Sustainable Clubfoot Care in Bangladesh (SCCB)
About SCCB
The Sustainable Clubfoot Care in Bangladesh (SCCB) project, funded by Global Affairs Canada and UBC, was launched to improve access to early diagnosis and effective treatment for children born with congenital clubfoot in Bangladesh. SCCB strengthened the Ponseti Clubfoot Care Pathway in Bangladesh by integrating training and treatment within the country’s public healthcare and education systems, and by developing National Strategy and Guidelines for Clubfoot Care.
By partnering with the Bangladesh Ministry of Health and Family Welfare, UBC, and local partners, SCCB established a lasting framework that continues to support healthcare professionals, families, and children affected by clubfoot.
Problem
Disability is a major cause of the developmental challenges of ill health and poverty. Each year an estimated 5,000 children are born with clubfoot in Bangladesh. Without proper treatment, children with clubfoot face pain, mobility challenges, social stigma, and limited prospects for employment and independence.
Historically, constrained public health systems and limited access to surgical treatment left many children without care, leading to lifelong disability. However, the Ponseti Method has been proven highly effective in correcting clubfoot and preventing disability.
SCCB worked to integrate Ponseti clubfoot care into Bangladesh’s healthcare and education systems, ensuring that early diagnosis and treatment became widely accessible.
Approach
UBC’s experience with Uganda Sustainable Clubfoot Care Project (USCCP) was highlighted by the World Health Organization (WHO) in 2011 as a successful way of treating clubfeet in the context of lower and middle-income countries. We were determined to do the same with Bangladesh.
SCCB began with a Baseline Situational Analysis of clubfoot teaching and treatment to identify the gaps in governance, service delivery, health workforce, awareness, sensitization, engagement, quality assurance, and national data.
SCCB was structured around three interrelated components, each lead by a Bangladesh partner and supported by Canadian experts in medicine (clinical and public health), international development, and education.
Our Goals
- Building capacity for Ponseti clubfoot treatment within the public health system
- Training staff
- Network of clubfoot clinics
- Integration of treatment within primary care
- Building capacity within public medical and allied health education
- Incorporating Ponseti clubfoot management into medical school curricula
- Training future healthcare professionals in Ponseti clubfoot management
- Ensuring quality and effectiveness
- Conducting evaluations to monitor treatment quality and adherence
By strengthening local capacity, SCCB aimed to eliminate neglected clubfoot as a major cause of musculoskeletal disability and poverty in Bangladesh.
Activities
SCCB partners focused on strengthening the Ponseti Clubfoot Care Pathway:
- Early identification of foot deformity at the community level
- Timely referral to a clubfoot clinic where diagnosis is determined and appropriate treatment carried out
- Follow up in the community to promote adherence
- Regular visits to the clubfoot clinic
Activities designed to strengthen the pathway:
- Training and Education
- “Train the trainer” methodology to train orthopaedic surgeons from government medical colleges
- Creating Ponseti clubfoot teaching materials, thereby integrating Ponseti clubfoot teaching into the public higher education system
- In service training for institutional and community healthcare workers, thereby integrating Ponseti clubfoot treatment into the public healthcare system
- Development of National Strategy and Guidelines for Clubfoot Care
- Establishment of a Network of Clubfoot Clinics
- Development of a Ponseti clubfoot program database within the data management systems of SCCB partners
- Conduct surveys to inform policy
Results
Policy Development & Institutional Support
- Development and approval of the National Strategy and Guidelines for Clubfoot Care in Bangladesh
- Establishment of a National Clubfoot Programme within the Directorate General of Health Services, supported by a dedicated National Clubfoot Programme Manager.
- Approval of the 4th Health Population and Nutrition Sector Programme Operational Plan (2017-2022) by the Government of Bangladesh, ensuring sustainable funding and integration of SCCB initiatives into national healthcare services.
Capacity Building & Medical Education
- Development and approval of Ponseti teaching modules integrated into MBBS and postgraduate orthopaedic curricula.
- Creation, approval, and distribution of Ponseti training materials and teaching models, including:
- 5,300 Bangladesh Ponseti Pocketbooks distributed to MBBS students.
- 1,000 Bangladesh Ponseti Pocketbooks distributed to postgraduate orthopaedic students.
- 67 Master Trainers trained with evaluation of training quality to ensure effectiveness.
- Clubfoot teaching models provided to 23 public medical college hospitals.
Infrastructure & Service Delivery
- Opening of 17 Ponseti Training Centers at medical college hospitals, improving access to specialized clubfoot care.
- Development of information, communication, and educational materials for parents and community health workers (CHW’s) to raise awareness about clubfoot treatment.
Early Detection
- Training of 123 BRAC trainers to orient CHW’s on newborn screening for foot deformities.
- Orientation of 28,330 BRAC CHWs, equipping them to screen newborns for clubfoot and refer for treatment.
Data Collection & Research
- Development of a patient record form to enhance clinical documentation.
- Creation of administrative and research databases to track patient outcomes and treatment effectiveness.
- Completion of an incidence of clubfoot in Bangladesh survey in Rangpur District, screening 102,424 live births and identifying 177 children with clubfoot.
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