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Modhumita: An integrated approach to service delivery

November 01, 2012

Across Bangladesh, a shared vision of delivering comprehensive health services to at-risk populations has sparked unique, cross-cutting collaborations. Through the Modhumita program, FHI 360 is partnering with nongovernmental organizations, local communities and state and national institutions to integrate HIV services with other essential health programming.

The Modhumita (“sweet friend” in Bangla) program, funded by the U.S. Agency for International Development (USAID), offers critical HIV prevention, treatment and care services to some of the most hard-to-reach populations in Bangladesh, including sex workers, their clients, injecting drug users and hijra (people born male but who adopt a female identity). Peer support; HIV prevention, counseling and testing; and sexually transmitted infection diagnosis and treatment are among the services provided through a network of more than 40 Modhumita health clinics across the country.

Yet Modhumita clinics offer much more than HIV services; they have become a one-stop shop where clients can access primary health care and support that they might not have received otherwise. These services are critical for sex workers, injecting drug users and hijira who often live on the margins of society, face extreme discrimination and are frequently excluded from vital lifesaving health services.

The integration of health services at Modhumita clinics across the country has been made possible through a collaboration with the Smiling Sun Franchise Program — a USAID-funded network of clinics operated by nongovernmental organizations and one of the largest providers of health care in Bangladesh. Smiling Sun staff members come to Modhumita clinics on a weekly basis to provide additional services not usually available on site, such as vaccinations and general health and prenatal care.

Through this partnership, a Modhumita clinic that provides confidential HIV testing and care is also able to offer services and support for tuberculosis, family planning, reproductive health and primary health care. In one visit at one clinic, a young woman with HIV can get help to manage her treatment, prevent sexually transmitted infections and decide whether and when she will have children.

Pooling resources

A cornerstone of the Modhumita program is its ability to build relationships with government entities and leverage existing government and community resources to enhance programs and service delivery. To help stop the spread of tuberculosis (TB) and support the national response to TB/HIV co-infection, Modhumita hires people from its target populations to contribute to early case detection and control of TB in their communities. Experts from the National Tuberculosis Program train these workers to spot symptoms, screen clients on location, gather samples of sputum (lung fluid that can carry tuberculosis bacteria and spread it through coughing) and deliver them to testing centers. When a test is positive, clients are referred to government treatment facilities. Each of the more than 40 Modhumita clinics in Bangladesh has a tuberculosis sputum collector who uses training and knowledge about his or her community to screen thousands who previously lacked proper access to TB services, often due to stigma and discrimination.

Modhumita has also worked with the police to route injecting drug users to treatment rather than prisons, and the Ministry of Women and Child Affairs now trains sex workers for alternative livelihoods such as agriculture, animal husbandry, printing and sewing.

Currently, the Modhumita Project works with 21 local nongovernmental organizations to provide health services to at-risk populations through 40 Modhumita clinics.