High-quality healthcare services in rural areas

Achieving Sustainability Towards Healthcare Access (ASTHA) aims at contributing to the development and expansion of sustainable and high-quality healthcare at the community level by training young adults (50% women) from seven rural districts as skilled health workers. The ASTHA-project improves the health and living conditions of the local population and, at the same time, addresses the problem of the high number of un- and underemployed youth in Bangladesh. 
Project duration
2019 - 2024

Bangladesh suffers from both a shortage and geographic maldistribution of Human Resources for Health. There are only 8.3 health professionals per 10 000 population in Bangladesh, while the World Health Organization (WHO) recommends 44.5 skilled health professionals per 10 000 population. The availability of primary healthcare services and skilled healthcare professionals is very limited in rural areas in particular.

The project

ASTHA, formerly known as TARSAN, started in 2011 to address this gap in Bangladesh’s health sector. 
As a result of the project’s previous efforts, the Community Paramedic Training Programme is now an established professional training offered by private and public training institutes and governed by the Bangladesh Nursing and Midwifery Council under the Ministry of Health and Family Welfare. Young men and women acquire medical knowledge and specialised competence in the two-year course for Community Paramedics. Apart from theoretical training with a strong focus on mother-child health, they complete a six-month internship in a hospital. This qualifies them for diagnosis and treatment of frequently occurring diseases that are not complex. Moreover, the graduates are able to provide professional support during pregnancies and assistance at births.

ASTHA is currently in its second four-year project phase (2019-2022). The project works in the four areas:

•    Strengthening Capacity of Community Paramedic Training Institutes in the areas of delivering trainings, marketing, and organisational management.
•    Enhancing Capacity and Service Provision of Community Paramedics to develop, promote and retain quality primary healthcare services in underserved rural areas.
•    Raising awareness on Community Paramedics and their High-Quality Services in the rural communities
•    Sensitising Public and Private Agents to advocate and promote the Community Paramedic Programme at a national scale.

ASTHA Phase II (2019 – 2022) is being implemented in seven districts of Bangladesh: Nilphamari, Lalmonirhat and Rangpur in the north, Sunamganj and Sylhet in the north-east and Barguna and Patuakhali in the south.

Project Goals (2019-2022)

  • 638 participants (at least 50% women) complete the 2-year training.
  • 370 Community Paramedics are self-employed, or salary employed
  • 270 000 community people are informed about the Community Paramedics and their services in their neighbourhood
  • 183 250 community people accessed improved healthcare services

Project partners

  • Bangladesh Nursing and Midwifery Council
  • Ministry of Health and Family Welfare
  • Community Paramedic Training Institutes
  • Alliance of Community Paramedic training institutes
  • Local NGOs
  • Grameen Telecom Trust
  • Auleek Limited


Results until June 2021:

  • 216 Community Paramedics (62,5% women) graduated.
  • 222 Community Paramedics (51% women) are self-employed (121), or salary employed (101).
  • Around 140 000 rural residents (68% women) became aware of better healthcare practices and Community Paramedics working in their vicinity.
  • Around 95 500 rural community residents (59% women) received healthcare services from Community Paramedics.
  • Over 88% of graduates are able to start their own practice or secure salaried employment within one year of graduation. 
  • A dedicated drug list for Community Paramedics to prescribe essential medicines was approved by the Government of Bangladesh. 
  • 12 local training institutes have been taught in how to use digital pedagogical tools.
  • 23 training institutes have received IT infrastructure support.
  • 3,200 Community Paramedics and other public health workers have received personal protective equipment (PPE).
  • 200 Community Paramedics received online training on COVID-19.
  • Community Paramedics have been appointed by the local government to join the forces with the government in the COVID-19 sample collection and vaccination processes.

Results previous phase 2015-2018

  • 363 (178 women) young adults completed the 2-year training course to become community paramedic.
  • 255 or 70% of young men and women from the project are employed Community Paramedics and 80% of them could increase their income.
  • 11 local training institutes offer high quality medical training and have improved 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.
  • Over 180 000 people in the project districts were informed about the healthcare services and about 83 000 have used the local community paramedics as qualified healthcare provider.

Financing partners

This project is financed by Novartis, the Evi Diethelm Winteler Stiftung, the Laguna Foundation, the Leopold Bachmann Stiftung, among other donors. As part of the Swisscontact Development Programme, it is co-financed by SDC (Swiss Agency for Development and Cooperation, Federal Department of Foreign Affairs FDFA).

Videos for Community Paramedics

General service guideline in the time of Covid-19
(in Bengali)
COVID Symptoms
(in Bengali)


Initial vocational education and training
ASTHA launches the pilot of e-Learning for Community Paramedics
ASTHA has recently launched the pilot of creating an e-learning platform for prospective Community Paramedics.
Initial vocational education and training
COVID-19 in Bangladesh: Community Paramedics join forces in national vaccination programme
Since the beginning of the pandemic, the Community Paramedics (CP) services has been increasingly adopted in the national healthcare responses. 
Kosovo, Bangladesh, Bolivia
Upskilling and reskilling, Labour market insertion
How digitization is driving skills projects forward
Projects implemented by Swisscontact around the world had to adapt to the changed circumstances in the pandemic year 2020. Digitization not only demanded new skills from the learners, but also posed major challenges for the projects in how they provide skills training. Social Media and easy-to-use applications and tools have played a big role in overcoming some of the challenges. For example, in Kosovo, where the project “Promoting Private Sector Employment” aims to improve competitiveness of market actors and inclusion of women farmers.

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