Who will use the clinic?

Unless the clinic is part of a genuinely community-based programme the least needy may use it most, and the neediest will use it least (Figure 13.2). Often this is due to various barriers to accessing health care, which can sometimes be surprising and varied. Focus groups with women or other community groups can give insights into what the barriers are. For example, in South Sudan, a health centre was set up with a clean, white-washed delivery room, but women were not willing to deliver in a place where blood might show on the walls. The clinic had to paint the lower half of the walls dark brown to resemble a local hut.

The least needy who use it most may include those with minor health problems wanting injections and pills; those ill a long time who have already seen many doctors, and arrive clutching sheaves of reports; or those living nearby who can easily attend, who are well enough to reach the clinic, or who have relatives able and willing to bring them. Finally, men in poor communities often have more time to attend than women, and are less willing to tolerate pain.

The neediest who use it least may include the very poor, the most vulnerable, people living a long distance away, and those too timid to attend; women unable to leave home because of household duties, the needs of their children, or harsh words from their partner; children too sick to walk, or with no one to carry them; the very ill, the very old, people living with disability; and those with mental illness.

Our clinics must work hard to reverse this pattern. Clinics must be user-friendly, sensibly priced, appropriately sited, and run in partnership with the community. In addition, our clinics must genuinely contribute to the global health priority of Universal Health Coverage (UHC). It will be important to monitor use of the clinic and find out reasons why those most in need may not be using it, i.e. discovering any barriers to its use. Of course, there may be positive reasons for low attendance such as effective CHWs who deal with most of the community’s problems. But often there are other reasons which are not obvious.

For example, a Ugandan study asked community members why they did not take sick children to the health unit. The responses included lack of money (90 per cent), transport problems (26 per cent), and other children at home to care for (15 per cent). Also mentioned were that the health services were substandard, the father was sick at home, the husband was absent so unable to give his opinion, an ill child improved after the first treatment, or that there was no alternative but to remain at home.

Choosing the type of clinic to set up

This should be decided in partnership with the community, and in discussion with the DMO or equivalent. We will need to understand the specific needs of the community, e.g. through a Participatory Appraisal (PA) and survey (Chapter 6) and this should shape our plans. Occasionally, donors may specify their wishes but we need to avoid being ‘donor-driven’ in our approaches (see Chapter 2). In practice, some programmes will develop general clinics, also known as multipurpose or polyclinics. Here, any person can attend with any problem. Others will run specialist clinics such as Maternal and Mother/Child Health (MCH) clinics on one day of the week, TB clinics on another (if they are part of the national TB programme).

General clinics are usually more convenient for patients. These can be used where access is easy, or patient numbers large and also in established refugee camps.

Moreover, each individual can use the same visit to have all problems seen on one occasion. For example, a mother may come to the clinic with sore eyes, a chronic cough, needing a final antenatal check, and requesting advice about family planning. Sometimes the type and frequency of the clinic will depend on what health personnel are available.

Family Practice

We focus on providing quality, accessible healthcare for the whole family. The majority of our medical providers are family practice, that means when you come to Community Health Care you can take care of all of your children’s health needs, as well as your own. We work to ensure all of our patients are in peak health, that children are meeting their development marks, they’re getting their shots, and are growing healthy bodies. We want you and your whole family in the very best health and you can count on Community Health Care to make that happen. Call us at (253) 722-2161 to schedule an appointment at any of our clinics with our family practice providers, pediatricians, and the rest of the Community Health Care team.

Women's Health Services

Comprehensive Women’s Health Care

What precisely is “Comprehensive Women’s Health Care?”

Women’s healthcare encompasses a number of things, starting with regular, annual pelvic exams and pap tests, family planning and finding the right birth control, treatment for sexually transmitted diseases, counseling, education, maternity (pre- and post-pregnancy care). Whether you are looking for a family practice doctor to help with your comprehensive women’s healthcare or an OB/GYN specialist for more complicated matters, Community Health Care can assist with all your women’s healthcare needs.

our Family Practice Physicians provide routine obstetric and gynocological services and collaborate with the specialized Women’s Health Team to provide exceptional care with the experience and compassion which is the high standard of our service to our patients.

Abstract

This chapter explores how to set up and develop community health clinics which not only treat illness but become a focus for health promotion and community involvement. It encourages programmes to use or strengthen existing primary health centres or health posts and to work in collaboration with the government. It discusses types of clinic, who might use the clinic, and clinic capacity and location. It works through practical aspects such as when the clinic should start, centre design, setting up clinic stations, and keeping and transferring records. It describes systems of payment, affordability, and the welcome and affirmation of those attending. It describes referral systems and preparing for serious illness and accidents. It mentions the value of mobile clinics as an integral part of a community-based system.