The LAMB Model
1. The LAMB Project started in north-west Bangladesh in 1979 and has been evolving and expanding ever since. The modern LAMB model of integrated health care and development, based on over 25 years’ experience of what works in practice, is, we believe:-
- a new way of assisting the poor and underprivileged;
- of proven effectiveness;
- which can be replicated elsewhere in developing countries.
2. Its essential features are:-
- an integrated system combining primary health care, basic curative care and referral to hospital when necessary;
- a holistic approach to health, encompassing emotional needs, self-worth and freedom from fear as well as physical health;
- the involvement of the local communities in the management of their services;
- economic development through community-managed micro-credit schemes;
- an emphasis on the rights and status of women, children and people with disability;
- a focus on reducing infant and maternal mortality;
- priority for the poorest of the poor, whose health needs are generally the greatest;
- the empowerment of local communities to seek justice in fulfilment of their rights to proper health care.
What LAMB provides
3. To achieve these objectives the LAMB Project includes:-
- Village Health Volunteers, who provide public health advice and basic curative services in the community.
- support to communities to set up and manage local Health Care Centres.
- a 125-bed hospital, which specialises in obstetrics and gynaecology but also includes medicine, paediatrics and general surgery. The hospital offers outpatient consultations and diagnostic services six days a week and 24-hour, 7 days a week, emergency care and hospital admission if needed. It admits 7,000 in-patients a year and sees about 50,000 out-patients.
- a Poor Fund, which covers the cost of treating those unable to pay.
- a Human Resources Development Centre which provides training for local health workers (e.g. skilled birth attendants and para-medics) and Village Health Volunteers to work in their own communities; for government and NGO workers in emergency obstetric care; and for other specialist health workers.
- a tuberculosis control programme.
- advocacy via local community meetings for women’s rights, including the prevention of, and appropriate response to, violence against women.
- a Community Capacity Development Programme, which helps groups of women to achieve financial reliance, e.g. through micro-credit schemes, and to play an active role in their communities.
- a disability programme to improve the capability and status of those with a disability (some of the most marginalised people in the community).
- support for local Health and Development Committees, made up of elected representatives of women’s self-help groups and local community leaders, to manage local health services and development activities.
- research addressing key rural health problems.
- an English medium school offering high quality education, thus enabling skilled LAMB staff with children to stay in a rural area.
- disaster relief in the local area when needed.
What LAMB has achieved
4. The project has a catchment area containing over 1.5 million people. Achievements in this area include:-
- a substantial decline in the rate of deaths of mothers and babies in childbirth. Maternal mortality is now 30 per cent below the national average and perinatal mortality 35 per cent below; and rates of antenatal care are twice the national average.
- the attainment by the hospital of WHO “Baby Friendly” status by the hospital in 1997.
- the commitment, made possible by the poor Fund and now well known locally, to treat everyone regardless of their ability to pay. Previously many did not seek health care until it was too late because they were afraid of the cost.
- over 400 flourishing micro-credit schemes providing women with their own means of livelihood by means of loans. Over £60,000 is currently being borrowed through these schemes.
5. The value of the LAMB Project’s approach is also being increasingly recognised at national level. For example, LAMB’s gender policy – that women are equal with men – has been applauded as an example to the whole country; and LAMB experts have contributed to a national midwifery textbook and written several government-approved training courses, which are unique in their focus on values as well as technical skill development.