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High-quality healthcare services in rural areas ASTHA

Achieving Sustainability Towards Healthcare Access (ASTHA) aims to increase youth employment through training and developing community paramedics and ensuring sustained high-quality community paramedic services.

Massive shortage of skilled healthcare providers in rural communities is a crude reality for Bangladesh, impeding the progress towards attaining universal health coverage (UHC). There are alarmingly 0.66 healthcare providers per 1000 population in the country while the WHO recommendation is 2.28 per 1000 population. Despite this huge gap in workforce, the burgeoning youth population (15 to 25 years) in Bangladesh is suffering from acute unemployment and underemployment. According to ILO, almost 2.2 million youth enters the job markets every year without attaining relevant and transferable skills to compete in a very dynamic and growing national economy.

The Project

ASTHA, formerly known as TARSAN was introduced in 2011 to address this gap in health sector of Bangladesh. Jointly funded by Novartis and Swisscontact, the project aims to develop skilled Community Paramedics (CPs) and improve access to quality healthcare services at rural level.

As a result of the project’s previous efforts, the CP Training Program is now an established 2-year course offered by private and public training institute and governed by Bangladesh Nursing and Midwifery Council (BNMC) under the Ministry of Health and Family Welfare (MoH&FW). 

ASTHA Phase II is the latest phase of ASTHA - a four-year project (2019 – 2022) designed to facilitate the further improvement and popularisation of CP services in rural Bangladesh. It promotes the CP profession that assures high-quality Basic Primary Healthcare services including Maternal and Child Health and Family Planning. ASTHA II focuses on ensuring CPs employment, business and professional viabilities and continuous medical education.

The 4 core areas of intervention include: 

  • Strengthening Capacity of Community Paramedic Training Institutes in the areas of delivering trainings, marketing, and organisational management, for sustained production of CPs.
  • Enhancing Capacity and Service Provision of CPs to develop, promote and retain quality primary healthcare services in underserved rural areas.
  • Mobilizing Communities to Create Awareness about improved healthcare services delivered by the CPs.
  • Sensitising Public and Private Agents to advocate and promote CP Programme at a national scale.

Project Goals

  • 73% of graduates from each batch of CP programme will be either hired by the local and national healthcare institutions or self-employed CPs at the local communities.
  • Self-employed CPs will be earning at least 20% higher income every year.
  • 183,250 people at the communities will avail primary healthcare services from skilled CPs
  • 270,000 community members will be informed about better healthcare services and have access to CPs and specialist physicians through quality referrals.


Results  2018

  • 441 CPs are currently active primary healthcare providers in the project locations, where:
  • 249 are self-employed CPs providing services at their outlets and throughout the communities
  • More than 82,938 people (2015 – 2018) have received high-quality primary healthcare services
  • More than 183,920 community members (2015 – 2018) are informed about CPs and their services 

High-quality healthcare services in rural areas

Project partner

  • Community Paramedics (CP)
  • Community Paramedic Training Institutions (CPTI)
  • Ministry of Health and Family Welfare (MoH&FW)
  • Telenor Health

Project countries

  • Bangladesh

Project duration

2019 - 2022


  • SDC
  • Novartis
  • Laguna Foundation
  • Julius Baer Foundation

Working area