Lack of training for family welfare assistants and health workers in the safe prescription of medicines, including antibiotics, for the people seeking medical treatment in community clinics poses significant risks to the patients, most of whom are poor, experts said.
Both family welfare assistants and health workers receive 21 days’ basic training when they start their job but receive only a few hours’ training in the provision of drugs and treatment.
Manju Rani Sarker, a family welfare assistant at Uthuli in Manikganj who is assigned to provide treatment in a community clinic there, told New Age, ‘There is no detailed training provided in the prescription of medicine. We just have a few hours’ orientation on providing treatment.’
She said that they were simply told to prescribe certain types of drugs for certain types of diseases.
Bilkis Ara Begum, a heath assistant assigned to give treatment at the same community clinic, told New that she had prescribed antibiotics without having any training at all in the drugs.
She said that she had prescribed antibiotics for patients who come to the centre with fever, pneumonia and diarrhoea.
M Abdul Hai, a health assistant at Shibalay Upaswasthya Kendra, assigned to provide service at Chhata Boali Community Clinic in his spare time, said that he had 21 days’ basic training.
‘We need a detailed training in medicine use. The training we receive is too short to understand all the medicines and their effectiveness,’ he added.
ABM Farooq, a professor of pharmaceutical technology in Dhaka University, told New Age, ‘Antibiotics should not be prescribed without proper knowledge on it.’
Specific antibiotics work against specific bacteria, he said, adding that one has to know the kinds of infection to prescribe the medicine which is not possible for a person with this short period of training.
Mahbub Rashid-e-Mahbub, a former president of the Bangladesh Medical Association, said that he thought no one but a physician should be able to prescribe medicine for the patients.
The director general of the directorate general of health services, Shefayet Ullah, told New Age that only medical officers should prescribe antibiotics.
‘It was planned that only normal drugs, needed for primary treatment such as normal fever or diarrhoea, would be sent to community clinics,’ he said. ‘Patients should be referred if more powerful drugs are required.’
The government provides the community clinics across the country with different types of antibiotics such as azithromycin, amoxicillin, doxycycline, cotrimoxazole, metronidazole, azithromycin drop and penicillin V.
However, Makhduma Nargis, the community clinic revitalisation project director, said that the government sends to such clinics only antibiotics with minimal side effects.
She claimed that the government did not distribute azithromycin, a high-power antibiotic.
She said only medical officers or family welfare visitors, assigned to go to the community clinics, are supposed to prescribe these drugs.
While asked about the antibiotic distribution by the health workers and family welfare assistants, she said, ‘The monitoring of all community clinics is very difficult for us. We cannot force all to go by the rules.’