A health worker excels - GK paramedics digitally empowered

Hi, I’m Sharmin, a 19-year-old with a big dream: to become a nurse and help people in need. Recently, I got accepted into the GK training program, which has been an incredible experience.

In 2023, International Women’s Day focused on “DigitALL: Innovation and Technology for Gender Equality”, and inspired by this, GK encouraged paramedics like me to learn computer skills alongside our regular training. I had never used a computer before—my older brother was the only one in our family who had one. But I quickly realized that knowing how to use Word and Excel is essential for any job nowadays.

Excel fascinated me. It’s like magic—it can calculate percentages and analyze data. Now, armed with this knowledge, I feel more confident during our door-to-door visits in rural villages. As a paramedic, I can provide health information effectively and be a first responder when needed.

This training is just the beginning, but I’m hopeful. The blend of healthcare and technology empowers me to serve my community better. Together, we can make a difference—one step at a time.

When a gender reveal isn't a good thing - testimony from a GK traditional birth attendee in Bangladesh

Halima, 57 years: "I received Traditional Birth Attenders (TBA) training from Gonoshasthay Kendra (GK) and began working in my village. In Bangladesh, maternity care often occurs at home due to stigma around women going to hospitals. As a TBA, I provide health advice to pregnant women and support them during follow-up visits with GK paramedics and I also bring them to our sub-centers for ultrasound scans. Unfortunately, I sometimes encounter uncomfortable situations where families try to know the fetus’s gender. This can be dangerous: if it’s a boy, often the family is very happy and the mother praised and taken care of. However, if it’s turns out to be a girl, families can be unhappy and can blame the mother, neglect her or even lead to physical and mental abuse them.

To prevent this, in 2020, the Bangladesh High Court issued a rule to prevent gender-based discrimination against unborn children. GK not only abides this but to contribute addressing this serious issue, has incorporated gender awareness into our midwifery training. Through workshops, we educate elders and family members that woman are not responsible for a baby’s gender and that daughters are just as much of a blessing as sons. Within our role of traditional birth attendees, we can help eliminate discrimination and contribute to dismantling societal stigma.

Since my gender awareness training, I’ve actively promoted change within many  families and villages and have been proud to witness this."

India context in 2023: women, health and agriculture

Women’s Right 

The Women’s Reservation Act, 2023 (also known as the Nari Shakti Vandan Adhiniyam) is a historic step towards gender equality in Indian politics. It reserves one-third of all seats in the Lok Sabha, State legislative assemblies, and the Legislative Assembly of the National Capital Territory of Delhi for women. This includes seats reserved for Scheduled Castes (SCs) and Scheduled Tribes (STs) as well. The proposed legislation aims to continue this reservation for 15 years.

Health Policies

The Pradhan Mantri Jan Arogya Yojana (PMJAY) is a significant component of the Ayushman Bharat initiative launched by the Government of India. A flagship scheme aimed at achieving Universal Health Coverage (UHC) in India. It moves away from a fragmented approach to health service delivery and focuses on comprehensive, need-based healthcare. It provides cashless and paperless health insurance for secondary and tertiary care across public and private empanelled hospitals in India. PM-JAY is a crucial step toward ensuring affordable and accessible healthcare for millions of Indians, reducing out-of-pocket expenses and improving health outcomes.

New policies in Agricultural Sector

The new agriculture policy of the Indian Government aimed to promote growth in the Indian economy by focusing on increasing agricultural productivity, encouraging the adoption of modern agricultural practices, and promoting value addition in the agricultural value chain.

Fading flowers? No, facing the world! AREDS, India, 2023

I’m Shanmuga, an 17-year-old girl who’s been through quite a journey. Life wasn’t all rainbows and sunshine for me. Irregular periods, loss of appetite, tiredness, hair falling out like autumn leaves, and a constant feeling of fatigue. Yep, that was my life. Anaemia had me in its grip, and it wasn’t letting go. But that wasn’t the worst part. Every time I saw another girl my age, I felt like a drooping flower next to a glowing bloom. My self-esteem? Well, it was buried somewhere deep, along with my energy.

Here enters the AREDS Health Team. They didn’t just throw medical jargon at me; they built a bridge of trust. Slowly, I spilled my worries—the irregular cycles, the hair loss, the whole shebang. And guess what? They didn’t judge. Instead, they handed me a lifeline. “Shanmuga,” they said, “meet your new best friends: bitter gourd, beetroot, turkey berry, pomegranate, dates, gooseberry, curry leaf, and jaggery.” Iron-rich foods became my daily companions. I chomped down on them like a hungry squirrel. And you know what? It worked! Six months of commitment, and my body thanked me. My menstrual cycle decided to play nice, anxiety took a vacation, and my hair even stopped its escape act.

Now, I’m not saying I turned into a superhero overnight. But I did feel lighter—physically and mentally. No more hiding in the shadows. I could face the world, chat with friends and neighbours. Plus, my parents didn’t need to mortgage the house for doctor visits. Bonus!

So here I am, an 17-year-old with a renewed spirit. Anaemia? It’s still there, but it’s no longer the boss of me. I’ve got my iron-packed squad, and we’re rocking this health thing. If you see a girl with a spring in her step, that’s probably me. And hey, if you’re dealing with your own struggles, remember: You’re not alone. There’s always a way to bloom, even in the toughest soil.

Saving money because of social security - Cambodia, 2022

TESTIMONY 

Name: Mrs. Gnil Kimy

Age :  38 years old

Nationality: Cambodian

Profession: garment worker

Before Mrs. Gnil was unaware regarding the social security system of Cambodia (National Social Security Fund or NSSF), which covers health insurance, work accidents and pension. So when Mrs. Gnil had a health problem, she would go to the hospital or to the doctor and spend a lot of money on medicines and health checks. But she attended a training from CLC where experts of the NSSF explained the social security law, the benefits workers can avail through the social security system. After the training she had a clear understanding of the NSSF and how to apply for its benefits. Mrs. Gnil got access to the NSSF and if she falls sick now, she can consult a doctor and obtain her medicines for free, so she can save money for her family. When she gave childbirth, she also received financial support from the NSSF for several months.

In the companies where there is a union, it is possible to get access to the NSSF and to save on health spending, because expenses due to sickness or a work accident are covered by the social security.

Some results by intervention strategy...

Social security: 

1.100 union leaders and workers, of which 30% women and 35% younger than 35 years, were reached through actions focusing on giving better access to social security, through awareness raising initiatives, basic and advanced training, legal assistance and support, research and advocacy to decision makers. For many workers it is not easy to join the trainings because during the day the workers need to focus on their work, as they don’t want their salary to be cut or to be dismissed.

CLC had a chance to lobby, advocacy and bring up workers’ problems with the quality of the NSSF services, as its president is sitting in the board of the NSSF.  Within CLC a committee was established in 2022 for Examining, Monitoring and Evaluating the Implementation of Social Security Scheme. One result of its actions is that from 1st October on the new pension scheme is being implemented and that in the agricultural sector an additional 500 members have registered in the NSSF.

Bringing health services to over 10.000 Bangladeshi people amidst a pandemic in 2020: GK

In 2020, besides offering vocational skill courses to 79 people, GK also offered access to health amidst the pandemic. Over 10.000 members (67% women, 69% young workers) received medical advice or health insurance on preventive care with drug essentials, specialized health camps, grants for destitute groups, HIV/AIDS Screening. 162 people (85% women and 93% young) are provided with basic training on traditional birth attendants, rapport building and communication for paramedics, gender workshops and disabilities. 

During any national and international calamities, GK always tries to respond as early as possible through medical services, reconstruction of damaged houses, and food distribution, including safe drinking water. In response to the COVID-19 pandemic, GK was working 24/7 across the board. Efforts included various preventive measures in the hospitals and at the community level, including the development of a rapid test kit to detect COVID-19 named GR COVID-19 Rapid Dot Blot, raising fund for an Emergency Food Distribution Program, taking steps to increase social awareness about COVID-19 using social media and distributing leaflets to the general public, establishing a Designated Flu Corner at the Savar hospital and organizing a COVID-19 Call Center to provide telemedicine support and advice (report here).

WSM partner in Bangladesh, Gonoshasthaya Kendra (GK), the largest health provider after the Bangladeshi government, is one of the oldest non-profit, non-governmental, and national-level organizations in Bangladesh. GK is a people-oriented healthcare-based organization that provides services in health care, women's empowerment, education, disaster management, emergency relief, nutrition, water & sanitation, agriculture, basic rights-based advocacy, and research. Over the past five decades, GK has expanded its services to cover approximately 1.67 million people in 1,017 villages. GK serves mostly vulnerable and low-income groups in rural areas, mainly through its 44 rural sub-centers and six referral hospitals.

Garment workers, health, elderly - Bangladesh in 2019

“My name is Tahmina and I’m 25 years old. I worked as a garment worker for a 5.300BDT salary (58 EUR) per month but later, I became an operator in another factory and there I received 7,300BDT (80 EUR) as monthly salary. In 2015, I became a member of NGWF and attended several trainings, meetings and processions. I learned about the rights of workers and received women leadership training. In 2017, I started to organize workers by myself and in July I was elected secretary of our union. In 2019 however, I was fired verbally without any further notice from the factory. One month later, a grievance notice was sent to me for legal payment of 105,838BDT (1,150 EUR) to the factory management. I filed a case against them with the help of NGWF and their Legal Aid. The case was solved and I received 100,000BDT (1,087 EUR) as compensation. With that money, I bought some land for farming. I feel honored to be a member of NGWF and my dream is to grow awareness about labor rights among workers”.

First, NGWF is helping its garment workers members through legal aid assistance and advocates for better working conditions in Bangladesh through rallies, hunger strikes, human chains, memoranda handovers to the government, etc). In total, 62.330 members have improved their existing job, for example through basic training on labor rights and advanced training on collective bargaining. NGWF is also helping their members to get better social security coverage. Over 100.000 workers (67% women and 84% youngsters) were made more aware about social security through posters and leaflets and 55.000 workers were reached through their media releases regarding the situation and rights of garment workers. Many of the staff and members of NGWF are young workers, since they focus on youth leadership and development.

I am Sumi from Bhola Barishal in Bangladesh. I am 25 years old. I was forced by my parents to marry at the age of 17. As a day laborer, my husband hardly had any work. At that time, we could only eat one meal a day. I could not take care for my family, so I went to Dhaka on my own. There, I joined a button factory at the age of 19, which my husband also joined later. After working there for a couple of years, we got our first daughter and later we got a second one. Hence, we felt sick several times during that year. It was very hard to live with a limited budget, since we had to spent a lot for doctor visits and medicines. Then, I heard about a medical camp near the factory where I work. I went there and took a health insurance of GK. Now we can visit a doctor and buy medicines at a lower cost. Together with my husband I participated in some awareness raising trainings on various health issues, personal hygiene and occupational health safety. I also try to teach my children about personal hygiene. Now, my family feels less sick thanks to the health services provided by GK. 

The second WSM partner in Bangladesh is Gonoshasthaya Kendra (GK), the largest health provider after the Bangladeshi government. They started out by focusing on the rural areas, but now they also include garment workers. As it became clear in the above testimony, through the services of GK more people have enrolled in social security schemes or systems of social insurance (like pensions, maternity benefits, unemployment benefits, etc.). People also have improved access to health, because they subscribed to a health insurance system or were reached by activities offering health services by partner organisations, such as health camps, awareness raising, health insurance, day observation, personal hygiene, etc. In 2019, over 100.000 members (54% women and 79% youth) have achieved better access to health services. GK also provided over 150 people with vocational skill training to be able to find a better job and to have an improved income security. For example: after completion of computer and embroidery training, 40 out of 60 women got new jobs.

The exchanges between GK and OKRA regarding elderly also continued, with OKRA Coordinator Mark DeSoete and three other staff from OKRA visiting Bangladesh. They also invited an actor who, based on his experiences in Bangladesh, created a play that will tour around the OKRA meeting points in Flanders during 2020 raising awareness about the issues of elderly and social protection.

Last, a lot of people benefited from the services provided by the WSM synergy program in Bangladesh. Nazma for example got training on social protection and labor law arranged by the synergy activity. As an activist and women leader, she was motived to learn about important labor laws and rights. On the 22nd of April 2019, all workers put forward a Charter of Demand to their factory management. Now workers get a weekly holiday, attendance bonus, maternity leave and casual leave with payment, medical facilities, etc. “Workers are finally enjoying their rights, which is a great achievement for me”, said Nazma.

As an impact of the activities of the WSM partners in the past three years, the WSM supported activities contributed that over 60.000 people found a new job or improved their existing job. Almost 300.000 people had better coverage, be it for social security or access to health. Three important legislation were also passed to benefit garment workers: the minimum wage was increased; Safe Working Condition were improved and freedom of Association for trade unions and collective bargaining were better guaranteed.

In 2019, over 600.000 people reached through:
For labour standards: over 160.000 garment workers (60% women and 70% youth) reached through:

• Over 150.000 garment workers are more aware of their rights through campaigns and public outreach. 
• Almost 3.000 garment workers are newly organized
• Almost 400 received basic or advanced training 
• Over 3.200 garment workers received legal assistance. 
• Over 1.200 workers were mobilised to demand to increase the minimum wage. 

155 people got vocational skill training through GK, and they raised awareness regarding women driving.
200.000 workers were made aware of their social security rights and 30 got a basic training.
Almost 200.000 people were involved to improve their access to health because of GK, with 15.000 people getting direct medical attention.

Partners: NGWF, GK, OHS Initiative, BSPAN               Budget 2019: 100.000€
Donor: Own WSM funds                                                   Programme: 2017-2021

Nepal: only 102 positive corona cases, but many challenges lurking - Interview with Ramesh Badal from GEFONT

Ramesh Badal,
Vice-President of GEFONT

• What is the situation regarding COVID-19 in Nepal, a country between China where the outbreak happened and India where so many problems have been reported? 

Till now (8th of May 2020), Nepal has very few detected cases. The first corona case was detected in Nepal on 30th of January. After an initial slow start, over 70.000 tests have been conducted, which revealed only 102 positive cases. So far, Nepal has:

• no corona related deaths, 
• 30 people cured and released 
• 72 remain hospitalized 
• 135 are in isolation. 

As preventive measures, over 15.000 people are under government quarantine. All international flights and borders are closed till 31st May and a complete lock-down is imposed till 17th of May. However, in the past days, some 43 industries related to food or other items have been allowed to re-open with strict measures to abide for workers to avoid infections.
In the coming months, cases will most likely increase, as the lock-down will be lifted in phases and many of the Nepali migrant workers want to return from abroad. Nepal would have great difficulties to ensure proper quarantine for an estimated 177.000 returning migrant workers (127.000 from Gulf states & Malaysia and over 50.000 Nepali workers in India).

• How does GEFONT and the Nepali trade unions deal with this? What struggle are you currently facing?

Despite the few cases, of course, the Nepali economy is heavily impacted by this crisis. The lock-down caused many workers to be out of work, tourism revenue has dropped to zero and remittances from Nepali migrants, an important source for many Nepali households, are decreasing.

Bangladesh - COVID-19: corona testing kits and food distribution

Gonoshasthaya Kendra (GK), the biggest health provider in Bangladesh after the government, is at the forefront by developing a corona-virus testing kit (see our previous post here), GR Covid-19 Dot Blot, which would allow detect infection in 15 minutes.
After the green light to import the needed material, GK plans to have a first batch finished by the 11th of April, so that it can be submitted to WHO and the Bangladesh Government. If they approve it, they can start mass production. As previously reported, they want to make this testing kit available for as many people as possible, at a very affordable price of 200BDT(2 EUR), to avoid a massive outbreak.

GK has also started food distribution, with over 2.000 families assisted last week. These packages include rice, lentils, cooking oil and other necessities, with which a family should survive for one month. GK hopes to be able to help 100.000 families in one month. Follow their Facebook Page for more details. GK also invites people to support them here.

 The National Garment Workers Federation (NGWF) distributed rice, lentils, potatoes, onions, soap, and other essentials to 213 garment workers. Also,  Bangladesh Occupational Safety, Health and Environment Foundation (OSHE) distributed masks, gloves, soap and awareness leaflets among the ready-made garment workers. They called upon the Bangladeshi government to declare COVID-19 an Occupational Disease under the labour law.

According to OSHE, at present over a million of workers and employees in health service, waste recycling, food and medicine supply chain, ready made garments, tea plantation, mass media, bank and financial services etc. in Bangladesh continuing to serve at workplaces due to urgent national and commercial needs with potential health hazard and inadequate health and safety protection. Many of them potentially get infected with corona virus at work and on the way to work or get back home during this pandemic period require necessary legal protection.

Repon Chowdhury, Executive Director of the OSHE Foundation said “This is very much a genuine and timely demand under the context of present reality in Bangladesh. COVID-19 needs to be declared as an occupational disease under the present national Labour law immediately through an official executive order by the government towards ensuring health and safety rights of the working population at workplaces passing time with the vulnerability and risk of Covid-19 infection”.

Urgent efforts are needed to ensure that vulnerable group of workers and employees with COVID-19 should have appropriate access to proper housing, with space for quarantine and social distancing while sleeping and eating, potable water and proper sanitation facilities on and off the job, free health care, safe transport, safe work practices and income protection.

ILO overview of COVID-19 measures implemented by governments, employers’ and workers’ organizations, and the ILO for Bangladesh: link

India: COVID 19 follow up

We all welcome the India government’s announcement of aid package to the unorganized and vulnerable. It is the result of many organizations and movements, including ours, demanding pro-active programs and help to the unorganized and the most vulnerable. Now the entire media and political parties have joined in advocating for more concrete actions to halt economic loss for the unorganized. The Corona pandemic has shaken the world beyond all predictions and so-called progressive economies have almost come to a standstill, with a lot of uncertainty for the future.
We see a change in the attitude of leaders of fundamentalist parties and rightists who have also started demanding more budget to be allocated to meet the needs of the most vulnerable and the daily wage earners. The unpreparedness and the lack of listening to experts have created more problems for the internal migrants and the vulnerable in India. No transport facilities, no safeguards to make these people get back to their homes and no economic backup to meet their daily needs for food etc. The visuals we see in the news and in social media of police brutality and the type of punishments given to the so-called violators of the curfew is are inhuman and one wonders whether these police have been trained to assist and help or to escalate and cause more pain in already exiting sores. We see unorganized workers walking hundreds of kilometers to their homes. The pandemic has taken away almost all the working possibilities for unorganized and they lack safe shelters and food storages forces them to venture out and risk their lives.

Nepal: relief package for workers

The Government of Nepal responded to the demand of GEFONT and issued the following relief package to workers affected by Corana-virus pandemic on 29th of March 2020:

1. Government shall pay 31% of basic salary needed to pay to the Social Security Fund by employer and employee. Employer shall pay remaining amount only to the employees.
2. Employers should not cut the salary of employees during the pandemic-ensued lockdown.
3. Local government should manage and provide food during the lock-down to all daily waged and informal economy workers.
4. Unemployed people, migrant returnees and those who cannot fly to their country of destination due to the pandemic may join the Prime Minister Employment Program and get subsistence allowance.
5. Private school fees for this month may not be paid by workers.
6. 2,5 Million NPR insurance to the medical person, ambulance driver, garbage cleaners and other employee.
7. Subsidized electricity supply during the pandemic.
8. Personal Protective Equipment (PPEs) shall be provided free of cost to the employees concerned.
9. The treatment for people infected by COVID-19 shall be done free of cost.

Corona virus in India shows need for universal social protection: WSM partners in India address an open letter to Prime Minister Modi

Unfortunately, India has not been spared from COVID-19. But WSM’s partners in India are doing whatever is in their power to prevent its spread and to keep the situation as human as possible. On the one hand, they wrote an open letter to the India Prime Minister Narendra Modi, to ask for comprehensive and adequate social protection support measures, especially in these crisis times. On the other hand, they were already performing a lot of work on health care, which can limit the risks of contamination.

Since Tuesday 25th of March, India has been placed in lock down for a three-week period. This measure should curb the rapid spread of the coronavirus. The question remains how India, with 1.3 billion inhabitants and the second largest country in the world, will manage to enforce such a widespread lock down. As of 26th of March, nearly 500 infections have been confirmed. That number has clearly increased since last weekend and is probably a significant underestimation. 9 people have already died of the lung virus. According to Samy, founder of AREDS, the reply from the government came too late, because there was no screening at all of people coming to India. India still doesn’t have the required capacity to screen people with symptoms. Moreover, some travelers have taken to ingesting medication such as paracetamol to avoid being detected with fever and enter the country.

GK to develop Corona test for Bangladesh

Dr. Kadir is the Coordinator of Gonoshasthaya Kendra (GK) in Bangladesh. GK provides health care and health insurance to vulnerable populations in Bangladesh. He shares with us his current impressions regarding COVID-19 in Bangladesh, which is one of the most populated countries in the world and has a very poor health system:

As of 18th March, there are over 10 confirmed cases in Bangladesh. Moreover, the government has recently started to quarantine people. Recent figures tell that there are 2.314 people in quarantine.  Furthermore, schools and other institutions closed since yesterday (17th of March). But still, I think the government is already too late in taking serious measures, which they should have done two or even three weeks ago.

Nowadays it’s flu season, meaning there are more patients at the hospitals than normal. It is not always clear whether it’s just a cold, a normal flu or the corona virus. Bangladesh's largest vernacular daily Prothom Alo reported that only 1,732 testing kits were available in a country of nearly 180 million people.

That’s why GK is developing a coronavirus testing kit, using the Rapid Dot Blot technique. We were recently joined by Dr Bijon Kumar Sil, a micro-biologist, who was also involved in the making of a similar test in Singapore during the SARS outbreak in 2003. This meant we have the necessary skills to develop a testing kit, as this is the biggest challenge in Bangladesh now.  We are 70% finished with the test kit and hope to be able to start mass producing them soon, now that government also has given the green light (link).

How much will your corona test kit cost? 
I think it’s important to make this testing kit available for as many people as possible. We want to use it in our own GK hospitals, as well as in other health institutions, so we will sell the kit at a very affordable price (200BDT), since we’re not trying to create any profit from it, our main goal is to avoid a massive outbreak.

Which populations are you especially worried about?
The garment workers are of particular concern to us, since this sector employs over 4 million people in Bangladesh and they are mostly, women working in very crowded and small confined spaces. The risk of contamination is thus very high. So far, all garment factories are continuing working and very few are taking preventive hygiene measures. That’s why in the factories GK is present, GK is mainly focusing on prevention measures, such as hand washing, producing hand sanitizers, mouth masks, posters etc.

Also elderly are an important at-risk group, with worldwide much higher mortality rates if they get infected. However, so far in Bangladesh, very few elderly have been diagnosed with the virus. This is a bit of a paradox: many elderly are living more isolated, since they don’t have a job or most often continue living in the rural areas, while the young go to the city to work. Since they often have problems of mobility, they are already more likely to stay at home. While this issue of isolation is currently maybe preventing them from getting infected, if the virus becomes a pandemic, this might be a very big problem for them, since these same factors will put them even more at risk.

25 March update: Bangladesh in one week time has had 20 reported cases and one death, of an elderly gentleman.

A one man show on elderly in Belgium and Bangladesh at the Flemish Parliament

Aren’t we happy? That is the title of Peter Lambert’s piece, looking at how elderly live in Bangladesh and in Belgium. Addressing the audience, he started: “You all look good, at least for your age. Shows you are healthy, which is the most talked about topic among elderly. You all managed to get here, so you are all still getting around. We are all here together, so not alone. And you managed to pay the entrance fee, so not too tight with money. Those are the same issues Bangladeshi elderly worry about: health, mobility, loneliness and finances.”

But while ageing is increasingly drawing more attention from policy makers and the ILO, “We talk a lot about elderly, but how often do we talk with elderly?” underlined Marc DeSoete from OKRA. So he asked the invited parliamentarians two questions: do you realize the importance of ageing in the world, and do you recognize the necessity of social movements like OKRA to ensure our voices are heard? “My father lives in a rural area, and OKRA is really the only thing that still gets him out of the door. Of course, we also visit him, but often, there are only caregivers that come to see him during the week. His most social events are, sadly, funerals...” shared Ann De Martelaer from Groen. “We can learn a lot about the respect for greet hairs from other countries, to keep the connection between generations.” said Joachim Coens, CD&V.
Even at 27, the youngest political party president in Belgium, Conner Rousseau from Sp.a, explained how, through his mother who studied gerontology and wrote a book “Grijs is wijs” (grey is wise), the importance of taking care of elderly was emphasized to him since the earliest years.

While most of the time, audience was laughing and giggling, the play also had moments of silence and respect. Peter explaining how his mother struggled to communicate in the last years of her life. An allegory of all the elderly of a village having to climb in a tree and hang on for dear life while the rest of the village shakes it draws a frightening image of what happens when a society has no social safety nets and we push survival of the fittest too far.

The one man show will tour many OKRA meeting points in order to provoke thoughts and discussion about elderly and international solidarity, as OKRA partners through WSM with GK in Bangladesh to set up elderly clubs.

A day in the life of two GK paramedics caring for the elderly in Bangladesh

Follow a day in the lives of two paramedics from Gonoshasthaya Kendra (GK) in Bangladesh. 


From the early morning on the GK campus in Savar, their day starts with the community work done in the fields by all GK staff.  Then they get dressed for work and their visits, have breakfast and set out on their iconic bicycles, after receiving their assignments.
Most elderly people are not economically solvent and depend on their family or relatives. Many elderly also have various kind of illnesses and aches. GK provides primary care services for the elderly at their doorstep, services such as: checking blood pressure, personal hygiene, nail cutting, etc.  Those cases needing more attention are brought to the GK hospitals, for services like physiotherapy, or prescribing affordable medication if necessary.
All this is done for GK with a rights based approach, since elderly have equal right for health care services. 

UN High-Level Meeting on Universal Health Coverage

In exactly one week, leaders of the world’s nations will gather for the UN High-Level Meeting on Universal Health Coverage. After months of tough negotiations, they have reached consensus on a political declaration – which you can read here – that will be adopted on Monday, 23 September.  

The response, as expected, has been mixed. On one hand, the extensive document touches on many core messages and important issues, including mentions of migration and SRHR that were debated until the end. At the same time, weakened or murky language in places will make it easier to loosely interpret the fundamental principles of UHC: equity, social justice and the right of every single person to get the quality health services they need without financial hardship.

One thing is certain: whether you feel skeptical, optimistic or fired up, this is probably the largest global spotlight on universal health coverage to date, and another unanimous pledge that leaders will be on the hook for. We cannot afford not to speak up for what we believe and demand the urgent actions we need to see.

That’s why UHC Coalition, UHC2030 and the Civil Society Engagement Mechanism are teaming up for a 7-day Twitter Storm running from tomorrow, 17 September until the High-Level Meeting, with one focus theme per day:

·       Tuesday, 17 Sept: Leave No One Behind

·       Wednesday, 18 Sept: Commit to Gender Equality & Women’s Rights, including SRHR

·       Thursday, 19 Sept: Invest More, Invest Better

·       Friday, 20 Sept: Uphold Quality of Care

·       Saturday, 21 Sept: Regulate & Legislate

·       Sunday, 22 Sept: Move Together

·       Monday, 23 Sept: Ensure Political Leadership Beyond Health

More resources to join the Twitter storm can be found in today’s edition of UHC2030’s newsletter. As always, UHC Coalition will be tweeting from @UHC_Day, along with @UHC2030 and @CSOs4UHC, and you can join and follow the conversation with #HealthForAll, #HLMUHC and #Asks4UHC.

                                                                                                                     

UN meetings and resolutions are always only as transformative as we make them. It’s up to us to hold leaders accountable in our countries and communities once they have signed on the dotted line.

Improvements in 2018 for the new Indonesian Social Security

2018 saw the further implementation of the reformed National Social Security System and the expansion of the social security coverage, including the health insurance. At multiple moments KSBSI invited officials from the Health Insurance Body and the Social Security Body to discuss the various difficulties with the implementation of the different schemes, such as the contributions to be paid by employers and by workers. Nevertheless there were some breakthroughs:

• hospitals are now obliged to accept any patient and to ask for reimbursement for the expenses from the Health Insurance Body rather than from the patients themselves. 
• The policy on ‘Coordination of Benefits’ between the public social security and private company schemes has been clarified now.

Indonesian migrant workers get access to the regular social security schemes
The new Indonesian Migrant Workers’ Law for which the partner organisations advocated came into effect in November 2018. This law gives more and better protection to Indonesian migrant workers going abroad to work, mainly by making placement, recruitment and protection of migrant workers a responsibility of the state. A new regulation stipulates that migrant workers can have access now to the regular work accident scheme, the death insurance and to old age insurance (a kind of retirement savings). The actions of KSBSI and SBMI in 2018 focused on the dissemination of the new law to the migrant workers and on the negotiation of and advocacy for village level and district level regulations,  needed to execute the law.

Prevention is better than the cure (AREDS)

I have been working as a health worker with AREDS for the past 18 years. I have two daughters and my husband works in a trade union sector with AREDS for unorganized workers. I started the work because of the support from my husband. My husband believes that, if you approach things with a positive state of mind, we can change things, we can do great things. That positive energy pushed me to go work in the same field. Now, I work with pregnant women. I try to ensure continuous follow up and a trust relationship with each family. We’re not there just for one or two months, we follow the same family for over five years. It means we sort of become members of that family. I provide classes to the adolescent girls, where we talk about diseases and hygiene and sexual and reproductive health. Here, there is still a tradition that says that women can’t go outside if they are menstruating or be in a group. So there are still many misconceptions to educate people about. – Dhanalakshmi, AREDS

Access to health is one of the two priority areas for AREDS in the south of India and it believes prevention is very important. Almost 3.800 people (78% women and 80% adolescents) attended sessions on basic health, hygiene and reproductive health issues. While developing alternatives on a local level, AREDS increased awareness in 2018 of over 8.000 members on preventive health practices, water and environment sanitation, breast feeding, organic food growing and consumption, and on the uses of native medicines.

Health Insurance Scheme for garment workers from GK also supported by European buyers (BAN18 - GK)

Dulali, 25 years was born outside of Dhaka, near the border with India. When she was 12, a marriage was arranged for her. With her husband, also a garment worker, she has two children, 7 and 3 years old, all living in one room. While she initially stayed at the house, she started working as garment worker two years ago, because she wanted to add to the family income. She pays 20€ for rent, which represents 25% of her salary. She has opened a bank account, on which she deposits half, but the other half of her salary she gives to her husband. She gave her testimony at the GK medical center in Panisail, where she came for pain killers since her appendix was still painful after it had been removed at the GK Hospital. This operation was covered by her health insurance with GK to which she subscribed over a year ago, while in a private clinic it would have cost at least 300€. She roughly estimated that through the health insurance, she has saved at least 500€ during the past year.

WSM partner, Gonoshasthaya Kendra (GK) or the People’s Health Center is the second largest health provider after the Bangladeshi government. While it initially focused on the rural areas, GK has included garment workers in the urban areas since these are also in need of support for their access to health. GK has adapted its health insurance scheme to garment workers, with contributions coming from the worker but also from the employer or the retailer in Europe, like the French supermarket chain Auchan which covers 20.000 garment workers (link).

A Chance to Influence Declaration on Primary Health Care for UHC

Forty years ago, world leaders came together in what is now Kazakhstan to endorse the Alma-Ata Declaration, which established primary health care for all as a global priority for the first time. In many ways, this visionary document was the seed of today’s universal health coverage movement, which continues to recognize strong primary health care systems as critical to reaching every person and community with comprehensive, people-centered health care.

We have also have learned a lot between then and now: that health systems will not move toward equity without deliberate social policies and investment; that they must protect people from financial hardship; that they must be designed around communities’ and countries’ unique health needs.

This is why on 25-26 October, at the Second International Conference on Primary Health Care, leaders are planning to reaffirm and refresh their commitment to strengthening primary health care as a key step toward UHC. This conference will also culminate in a Declaration—and in the spirit of collective action, the organizers have given us all an opportunity to shape it. 

Please share your input on the draft Declaration here by midnight CEST on 23 April 2018.

We also hope you will share this opportunity with your social media networks:

• [SHARE] It’s been 40 years since the Declaration of Alma-Ata. Now it’s your turn to share how we can strengthen #PrimaryHealthCare to achieve #HealthForAll. Add your comments to this year’s declaration here: bit.ly/2HkJEx5
• [SHARE] Have ideas on how stronger #PrimaryHealthCare can lead to #HealthForAll? Share your thoughts as the world gears up to mark the 40^thanniversary of the Declaration of Alma-Ata: bit.ly/2HkJEx5
• [SHARE] This year marks 40 years since the Declaration of Alma-Ata. What should this year’s declaration say? Share your thoughts on how you would strengthen #PrimaryHealthCare to achieve #HealthForAll: bit.ly/2HkJEx5

Let’s continue to raise our voices until health systems everywhere truly put people first and leave no one behind.