Primary health care facilities in Bangladesh: a method for planning and design taking account of limited resources, local technology, future growth and change

Ara, Jasmin (1994) Primary health care facilities in Bangladesh: a method for planning and design taking account of limited resources, local technology, future growth and change. Doctoral thesis, University of North London.


This thesis attempts to derive an appropriate method of planning and design of Primary Health Care (PHC) facilities in Bangladesh. The constraints and strategies like limited resources, use of local technology, need for phasing and future growth and change are set as prime considerations for developing the method. A systematic and step by step approach is followed at each stage of development. The aim is to express the method and guidelines in a convenient form which will be useful for health facility planners, designers and users at each level of decision making, from inception to evaluation.

The First Chapter develops a clear idea about the existing situation through an overview of the country's health and health services with particular emphasis on PHC. It shows that PHC has been given priority in the health service planning of the country and various programmes are undertaken to fulfil that target. But there are a multitude of problems arising from existing approaches to planning. programming and designing the facilities. It appeared to be an appropriate stage to develop planning and design guidelines based on the grounds of policies and strategies undertaken and realising the problem areas and mistakes from past experiences.

Before evaluation and analysis of existing facilities, a first attempt was to investigate (Chapter Two) what constitutes a planning and design method, guidelines and guidance. Lessons are learnt from the experience of developed and developing countries, from reviews and analyses of different published material, guidance and research in the relevant field. Based on the acquired knowledge, a theoretical model is developed (Chapter Three) focusing 1) on the essential stages of planning and design, 2) methods, 3) the framework and structure of guidance. The aim was two fold. First to focus the study on particular areas essential for the guidance, and second to prepare a checklist of subject areas for investigation through field surveys so as to gather the required feedback information for future proposals.

To get a clear idea of the physical and functional aspects and successes and failures of the present approaches, an appropriate methodology is developed in Chapter Four for the survey. The methodology set the survey objectives, method of sample selection and outline procedure to be followed. The survey findings, presented in Chapter Five explore physical and functional aspects, the successes and failures in the provision of PHC services and facilities.

Based on the survey findings and feedback information the theoretical model is validated through developing planning and design guidelines for PHC facilities in Bangladesh. The final outcome is presented in a systematic method in the form of guidance in two chapters. Chapter Six proposes the planning guidance outlining basic information on roles, services and functions, distribution, location and size followed by outline operational policies of Upazilla Health Complex (UHC), Union Health and Family Welfare Centres (UHFWC) and Health Post (HP). The planning and design strategy of limited resources are discussed in this chapter. Chapter Seven presents the design guidance. The strategies and design principles (e.g. growth, change, phasing, building size and shape, environmental consideration, use of local materials and technology and so on) and their design implications took shape in the design concept and design development. Common activity components in individual facilities are identified and presented in a convenient form which is hoped to be useful for the design team followed by exemplar activity clusters and individual facilities.

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