In 2008, I worked as a physician in a community healthcare centre in a low-income neighbourhood in Dhaka, Bangladesh. The clinic had been established with funding from a US-registered international organisation, channelled through a local NGO.

Before the clinic opened, residents relied on local pharmacies for fevers, pain, and minor injuries, but over time, trust grew, and patients began to come to us. Just two years later, however, in 2010, funding cuts forced the organisation to relocate the facility to a cheaper but less accessible part of town. Within a few years, the clinic closed entirely, and patients returned to the pharmacies.

In 2013, I experienced the same cycle in another internationally funded clinic in the city. We earned the community’s trust, the grant money ended, the clinic shut down, and patients returned to the pharmacies.

Those same pharmacies remain open today and full of people seeking care.

The Pattern Behind These Failures of Global Health Financing

For decades, global health donors have measured success by the number of clinics built and patients seen. As a result, the landscape is defined by funding cycles ending and facilities collapsing behind them.

The best known example of this pattern in Bangladesh is the Surjer Hashi network, a USAID-funded network of static health clinics managed by local NGOs, that grew into the world’s largest non-government primary healthcare system.

At its peak in 2014-15 it served almost 17 percent of the population for maternal and child health, family planning, and immunisation, and delivered roughly 50 million annual contacts between 2012 and 2017.

After more than 20 years of support from USAID, however, in 2017, the network transitioned into a centralised social enterprise through the Advancing Universal Health Coverage (AUHC) project, in a bid at financial self-sufficiency,

This transition represented one of the most careful donor exits attempted in Bangladeshi history. Yet when the new entity inherited the network’s 369 clinics, it found only a 38 percent cost recovery rate, with just 134 clinics able to sustain themselves. In addition, few of the remaining clinics were effectively viable without continued subsidy.

Read the full article about community health clinics by Ishtique Zahid at Alliance Magazine.