Project proposal
for
Development of skilled
human resources for home care of elderly, chronically ill and disabled people (Home
Health Care Assistant) in Bangladesh
Proposal developed by:
SSMC-3 Society <http://www.ssmc
3rd batch society.org>
SSMC-3 Society is a non-profit,
non-political organization for medical and humanitarian services. The society maintains
a free Friday Clinic at Uttora, organizes outreach medical camps, and other
activities
Table of
contents
Executive summary
1. Background: With the growing need of care for the elderly, chronically
ill and disabled people in Bangladesh, this proposal is developed to train a
cadre of basic home health care service providers (Home Health Care Assistants)
who would implement the instructions of the consulting physicians for
medication, provide limited physiotherapy, counsel the family members on
patients’ diet and personal hygiene, and provide direct support services such
as dressing, feeding, cleaning etc. to the patients in need at home.
2. Goal, Purpose and Objectives
2.1 Goal:
The overall goal of this project is to contribute to improved
home care services to chronically ill patients, elderly and disabled people,
who are unable to manage themselves for survival in Bangladesh.
2.2 Purpose:
The purpose of this project is to develop a cadre of skilled
home-care service providers (Home Health Care Assistants) to provide day-to-day
home care services to chronically ill patients, elderly and disabled people
both in urban and rural areas of Bangladesh.
2.3 Objectives:
1.
Develop
a training institution to provide quality training;
2.
Provide
quality training to the home health care providers;
3.
Promote
the trained home health care providers in the society and community
3. Activities:
3.1 Develop a training institution with necessary training
facilities, furniture and other logistics: This would be initially done at a
rented house. However, the ultimate goal is to institutionalize the training
through development of a permanent training institution through procurement of
land and construction of necessary infrastructure.
3.2 Recruitment of staff: The project would recruit a
part-time project director, one administrative and finance officer and two
support staff to implement the project.
3.3 Selection of trainees and facilitators, and
implementation of training: The trainees will be selected through open
advertisement in the news paper. The training would be provided free of cost to
the interested candidates (at the initial stage). It is proposed to train 100 persons
on pilot basis in a year.
3.4 Promotion of trained providers: The project would promote
the trained providers through personal communication as well as through institution.
4. Implementation: The project would be implemented under the banner of SSMC-3
Society. A project implementation committee will be formed to implement the
project and a separate account for the project will be maintained.
5. Project period: The project period would be for 1.5 years – first 6 months
for preparation (preparatory phase) and next one year for implementation.
6. Budget: Total estimated cost of the project is about Tk. 3,550,000
(thirty five lac fifty thousand) only.
Project
proposal in detail
Bangladesh is a country of more than 161
million inhabitants.[1] Data of
2014 indicates that about 5% of its population is above the age of 65 years with
a dependency ratio of 64%.[2]
Bangladesh has achieved remarkable progress in health
and economic sectors with improvement of health and economic indicators. There is
significant reduction of maternal and child mortality during the last decades with
improvement of life expectancy .[3],[4] Data
indicates that average life expectancy at birth (2013) of Bangladeshi
population is about 70.6 years (female: 72.6 years; male: 68.7 years).[5] Bangladesh is
also progressing towards a middle income country as envisioned by Vision 2021,
an agenda of this current government.[6]
Though Bangladesh
has achieved substantial improvements in health indicators, there are growing
concerns about emergence of chronic diseases like hypertension, diabetes
mellitus, chronic renal diseases, cancer and others. A recent study with
nationwide samples indicates that the prevalence of hypertension among the population
aged more than 25 years is 14.8%.[7] On the
other hand, the prevalence of diabetes mellitus among adult population (aged
more than 35 years) is estimated as 9.7%.[8] In many
instances patients with these chronic diseases develop complications, such as
stroke (leading to hemi or paraplegia), renal failure and other disabilities
causing enormous suffering to the family members as they cannot maintain their
daily survival needs.
The treatment cost and hospital care in Bangladesh has
become very high compared to the income of general population. Studies indicate
that the out of pocket expenditure for health care in Bangladesh is about 64%, which is
one of the highest in the world.[9] Many of
the families become devastated and pushed into deeper poverty to meet up the medical
bills for hospitalization of chronic diseases. The hospital care cost could be
minimized if appropriate home care services were available with affordable
cost.
In developed countries, there are trained providers to
provide domiciliary services to the elderly and chronically ill patients.
However, there is no such cadre of trained home care providers in Bangladesh who
can follow the instructions of the physicians and provide necessary care to the
elderly, chronically ill patients and disabled persons at home.
In Bangladesh,
the number of beds at public hospitals is inadequate and the number of
facilities for geriatric care (old homes) is very scarce compared to the needs.
Moreover, for most of the families, it is not affordable to keep the chronically
ill patients and elderly people at the clinics/hospitals for extended period of
time. This is also not a cost effective way of managing the chronically ill and
disabled people who need support from family members. This proposal has been
developed to mitigate some of these growing problems through developing a
trained cadre of home-care providers for the care of elderly, chronically ill
and disabled individuals in Bangladesh.
Home Health Care Assistants (HHCA) is proposed to be a cadre
of trained health care providers who will provide some basic health care
services to the elderly, chronically ill and disabled patients at home. The
services that the HHCA would provide include: 1) implementation of consulting
physician’s advise for the care of patients at home; 2) provide limited
physiotherapy; 3) dressing; 4) postural management to prevent bedsore; 5)
patients’ feeding and dietary counseling to the family members; 6) maintain
personal hygiene of the patients; and 7) measure the BP and temperature etc.
The Sir Salimullah Medical
College – 3 Society or SSMC-3 Society is
a non-profit and non-political organization aimed at providing medical and
humanitarian services to the poor and marginalized people in Bangladesh.
This society is formed in 2014 by the 3rd batch graduates of Sir Salimullah
Medical College.
It is registered with the government and has approved constitution. The society
is governed by an elected Executive Committee (EC). Current activities of the
society include: a) free specialist medical services through a free Friday
clinic at Uttora (Jashimuddin Road);
b) organize periodical outreach medical camps in the rural areas. The society
has already organized 10 outreach health camps in the rural areas of different
districts. About 15,000 patients have received specialist care services free of
cost or with minimum fees from these camps; c) organize seminars at Sir Salimullah
Medical College
Hospital on various
issues as part of continuous medical education primarily by the specialists
working abroad. The society maintains a website <www.SSMC 3rd batch
society.org>, where all the relevant information such as activities,
constitution, list of members, Executive Committee etc are available.
4.1 Goal:
The overall goal of this project is to contribute to improved
home care services to chronically ill patients, elderly and disabled people,
who are unable to manage themselves for survival in Bangladesh.
4.2 Purpose:
The purpose of this project is to develop a cadre of skilled home-care
service providers (HHCA) to provide day-to-day home care services to
chronically ill patients, elderly and disabled people both in urban and rural
areas of Bangladesh.
These service providers would follow the instructions of the consulting
physicians for medication, provide limited physiotherapy, counsel the family
members on patients’ diet and personal hygiene, and provide direct support services
such as dressing, feeding, cleaning etc. to the patients at home.
4.3 Objectives:
The objectives of this project are
to:
1.
Develop
a training institution to provide quality training;
2.
Provide
quality training to develop skilled home health care providers;
3.
Promote
the trained home health care providers in the society and community for home
care services
Five percent of total population in Bangladesh is
at the age of more than 65 years. With this estimate, there are about 8 million
people at this age group. With the continued improvement of life expectancy,
this population group is gradually increasing. On the other hand, prevalence of
chronic diseases like hypertension, diabetes, kidney disease and other chronic illnesses
are high, especially among the older age group. Many of the chronic diseases are
associated with complications, which require, in addition to appropriate
medical care, home care services. Currently, there is no trained service
provider in Bangladesh
to provide basic home care services to this group of individuals. This project
proposes to train a group of individuals (Home Health Care Assistants) to
support home care services to chronically ill patients, elderly and disabled
individuals.
If this project is implemented, it would benefit the society
in taking care of the chronically ill and elderly people in a better and cost
effective manner. The trained individuals can be self employed or may have the
opportunity to work at private clinics and old homes, and would contribute to
the reduction of unemployment burden of the country. There may have opportunity
to export these skilled human resources to other countries that would generate
foreign currency to strengthen our economy and help achieving the vision 2021.
To fulfill the goal and objectives of this project, following
activities will be undertaken.
6.1. Comprehensive curriculum:
A comprehensive and detail curriculum including necessary
training materials (manuals for trainers and trainees) are needed to impart
quality training and develop skilled providers. A draft comprehensive
curriculum (attached with this proposal) has already been developed by the
curriculum committee of the SSMC-3 Society. The curriculum has been developed adapting
the curriculum of USA and Canada for developing similar type of provider but
keeping in mind the socio-economic and cultural context of Bangladesh.
The objective of the training would be to provide necessary
knowledge and skills to the participants to provide basic home care services to
the elderly, chronically ill and disabled people in the community. The job of
the trained individuals would be to follow the advices of the consulting
physicians for medication, provide limited physiotherapy, counsel the family members
on patients’ diet and personal hygiene, and provide direct support services
such as dressing, feeding, cleaning etc. to the patients at home.
6.2. Development of training institution:
6.2.1 Renting a house:
To organize the training necessary infrastructure and
facilities are needed. Initially, the Society will use a rented house to train
the providers. However, the ultimate goal of the society is to institutionalize
the training through development of a permanent training institution through
procurement of land and construction of necessary infrastructure.
6.2.2 Procurement of furniture, legists
and training aids:
In order to implement the training, in addition to the rented
house, some furniture (chair, table, file cabinets, almirah etc.), logistics (air
conditioner, white board, markers etc.) and training aids (laptop, multimedia
projector etc.) would be required. The list of necessary furniture, logistics
and training aids that would be procured for this project is shown in the
budget.
6.2.3 Recruitment of staff:
To implement, manage and coordinate the training activities,
the project will appoint minimum number of staff. The project proposes to
employ the following staff members:
A part-time Project Director: A part-time Project Director (PD)
will be appointed to implement and manage the project. The PD must be a member
of the SMMC-3 Society with previous experience of training, project
implementation and management. He will be overall responsible for
implementation, coordination, day-to-day management of the institution and
supervision of the staff. The project director will be reportable to the Project
Implementation Committee (PIC) (see management section). The project would
pay a little amount of honorarium to the PD for his/her time. However, if any competent
member of the society wants to provide voluntary services, that would be
considered positively while appointing the PD.
One administrative and finance officer: The project will hire this full time
staff. The Admin and Finance officer will assist the Project Director to implement,
manage and coordinate the training program, maintain day-to-day management and
maintenance of finance for the project. He/she will closely work with the PD
and assist him to implement the training program and provide periodical
financial report to the PD. A separate account (separate from the society’s
account) will be maintained for the project.
Two support staff: These support staff will be appointed full time by the
project. They will remain responsible to support the Admin officer, and
maintain cleanliness and security of the training institution in addition to
other necessary supports.
6.3. Selection of trainees and facilitators:
The first step to implement the training is to select and
enroll the trainees. The selection of the trainees will be done through open
advertisement in the daily news paper, through online advertisement and
personal communication. Training of initial few batches will be offered free of
cost (i.e., trainees would not have to pay for the training). Subsequently,
depending on the experience of this pilot phase, a small amount of training fee
may be imposed to recover the cost.
Selection of trainees: The admission criteria for this training will be: a) at
least SSC pass; b) both male and female; c) age between 20 and 30 years; and d)
have the right attitude to serve the chronically ill, elderly and disabled
people through home visits.
Selection of facilitators: The SSMC-3 Society has sufficient number of well
qualified and experienced professionals covering all the disciplines to work as
facilitator. Options will be given to all the Society members for the part-time
faculty (facilitator) positions. The committee (PIC) will select the
facilitators from the interested members. Facilitators will also be selected
from outside the members, as needed. For example, the society may need to pick
up physiotherapist and dietician as facilitator for this training program. The
facilitators will be paid based on the classes they would take. A tentative
list of facilitators for the training can be seen in annex 1.
Duration of the training: The duration of the training will be 3 months. The
first half of the training will be dedicated to theoretical sessions by
deductive and interactive lectures and demonstration of skills. The training
will be full time but non-residential. The other half of the training will focus
on skills development. For this the trainees will be placed at the private
clinics for practical hands on training.
Evaluation of the trainees: The trainees would be evaluated in the classroom at
the end of each lecture sessions. There would have a written midterm exam at
the end of the theoretical sessions. The final examination will be held at the
end of the whole course through written and practical examinations. The minimum
pass mark will be 50%, and on successful completion of the course the trainees
would receive a certificate from the society.
6.4. Promotion of trained providers:
This would be new cadre of providers unknown to the
community. The project would, therefore, take initiative to promote the trained
providers for employment and home-based services. This would be done by the
society members at personal level as well as through institution. At personal
level, society members will provide information (in the meting, seminars and
personal communication) to the private clinics about these trained providers
for patients’ care at the private clinics and at home. This may create full
time job opportunities for the trained providers in the private clinics and
part-time job opportunities for home care. This would also create a linkage
with the discharged patients for home care service delivery.
At institutional level, the training institute will promote
home care services (by the trained providers) through advertisement in the
daily news paper, distribution of leaflets, and electronic media including
online facilities. A database of the trained persons will be maintained by the
institution to track the trainees’ activities as well as to provide necessary
support.
The project will be implemented under the banner of SSMC-3
Society. To implement and monitor the project, the EC of the Society will form
a Project Implementation Committee (PIC). This committee (PIC) will be
comprised of 5-7 Society members (volunteers) interested in this activity. The
responsibilities of the PIC will be to:
-
Appoint
a project director from within the members of the Society for the project
-
Recruit
the proposed project staff
-
Closely
monitor and oversee the implementation of the project
-
Provide
technical and other supports, as necessary, for smooth implementation of the
project
-
Will
ensure organizational integrity and transparency of the project
-
Will
monitor the quality of the training
-
Submit
report to the EC at the end of each batch of training
-
Coordinate
and communicate with the EC if support is needed
-
Coordinate
with and submit periodical report to the funding agency as per their
requirement
The initial project period would be 1.5 years. The
first six months would be the preparatory phase, during which time all the
basic requirements for the training will be fulfilled, such as development of
curriculum, renting house, staffing, procurement of furniture, recruitment of
trainees and facilitators etc. Rest one year would be for the actual training
implementation. We proposed to train 100 HHCA in 4 batches (25 per
batch) in a year. A tentative timeframe is provided below.
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Sl
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Activity
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Time
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6 months
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6 months
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6 months
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1
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Development of curriculum
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2
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Recruitment of staff
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3
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Renting house
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4
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Procurement of furniture & training aids
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5
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Selection of trainees and faculties
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6
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Implementation of traiing
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9. Tentative budget:
Following is the tentative budget for the project with the
target to train 100 persons.
|
Activity
|
No.
|
Unit cost
|
Duration
|
Total: TK.
|
|
|
1
|
Development of institution:
|
|
|
|
|
|
1.1
|
House rent (for 13
months)
|
1
|
35,000
|
13
|
455,000
|
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1.2
|
Utility bills and
service charge
|
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20,000
|
13
|
260,000
|
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2
|
Procurement of furniture, logistics & training aids:
|
|
|
|
|
|
2.1
|
Chair
|
40
|
3,500
|
|
140,000
|
|
2.2
|
Table
|
5
|
17,000
|
|
85,000
|
|
2.3
|
Fan
|
5
|
5,000
|
|
25,000
|
|
2.4
|
File cabinet
|
1
|
20,000
|
|
20,000
|
|
2.5
|
Rack
|
2
|
15,000
|
|
30,000
|
|
2.6
|
Almirah
|
1
|
20,000
|
|
20,000
|
|
2.7
|
Air conditioner (2 tons)
with commissioning
|
2
|
110,000
|
|
220,000
|
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2.8
|
Light
|
50
|
200
|
|
10,000
|
|
2.9
|
Curtains
|
|
25,000
|
|
25,000
|
|
2.10
|
White board
|
1
|
10,000
|
|
10,000
|
|
2.11
|
Multimedia projector
|
1
|
45,000
|
|
45,000
|
|
2.12
|
Laptop
|
1
|
80,000
|
|
80,000
|
|
2.13
|
Printer
|
1
|
45,000
|
|
45,000
|
|
2.14
|
Tonner
|
5
|
20,000
|
|
100,000
|
|
2.15
|
Multimedia screen
|
1
|
12,000
|
|
12,000
|
|
2.16
|
Extension cords
|
3
|
700
|
|
2,100
|
|
2.17
|
White board markers
|
100
|
50
|
|
5,000
|
|
2.18
|
Miscellaneous
(stationeries etc.)
|
|
|
|
50,000
|
|
|
|
|
|
|
|
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3
|
Staff recruitment and salary:
|
|
|
|
|
|
3.1
|
Adds for staff
recruitment
|
1
|
25,000
|
1
|
25,000
|
|
3.2
|
Salary of Admin &
Finance officer
|
1
|
20,000
|
13
|
260,000
|
|
3.3
|
Support staff salary
|
2
|
12,000
|
13
|
312,000
|
|
3.4
|
Salary for PD
|
1
|
30,000
|
13
|
390,000
|
|
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|
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4
|
Selection of trainees and training
|
|
|
|
|
|
4.1
|
Advertisement in
newspaper
|
4
|
20,000
|
|
80,000
|
|
4.2
|
Honorarium for facilitators
(per class)
|
30
|
1,000
|
|
30,000
|
|
4.3
|
Photocopy of training
materials
|
125
|
350
|
|
43,750
|
|
|
|
|
|
|
|
|
5
|
Miscellaneous
|
|
5,000
|
12
|
60,000
|
|
|
|
|
|
|
|
|
|
Total budget:
|
|
|
|
2,839,850
|
|
|
|
|
|
|
|
|
6
|
Vat and tax (if applicable): 25%
|
|
|
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709,963
|
|
|
|
|
|
|
|
|
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Grand total:
|
|
|
|
3,549,813
|
Annex
1
List of facilitators with brief qualification
|
Sl
|
Name and current position
|
Qualification and experience
|
|
1.
|
Dr. Md. Habibur Rahman
Consultant, National Heart Foundation, Dhaka
|
MBBS, D Card, MCPS. Has more than 35 years experience in
patient care
|
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2.
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[1]
Population Census of Bangladesh 2011
[2]
http://www.indexmundi.com/ bangladesh/age_structure.html
[3]
Bangladesh
Maternal Mortality Survey 2010
[4]
Bangladesh
Demographic and Health Survey 2014
[5]
Bangladesh
Bureau of Statistics 2013
[6]
Government of Bangladesh.
Perspective plan of Bangladesh 2010-2021
[7]
Non-Communicable Disease Risk Factor Survey Bangladesh 2010
[8]
Akter S, et al. Bull World Health Organ. 2014 Mar 1; 92(3): 204–213A
[9]
Universal Health Coverage: Bangladesh
Perspective.
http://www.thedailystar.net/universal-health-coverage-bangladesh-perspective-64453
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