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High-quality healthcare services in rural areas ASTHA (angl.)

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 will improve the health and living conditions of the local population and, at the same time, address the problem of the high number of un- and underemployed youth in Bangladesh.

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.

Le projet

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 Program 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 2-year course for Community Paramedics. Apart from theoretical training with a strong focus on mother-child health, they complete a 6-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.

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


Results until December 2019:

  • 101 Community Paramedics (66 women) graduated
  • 98% of self-employed Community Paramedics increased their annual income by CHF 118 on average.
  • Salaried employed Community Paramedics’ income increased on average by CHF 239
  • 81 936 rural residents (61% women) became aware of better healthcare practices and Community Paramedics working in their vicinity
  • 53 820 rural community residents (around 50% women) received healthcare services from Community Paramedics

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.

Soins de santé de haute qualité en zone rurale

Partenaire du projet

  • Community Paramedic Training Institutes
  • Alliance of Community Paramedic training institutes
  • Ministry of Health and Family Welfare
  • Local government bodies
  • Grameen Telecom TrustAuleek Limited

    Pays du projet

    • Bangladesh

    Durée du projet

    2019 - 2022


    • Novartis
    • Julius Baer Foundation
    • Laguna Foundation
    • Leopold Bachmann Stiftung
    • DDC
    • Fondation Evi Diethelm-Winteler

    Domaine de travail


    Swiss Foundation for Technical Cooperation
    Hardturmstrasse 123
    CH-8005 Zürich

    Tel. +41 44 454 17 17
    Fax +41 44 454 17 97