Health program through community participation.

The initial steps taken in a community health plan for the island of Chanpara near Dhaka Bangladesh are described. In 1975 after the flood when 40000 homeless poor moved to Chanpara Island the World Vision of Bangladesh set up an emergency program. By 1978 it evolved into a development program involving health and family planning education economic development vocational training and community relations. Health and family planning were provided free until 1981 when community participation began. First the clinic charged 0.5 paisa (1.5 cents) per clinic visit. Next 12 local health and family planning motivators were trained and oriented. Then 12 paramedical workers were trained sponsored by the community. These paramedics work in the clinic in the community and have shops in the market. Finally 5 dais or traditional birth attendants were given 4 weeks training in hygienic delivery. At first they were paid 5 taka (15 cents) for each safe delivery; later the families paid them. The Chanpara health program is now 60% supported by the community. The World Vision of Bangladesh will withdraw its support in 1986.