Achieving Sustainability Towards Healthcare Access (ASTHA)

To improve the access to healthcare service for the people of rural and remote areas in Bangladesh, Novartis has been running the project ‘ASTHA’ (Achieving Sustainability Towards Healthcare Access) to develop Community Paramedics (CPs) since 2014 in collaboration with Swisscontact- Swiss Foundation for international development cooperation. ASTHA facilitates the development and integration of community paramedic services in rural Bangladesh with special attention to Maternal and Child Health (MCH), Family Planning (FP) and Basic Health Care Services. ASTHA’s focus is to increase medical healthcare outreach in the inaccessible rural and disaster-prone districts such as Nilphamari, Patuakhali, Sunamganj and nearby areas. Besides providing regular health care services, ASTHA also creates awareness among the rural people on health and hygiene and other health related issues in the project areas.

The project fosters health knowledge in the population and motivates young adults to participate in a two-years course for skilled health workers (community paramedics) who are desperately needed in rural areas and can provide first-line medical assistance. After completing the training course, the community paramedics will be able to diagnose and treat both frequent and relatively uncomplicated diseases. In addition, they will be able to provide professional support during pregnancies and assistance during births. As independent professionals (e.g. private practices and community pharmacies) or employees at local clinics and health centres, they can provide their services to the rural population.

Swisscontact is working closely with the local training institutions to ensure they can provide high-quality training to health workers and comprehensive support to graduates in their efforts to find jobs within their home communities.

Project activities

  • Strengthening training institutes and training young adults
    Young men and women from the rural project regions undergo two years of classroom-based training and a six-month internship at a health centre, during which time they learn medical skills. Swisscontact helps local training institutions to upgrade their training curricula and teaching methodologies, as well as to structure their management more efficiently while fostering active exchange with local and national health authorities.
  • Market development for local skilled health workers
    Together with local doctors and health centres, the project is building a referral system so that patients of health professionals can consult other qualified specialists when needed.
  • Informing the population
    People living in the project districts can participate in information events, marketplace meetings, and theatre productions on topics such as nutrition, hygiene, and health. Swisscontact is working together with civil society organisations to ensure they establish a presence in the communities and learn local realities to the best extent possible. These activities strengthen trust in the new health professionals and present these young people as an effective alternative or supplement to traditional healers.


(2nd phase- 2019 to 2022)

Strengthening the Training Institutes & the Community Paramedic Programme

  • 16 local institutes offer high-quality medical training programmes
  • 638 participants completed the 2-year training.

Enhance Capacity and Service Provision of Community Paramedics

  • 370 CPs will be self-employed, or salary employed of 2022

Awareness Raising on Community Paramedics and Their High-Quality Services

  • 270 000 community people will be informed about the CPs and their services in their neighbourhood
  • At the end of the project, 183,250 community people will be benefitted through improved healthcare services.


Project progress in 2017

  • 6 Community Paramedic training institutes have been trained on how to enhance their management practices and financial management procedures.
  • 20 faculty staff (8 women, 12 men) from 10 training institutes have been trained on the revised Community Paramedic curriculum and basic training & facilitation skills.
  • In 2017, 465 CP-students (281 women) were enrolled in the programme.
  • Employment rate: 215 young men and women from the project location are employed Community Paramedics by the end of 2017.
  • During the year, total 42, 724 community people (29, 888 women) have been introduced to the local community paramedics as qualified healthcare provider.

How ASTHA is changing lives:

Not Letting Her Skills Rust

Marzia Akhtar Popi, Community Paramedic, Sunamganj Marzia Akhtar Popi (24) was newly married in 2012 and just moved to a new village with her husband inDowarabazar of the Sunamganj District in Bangladesh. Marzia’s husband worked as a construction Manager in the urban city of Sylhet and had to often work at heights risking his life. A year later when thecouple had a child Marzia realised that she needed to secure the child’s future by developing some skills that will help her make a living in case something ever happened to her husband.Thankfully Marzia was already educated till the 12th grade and upon hearing about the prospects of the community paramedic profession she enrolled at a nearby institute in Sunamganj. After two-years of intensive training focusing on maternal and child healthcare and four months of practical learning at a hospital, Marzia graduated as a community paramedic. Marzia was a very bright student and soon caught the eyes of some employers. Although she was offered a job at a city hospital she refused as she would have to stay away from home. Not knowing how else she could use her skills, Marzia soon let her newly gained knowledge rust at home for months. Until one day when her husband informed her of a news that the ASTHA project worked to establish community paramedics in rural villages to increase healthcare access.

Marzia approached the project in 2016 for support and from then on, her career really began. She started attending scientific seminars organised by ASTHA to enhance the knowledge of self-practicing community paramedics.

Achieving Sustainability Towards Healthcare Access

Based on her performance and willingness to set up a practicing outlet in her village, the project donated her a medical kit-box that had all the essential equipment required to provide primary healthcare services. Soon when she opened a small pharmacy in Katakhali Bazar with the help of her husband and started providing services, the project organised a marketplace meeting where she had the opportunity to introduce herself to over 400 people in her community. With the publicity that she received as a skilled healthcare provider, combined with the aid of an outlet signage for branding provided by ASTHA, Marzia was able to attract a growing number of patients.

‘‘I never really thought that I could do both, i.e. look after my family and at the same time make such a respectable living. The mothers and children in my community now come to me for their healthcare needs. None of this would have happened if it wasn’t for the support that ASTHA gave me’’, says a very satisfied Marzia.

Today, she sees over 150 patients a month and earns approximately BDT 20,000(USD 240). She plans to set up a larger practice outlet to serve a greater number of patients in the coming days.