Health Literacy of the community and the role of Physicians, Politicians and Policy makers to achieve health related MDGs and beyond Zafrullah Chowdhury Gonoshasthaya Kendra (GK) House 14 E, Road 6, Dhanmondi Dhaka-1205, Bangladesh

Problem of millions of deaths and Inequity Every year, half a million maternal deaths and roughly 9.5 million maternal morbidities occur mostly in developing countries. Another 1.4 million survive through near miss events constituting life threatening complications of pregnancy. Globally, over 10 million children die every year of which 4 million are neonates, also poor.

Simple low cost interventions to overcome the big problem : Even a small mouse can release the entrapped lion. If the following simple (may be too simple) tasks are performed regularly by health workers most deaths among pregnant women and under-5 children will be prevented. 1.Visit pregnant women and young children at home along with TBAs. 2.Organise regular ANC & PNC camps. 3.Give at least 2 doses of Tetanus Toxoid, consult in case of danger signs; prompt referral to public hospitals if required. 4.Check blood pressure and nutritional status. 5.Record Blood Group and Random Blood Sugar (RBS) 6.Regularly vaccinate young children DPT, HIV and measles. 7.Stop smoking in front of pregnant women and children. 8.Treat anaemia and malaria and look for tuberculosis. 9.Convince mothers-in-law to allow pregnant daughters-in-law to take mid day rest and allow her eat first and make more food available,. Also encourage her to eat more local citrus fruits and vegetables. Such generous motherly behaviour will guarantee a healthy grand child. 10.Mosquito net for pregnant woman. Later on, for new born as well. 11.Value of early (first) milk (colostrum) and exclusive breastfeeding; complementary feeding later on. 12.Plant a fruit tree and prepare a clean delivery room.

13.Water and sanitation for poor families. 14.Improve personal hygiene of family members and health care providers including TBAs; cut fingernails regularly. Wash hands with soap and plenty of water before and after the child birth. 15.Cut the umbilical cord 1-2 minutes after the birth and put the baby to mothers breast immediately. 16.Visit newborn and mother frequently during first 4 weeks (neonatal period) 17.Vitamin-A and Zinc supplements for the newborn. 18.Provide Antibiotic Amoxicillin for pneumonia and sepsis. 19.Keep ORS ready at home and in case of diarrhoea also continue breastfeeding. 20.Teach temperature management of newborn especially premature and LBW babies with kangaroo method i.e. baby to mothers chest. 21.Resuscitate newborn with mouth to mouth breathing and neonatal AMBO bag. 22.Examine both eyes at birth and during neonatal period for congenital glaucoma, congenital cataract, acute dacrocystitis, squint and opthalmia neonatorum (to be treated with antibiotic eye drop) 23.Revive school health program for eye sight testing (poor children will be more benefited) 24.Regular Community Health Audit improves accountability and health performances.

Low cost simple interventions help achieving MDG- 4 & 5

Simple low cost interventions to overcome the big problem : Did little mouse succeeded to release the entrapped Lion?

Translating Knowledge into action and practice

Individual Health Literacy is not enough: Strong national actions are required

Gonoshasthaya Kendra (GK) Promotes community health literacy Since 1972, Gonoshasthaya Kendra (GK) a public charitable foundation developed integrated Primary health Care (PHC) in rural Bangladesh. Presently GK provides full preventive, nutritional and basic curative care among 1.2 million people in 17 disadvantaged rural areas mainly with trained Community Health Workers (over 75% are females), paramedics, TBAs and a small number of qualified physicians. Every programme has a Local Management Committee which is chaired by an elected female member of Union Parishad (Local Council). Poor families get all services almost free of charges while middle class and rich families pay user fees and full price of essential medicines. Home delivery and frequent visit during first 4 weeks are promoted, supervised and followed.

Community Health Audit of the causes and circumstances of every maternal and infant death are regularly organised. Whether such deaths could be prevented is also discussed in a community health audit. These audits make both the health service providers and the family members accountable for their actions/inactions and helps reduction of IMR and MMR. Such audits are chaired by elected female UP members. Community Health Audit is a yard stick of Health Literacy.

Epilogue or Epitaph? Success of knowledge translation and knowledge transfer is dependent mainly on the political commitment and interest of politicians and policymakers. Their social class background often put blocks on the way to change. Practice of commonsense low cost interventions is not usually easy. Even then, the change shall follow as Health literacy of the community creates demands and builds waves to overcome blocks to changes. GK Workers Reach them Regularly