a group of women sit huddled together, chanting the symptoms of high pressure. Ayesha Siddika asks the group where they should go when they experience these symptoms.

"To the clinic," everyone replies in unison. 

Ayesha Siddika is part of the support group and helps conduct community engagement sessions. She used to work at the hospital for 10 years and suffers from diabetes and high pressure herself. 

As she lives near the community clinic, she got tested there first and got her diagnosis. Now, she voluntarily works to spread awareness among her community about the symptoms of noncommunicable diseases (NCD) and the measures to take for them. 

Ayesha was trained by Japan International Cooperation Agency (JICA) on how to conduct these sessions. Furthermore, the community clinic she urges everyone to go to in Sikder Para, Cox's Bazar, was funded by JICA. 

JICA has been providing assistance for Bangladesh's health sector since 1974 in different ways, such as, grants, loans, technical cooperation, training, etc. 

As a patient herself, she feels the need to help her community by teaching them about NCDs instead of neglecting it until it is too late. Ayesha says, "When their head hurts, they take paracetamol and dismiss it. Instead, I tell them to go to the doctor to test their pressure." 

Walking into the community clinic was humbling. Throughout my life, I have only seen patients approaching doctors once their condition has deteriorated. But the problem with NCDs is that they are silent killers.

Noncommunicable diseases are not infectious, however, they are developed by an unhealthy lifestyle or genetic predisposition. The four major NCDs are heart disease, cancer, chronic respiratory disease, and diabetes.

Country Lead and Quality Improvement Consultant of SHASTO2, JICA, Dr Mahfuzur Rahman Bhuiyan, elaborates on this, "When we look at the world and the people that pass away, 74% of them are passing away from NCDs and 77% of those people are from lower-middle income countries."

He continues, "It has been reported that approximately one in five adults in Bangladesh has high blood pressure. Additionally, the issue with NCDs is that they affect not only the elderly, but also the younger generation. Premature death occurs between the ages of 30 and 70, and according to the WHO report in 2022, the probability of premature death due to the four major NCDs in Bangladesh  is 19.0%"

In the community clinic sat a patient who came for his checkup. He came in twice every month to test his diabetes. The doctor prescribes him medicine for a month, which he can get for free at the district hospital. 

Watching so many people coming in for regular check ups, taking preventative steps for their health, is quite a new scene. The small clinic accommodates around 60 to 70 people on a daily basis, with queues of people either waiting to get a check up or to get their children vaccinated. 

Chief Advisor of SHASTO2, JICA, Rie Ozaki emphasises the importance of preventing NCDs. She mentioned that over the past five years, Bangladesh has made remarkable progress in implementing measures against NCDs. 

The government established a healthcare system to provide NCD services, focusing on hypertension and diabetes, at the primary healthcare level. The SHASTO Phase 1 project (2017-2022) supported the government in collaboration with other stakeholders to establish this system. 

Currently, more than 300 NCD corners in Upazila Health Complexes provide health services based on standardised national protocols, greatly improving access to services for the local community.

However, it is essential to focus on further strengthening preventive measures as we move forward. The introduction of the SHASTO2 project, which was initiated last September, prioritises enhancing community-based interventions for NCD prevention by strengthening the existing community healthcare system. 

The project will last between September 2023 to September 2028 in dedicated areas in Cox's Bazar, Cumilla, and Narsingdi. 

The reality is that reaching so many people is not as easy as prescribing them free medicine. In more ways than one, the community itself has a huge impact on this. 

On top of having community support groups spreading awareness to the community, peer pressure also has a role to play. 

Community Health Consultant of SHASTO2, JICA, S M Rezaul Islam, said, "In the community, there is peer pressure. In some cases, people turn bad from peer pressure, but in other cases it can be good for them. A smoker who falls ill and gets treated at the clinic may tell their peers to go to the clinic as well. The peers are more likely to listen to a member of their community rather than the doctor."

Another patient waiting in line mentioned how she came to know about the clinic. "My neighbours and family told me about the clinic and said I would get better if I came here." 

When asked how they had heard of the clinic in the first place, she said, "The people visiting the clinic went back home and told us about it." Her account shows the power of word-of-mouth in their communities. 

Furthermore, having the clinic settled right in the midst of the community made it easier for locals to access basic healthcare and facilitate screening for NCDs. 

For the locals who live on their day-to-day wages, their time, energy, and money are some of their most important resources — and their district hospital is about a 40-minute drive away. 

JICA's reach in the healthcare sector in Cox's Bazar does not stop there. The patients from the clinic will most likely travel to the 250 Bed Sadar District Hospital to get treatment, including medication, from doctors and nurses. 

There, in the Coronary Care Unit (CCU), you will see more ways how JICA's contributions have impacted lives. 

The CCU is packed with rows of beds, each hooked to a monitor, and not a single one is empty. In this room, each patient's life depends on these monitors. 

Assistant Professor Dr Lutfun Nahar Begum said, "Before starting operations here, we began providing services in a small room with the capacity to admit six patients, with support from JICA. As demand gradually increased, operating with a few beds and monitors became challenging."

"Subsequently, with additional support from JICA, we relocated the CCU to its current room and expanded the number of beds from six to 10. We added another 10 beds in our PCCU (Post Coronary Care Unit)." 

With JICA's help, the hospital is now able to serve even more people, saving lives. 

Furthermore, the Upazila Health Complexes in Chakaria and Ramu Upazila, as well as the 250-bed Sadar District Hospital, reveal an entirely new scene. 

Throughout the whole hospital, only one corner is separated from the rest with its green walls. The coloured walls indicate the area designated as the NCD corner, which was established by the government with support from JICA.  

Inside, there is a machine where patients just need to insert their hand in to test their pressure. 

A nurse of the hospital explained, "Manually, it can take several minutes to measure a patient's blood pressure. The blood pressure machine allows us to do it in seconds."

Equipment, such as the blood pressure machine, was provided by JICA in order to speed up the screening process. This allows the hospital to get through patients quicker, increasing the capacity of their services. Furthermore, JICA also provides the hospital with staff training and quality monitoring.

JICA's works have, without a doubt, made an impact. According to data provided by the 250-bed Sadar District Hospital, which began operations in 2018 with support from JICA, a total of 56 patients were admitted to the CCU, among them 20 died that year. Gradually the situation improved, and in 2023, out of the 1,376 patients admitted to the CCU, only 185 people died.

The impact of the organisation is felt throughout Cox's Bazar. Senior Health Education Officer of Civil Surgeon Office, Cox's Bazar, U Cha Prue Marma  agrees with this after monitoring the results. 

He said, "To see if JICA's contributions have made an impact, the teams in the districts and upazilas visit the community clinics and monitor whether the patients are able to receive quality care to combat NCDs. Compared to other districts, the people of the three upazila that JICA's project has reached are much more aware of NCDs."

JICA ties everything together – from sessions with community support groups to increasing the overall capacity of a CCU. This allows people to learn about their symptoms and, if needed, receive better healthcare services from their local hospitals in future.