The nature of cancer control is changing, with an increasing emphasis, pushed by public and political demand, on prevention, prompt diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted by governments and health funders worldwide as the preferred setting for most health care to meet demands of increasing need, stabilize health-care costs, and accommodate patient preferences for care close to home.
Thus, it is timely to consider how primary care can influence cancer control, where the discussion has been dominated by highly technical interventions centered on treatment and in which the contribution of primary care has been largely perceived as marginal (Ref: https://www.thelancet.com/commissions/primary-care).
Primary care has been demonstrated to be associated with greater access to health services and better health outcomes. Community-oriented primary care is medical practice that undertakes responsibility for the health of a defined population. The demonstrated barriers to high-quality primary care are under-financing, inadequate payment models, lack of community linkages, limited scope and comprehensiveness, limited integration with other components of the health system, and unexciting/unattractive conditions for physicians.
In June 2023, on its 8.2-acre medical campus in Rampal, in climate-change-threatened southern Bangladesh, with the financial help of the Bangladesh Government, Amader Gram will complete construction of the first two three-story buildings: a 12,090 square feet outpatient center and a 14,728 square feet diagnostic center.
The mission of the Amader Gram Cancer Care & Research Center is to develop visionary, innovative, transformative, and trusted model community-oriented health care services addressing cancer, and other non-communicable diseases (UN Sustainable Development Goal 3.4) (*See reference below)
The goal of the AGCRC is to provide accessible, affordable and high-quality cancer care for all Rampal upazila residents and self-selected regional residents under a sustainable health care model.
The specific aims of the AGCRC are beginning in mid-2023, to:
1. Create an integrated and linked network of community health workers, virtual care services, and ambulatory care facilities and services.
2. Integrated services with two information technology tools: an electronic medical record and wireless broadband access.
3. In collaboration with the Bangladesh Government (Health Services Division) and the Community Clinic Health Support Trust develop and implement an adaptive management model for integration and complementarity of current government health care facilities and workers’ activities and those being developed by the AGCRC (See reference below **).
4. Train, equip, provide intervention guidelines for, and employ 100 community health care workers (CHWs) to serve all households in the 138 villages of Rampal upazila, anticipating an average of approximately 6 CHW visits per household/year providing home health care, health education, registration into upazila disease registries, and facilitation of access to the Amader Gram ambulatory care facilities.
5. Train, equip, provide intervention guidelines for, and employ community health workers to staff a 24/7 virtual health care telephone service.
6. Open ambulatory facilities on the garden campus and begin operations there with:
• A staff with a paraprofessional:doctor ratio of 1:7
• Intensely trained local paraprofessional staff who conduct the majority of record keeping
• Diagnostic pathway and treatment guidelines
• Several regularly-needed point-of-care diagnostic tools
• Specialty tele-consultation capacities
• Urgent care services
• A quality assurance program measuring intervention efficacies safety and efficiencies, patient-centeredness, timeliness, and equity of patient care.
• A goal of serving 100 patients/day
7. Develop a Bangladeshi-circumstances customized interoperable, privacy controlled electronic medical record (EMR) system focused on major patient-care related functionalities, specifically charting and decision support.
8. Implement the Amader Gram wireless broadband system using the Microsoft Teams communication platform.
9. Create and implement a sustainable social business model with:
• A subscription system for ambulatory services
• National line-item annual support
• Fees for ambulatory care services
• Fees for services by community health workers
• Fees from consultant and other services
• Funding from research projects addressing in particular common non-communicable diseases like cancer, diabetes, hypertension, and climate change-affected health problems.
• Philanthropic support both from the local business community which can only thrive with available accessible high-quality medical services, and the international community which needs model and successful primary care and public health oncology programs.
10. Create Rampal upazila disease registries for cancer, hypertension, diabetes, asthma, and palliative care.
11. Create a clinical laboratory for studies of implementation strategies for improving public health.
*Love, R.R., Salim, R.: Walk the talk: A program model of community-oriented primary health care. Int J Family Med Healthcare 2022. 1:1-6.
** Love, R. R. and Salim, R.: Public health oncology in practice The Amader Gram Rampal project in rural Bangladesh. J Cancer Policy 2015. 4:15-20.
Key components of the Amader Gram medical system model are:
∎ Primary care ambulatory services with major locally-trained paraprofessional-specialist conduct of routine guideline-defined processes
∎ Key point-of-care diagnostic capacities, and immediate tele-consults, facilitated by a Bangladesh-circumstances-customized, interoperable electronic medical record system focused on major patient care-related functionalities
∎ Wireless broadband connections using the Microsoft Teams communication platform
The Bangladesh government has provided $2.5 million towards construction of utilities and the first two campus buildings: an ambulatory care clinic and a diagnostic center, to be completed in the late spring 2023.
Amader Gram is seeking donor investment of $500,000 to complete construction
Amader Gram Cancer Care & Research Center (AGCRC) needs immediate investment of $500,000 to complete construction of the first two campus buildings: an ambulatory care clinic and a diagnostic center, to be completed in the late spring 2023.There are two floors in each building, and two blocks on each floor.
Amader Gram will give naming rights for donations as follows:
∎ Ambulatory care clinic or diagnostic center $200,000 (2 buildings)
∎ Floor of ambulatory care clinic or diagnostic center $100,000 (4 floors)
∎ Block of rooms in either ambulatory care clinic or diagnostic center $50,000 (total 16 rooms)
Donors will be invited to participate in special events associated with the opening and operations of the AGCRC facilities and programs and provided interim reports on the development of the AGCRC.
Personal visits by center leaders with interested donors can be arranged on request.
To send your support please contact Reza Salim, Founding Director at: firstname.lastname@example.org
Board of Advisers
Prof. Dr. Syed Modasser Ali, FRCS, FRCOpth, Former Health Adviser to Honorable Prime Minister
Talukdar Abdul Khaleque, Honorable Mayor, Khulna City Corporation
Habibun Nahar, Honorable Member of the Parliament, Bagerhat-3 (Rampal-Mongla)
Syed Marghub Murshed, Former Secretary, Government of Bangladesh
Dr. Rafiq Ahmed, MD, PhD, FACC, FCPS, Baltimore, USA
Dr. Kamal Abdul Naser Chowdhury, Former Principal Secretary, Government of Bangladesh
Syed Zahid Hossain, Businessman & Philanthropist, Khulna
The Board of Trustees
(The Deed of Trust of the Amader Gram Cancer Care & Research Center is registered under the Registration Act 1908 at the Directorate of Registration dated May 9, 2022 under the jurisdiction of the Law & Justice division, Ministry of Law, Justice and Parliamentary Affairs, Government of the People's Republic of Bangladesh)
Debashish Nag, Former officer, BCS Administration Cadre (BCS 1973)
Reza Salim, Founding Director, Health & Development Communication Specialist
S.M. Haroon-or-Rashid, Former officer Grade-1, BCS Administration Cadre (BCS 5th Batch)
Md. Nazmul Islam, Physician & Professor, BCS Health Cadre (BCS 13th Batch)
Musa Ibrahim, First Bangladeshi to conquer Mt. Everest, Social worker
Jiniya Afroze, Ph.D., Researcher and Development Practitioner
Government Nominated Representative
Nazmul Haque Khan, Additional Secretary (Hospital), Health Services Division, GoB
Sheikh Bazlur Rahman, Former Chairman, Rampal Sadar Union, Rampal, Bagerhat
Medical Program Adviser
Prof. Dr. Richard Love, MD, MS