My position, function and role in the organization:I was employed in this organization approx. for 3 years. Initially I joined as medical officer in BRAC Clinic which is part of BRAC health, nutrition and population program (HNPP)and later I was re-deigned as senior medical officer and clinic in charge (Team leader).My role as a Senior medical officer:• Management of outdoor and Indoor patient and assist major surgery.• Provide Antenatal services to detect high risk pregnancy, postnatal care, Neonatal patient management.• Ensure family planning, and sexual health services.• Keep records of pregnancy and post-operative complication with their analysis to prevent them to a minimum level.Role as a Clinic In-charge (Team leader):• Perform assessments; providing treatment to clients of clinic• Recruitment of local health care staff as well as hiring promotion of staff members• Observes as well as assists staff members at work sure, safe and ethical practices and solve problems demonstrate technique• Conduct training program to create awareness about health, nutrition and hygiene• Develop a program for clinical quality control• Maintaining the inventory, budgeting, organizing staff meeting and participate in the performance improvement program• Arrange weekly field visits of every team members of clinic.• Works in close collaboration BRAC Maternal and child health program (MNCH) and Organize monthly meeting with regional managers of MNCH to discuss about monthly success and failure, patient satisfaction etc.B. Description of situation/ time when further development needed.Main challenges: Main challenges I faced when started to work there newly that Gap between formal clinic setting to community which result in delay in decision-making to seek emergency obstetric service, delay in receiving services at place of referral (BRAC Clinic).Possible reason/Background factors:When I started to work there and my responsibility was to provide health care in BRAC Clinic which is ‘one-stop’ services for pregnancy and delivery including care for the children by qualified doctors, nurses, lab technician and other health staffs. for urban slum peoples in one area (Dhanmandi) of Dhaka city ,BRAC health center was newly established there .I was responsible to run a new health center successfully, increase patient flow, provide comprehensive service to them but at that time I was not connected with local people, health workers working on that areas, regional manager, branch managers of that region who are under MNCH program and directly connected to community and suppose to referred pregnant mother to ensure emergency obstetric care and other emergency cases to clinic from various branch of that region. I was responsible for clinic service where my team received complicated case of pregnancy that can’t managed in BRAC maternity center where delivery conducted by trained birth attendance. So, I didn’t get opportunity to reach people directly. I didn’t have idea of beliefs, values, attitudes, knowledge and behaviors of target peoples (mother and child under five) related to their health problem. socio-demographic characteristics of the urban slum, key influential people for health-related matters, current health networks/resources and facilities, existing MNCH practices and perceptions. I found that pregnant women did not take any preparation for birth beforehand. Until complications arose, they considered every pregnancy normal. They did not receive antenatal care during pregnancy. They would rely on community health worker and did not perceive any necessity for qualified doctor and nurse for normal delivery. Long time they waited in maternity center or at home and tried for delivery and when it’s become prolonged, obstructed labor and complication arises for mother and child they referred it to BRAC clinic. They were not comfortable referral system, although BRAC MNCH program bear cost of referral, even charge of major surgery also taken according to economic condition of patients and rest of cost of services provided by MNCH program. There were some gaps in information distribution about the content and costs of the health services of BRAC clinic.• To change the situation, me as a team leader of BRAC clinic and MNCH staffs e.g. regional manager, branch manager, community health workers joined together and discussed our situation and decided to conduct monthly meeting to see failure or success ,arranged field visits of every staffs of BRAC clinic weekly to reach community directly, organize training of community health workers to provide information of referral to Clinic, team building training ,develop a program for clinical quality control.• After few months later, surprisingly we observed, dramatic changes of situation. Community health workers referred complicated patients as soon as possible so we can promptly take decision to ensure healthy mother and child, increase number of antenatal and postnatal services and other outdoor services of clinic, patient started to rely on qualified doctors and nurses, and they were satisfied with services of BRAC clinic.• I think we were succeeded as a team to reduce gap between formal clinic setting and community which could be main reason for the success of the development progress.
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