Frontier workers of BRAC’s essential health program

With democracy comes freedom entailing the power and right to equality, legality, mobility, and essentially to live a healthy life. In the western part, one does not have to think twice about their ability to endeavor in good health. However, in other parts of the world including Bangladesh, citizens from the rural areas, especially the disadvantaged communities cannot be assured the pleasure of prosperous health although freedom exists.

BRAC, an organization who’s roots stretch deeply into the history of Bangladesh has taken charge in enabling the people of Bangladesh who have struggled with poverty, disease, and injustice to transition to a better way of life.

Essential health care is the basis of the health program initiated by BRAC focusing on health & nutrition education, water & sanitation, family planning, immunization, prenatal care, basic curative services and tuberculosis control. During a brief visit to two villages surrounding the town of Gazipur, I was fortunate to observe the benefits of the health program conducted by BRAC that touches the lives of over 100 million Bangladeshis across 64 districts.

BRAC’s health program is so effective because of its constant presence at the community level. Upon arrival at the Village Purba Dhigirchala, I was greeted by two ladies; Sahera Begum and Sahida Khanam, who I came to know to be the community health promoters (shasthya shebikas in Bangla) and community health workers (shasthya kormis in Bangla) of the community.

The health promoters are volunteers that receive a two week training session that allows them to provide basic health services including; health & nutrition, family planning, promoting & mobilizing sanitation & immunization, along with treating the 10 most common diseases such as anemia and diarrhea. They also receive a monthly refresher course. Currently there are 80,000 health promoters across Bangladesh serving their communities. In the case of Sahera she is responsible for 261 households, visiting roughly 15 daily.

Health workers, who are paid workers receiving an average 3000 taka salary in which their responsibility is to oversee the duties of 12 health promoters. Their duty also includes conducting monthly group meetings with the community, providing antenatal care, and postnatal care. A health worker visits the community of each health promoter for two days in a one-month period performing health services.

Today was the second visit of the health worker in the village Purba Dhigirchala, in which both Sahera and Sahida focused on assessing the locals’ knowledge of the danger signs during pregnancy and nutritious foods to consume during pregnancy.

Sahera also has the ability to purchase medicine and contraceptives from the regional BRAC offices that she sells to the community to earn a small profit. Although Sahera makes a profit on the delivery of medicines, she realizes the economic situation of the community and through translation added, “In the village, people respect me, and I also respect them. If the people need the medicine but do not have the money, I will provide it for them and receive the pay whenever they can pay me back”.

The second day of the field visit had me situated in Salna Village, where I received the chance to witness BRAC’s nutritional sprinkle program, reading glasses program, and tuberculosis program performed by the frontier health workers.

Children in Bangladesh suffer largely from iron deficiency and anemia, specifically among the poor and ultra-poor. Sprinkles, which contain ferrous fumarate (iron) and other essential micronutrients, are to be mixed with food before consuming. Children between the ages of 7 and 60 months can take advantage of this program to improve their nutritional status.

Together with VisionSpring, BRAC has introduced a reading glasses program where spectacles have been delivered to 7.9 million people with vision problems. Prior to obtaining the glasses from Rasheda Begum, in Salna Village, the people of the community have both their near and far vision screened. Often basic charts are used to screen near vision deficiency that can be treated with glasses sold at 195 taka (about $2.50), while far vision problems as well as complications are referred to professionals at local hospitals. Through the course of the program, I met a woman who, through the screening, was determined to be far-sighted. Although referred to the hospital to seek additional care, she complained that many of the villagers had no way of getting to the hospital to receive the care along with the ability to purchase eye glasses if needed due to their financial state.

Within the same village, I was also introduced to a villager, Ibrahim who contracted tuberculosis. BRAC’s tuberculosis control program has reached 89.5 million people with 23,771 cases diagnosed and 92% being cured. Prior to receiving treatment for tuberculosis, Ibrahim had to make a 200 taka (about $2.50) deposit that would be returned only once he completed the rigorous 6-month treatment. During the treatment Rasheda watches Ibrahim as he takes his daily medication in a strategy known as DOTS (Directly Observed Therapy Short course). Once the course of the 6-month treatment is completed, Rasheda receives a small incentive of 500 taka (about $6.00). Rasheda has been providing DOTS treatment for 13 years to over 30 tuberculosis patients.

When I had asked Rasheda what motivates her most to serve her community she told me that money is not the reason. When she was a child, her father had died of tuberculosis because of his inability to access treatment. As a result Rasheda believed that it is her responsibility to save lives of her community suffering from tuberculosis, so that a child will not have to live without a parent.

It is evident that the work of both the community health promoters and health workers are critical in BRAC’s implementation of health services at the community level. Although BRAC has made great strides in improving the health status of many Bangladeshis, there still exist a number of individuals who are unable to access health care services due to its financial burden. We look forward to a convenient health care system to ensure health.

By Daneal Doub, McMaster University

Intern

BRAC Health Programme.

BRAC markets solar lights to illuminate thousands of lives!

BRAC's agriculture and food security programme has taken the initiative to launch D.light Design’s solar products in Bangladesh, aiming to provide power sources for the marginalised people who do not have access to the national power grid. This initiative will help rural poor with an alternative low-cost light source to kerosene lamps and reduce the health risks posed by the kerosene fume. BRAC officials believe that this will also contribute in meeting the growing demand of electricity in Bangladesh.

Three types of solar lights with different features are being marketed; d.light S 1, d.light S 10 and d.light S 250. The products are sturdy, designed for maximum versatility and come equipped with a high-quality, efficient solar panel that is weather-resistant. Additionally, d.light S.250 can serve as a mobile phone charger and has multiple brightness settings. The prices of these products range from 780 to 2600 taka ($9.50 - $32.00). Primarily the products will be marketed in Dhaka, Chittagong, Comilla, Mymensing, Kishorgonj, Rajshahi, Rangpur, Dinajpur, Bogura, Jessore, Gopalgonj and Jhalokatthi districts through dealers, and in some sub-districts of Bagerhat, Khulna, Satkhira, Borguna, Potuakhali and Pirojpur through programme channels.

BRAC will distribute the products by using its extensive network and appointing local dealers. BRAC’s network will reach the poor in hard-to-reach areas who will be able to pay in instalments for the products. This system is expected to create a positive distributional impact, which will help to change the scenario of the rural Bangladesh in the long run.

D.light design is a social enterprise started out in Palo Alto, California in 2006 fathered by a socially-motivated team of business people and engineers- Sam Goldman, Ned Tozun, Gabriel Risk, Xianyi Wu, and Erica Estrada. D.light is operating with a mission to enable households living without reliable electricity to attain the same quality of life as those with electricity. The company targets to reach 50 million people by the end of 2015. BRAC, being the largest development organization reaching over 126 million people worldwide, presents the most suitable opportunity for a successful partnership which can change millions of people’s lives and create a better future.  

Managing change in the Bangladesh water sector: experiences and challenges

Change is inevitable; rather it is a much needed process for the benefit and progress of any organization. With such intentions of change Dr. Jaap M. De Heer, VU University Amsterdam, presented his study on the various aspects of an organization which, when integrated together, initiate a wholesome change process. The organization in focus was the Bangladesh Water Development Board (BWDB) and the presentation was coordinated by Andrew Jenkins, Donor Liaison Officer at BRAC, at the seminar titled “Managing Change in Bangladesh Water Sector: Experiences and Challenges; Setting the right courses and turning the wheels of change”, on the 22nd of May 2012 at the BRAC Centre. The panel was chaired by DR. W.M.H Jaim, Director of BRAC's Research & Evaluation Division (RED) and the chief guest was Mr. Mukhles uz Zaman, former Director General of the Bangladesh Water Development Board.

The audience consisted of researchers from the BRAC University Climate Change Research Department, researchers from RED, experts and scholars on climate change. The focal objectives, change process within the Bangladesh Water Development Board and enhancing community participation in its various development programs, were briefly explained. Ideas and expectations of the future were briefly explained followed by a detailed outline of the possible solutions incorporating the uses of the limited resources. Highlighting the various elements of change, focus was greater on proper strategy implementation, change process patterns, organizational lifecycle and the organization’s environment itself. The study emphasized strong, active and inspiring leadership for an effective change process.

A briefing followed outlining the current scenario of the Bangladesh water sector and the ongoing transition period towards good governance, service orientation and efficiency. Such transition can be catalyzed by the leadership of Director General of BWDB, an efficient task force and the Netherlands twining force. At this stage to set as an example, the Integrated Planning for Sustainable Water Management programme, implemented by BWDB, was discussed to substantiate the possible path towards change.

Based on the experience of various levels of success of numerous infrastructure development projects for water resources management, the BWDB realised that stakeholder participation, local level water management, and multi-disciplinary project planning and appraisal are essential for an improved and sustainable operation and maintenance of water resources management infrastructures. This view is also reflected in the National Water Policy, Guidelines for Participatory Water Management and National Water Management Plan (NWMP), and based on all these Integrated Planning for Sustainable Water Management was conceived (Source: ipswam-bwdb.org.bd).

The water management programme assists the BWDB to find a practical way to introduce realistic, affordable and sustainable participatory and integrated water resources management. It is a pathfinder programme because the methodology developed is based on actual practical experience. The total budget of this programme is jointly allocated by the Government of The Netherlands and the Government of Bangladesh.

A video, detailing the programme in a specific area and the various interventions of BWDB there, was presented to portray the establishment, continuity, progress and a few short comings of the program, and the effectiveness and multiple positive outcomes of community participation which leads to sustainable development. It is quite a holistic approach in the community as farmers are able to grow more crops every year, water is available at any times of need, fish farming has improved, people are enjoying life, they are more confident, they have gained control over their lives and have the courage to look forward to a brighter future.

Mr. Mukhles uz Zaman, who was also the project director of the water management programme, insisted that such kind of change is a long, painstaking and a continuous process. It is about developing a partnership with the people, and finding the right kind of people who are willing to participate in community development without personal benefit is the most difficult task. The responsibility of the Government and the NGO’s only lies in being the support system which will help the local people to utilize their resources more effectively. The government and support organizations should always be resourceful, develop round the year engaging activities, so that timely support can be provided to the actual beneficiaries. It is necessary to make this into a continuous process, both in the grass-root level and in the policy level.

Progressive and positive change takes time and the willingness to change. Decisions made at a policy level, may not be practically feasible at field level because here people act differently. Various complex factors influence the ultimate result, for instance, budget can act as a huge blockade to the much needed change within the organization. Dr. Jaap concluded the seminar focusing on dissemination of the process of change. A process that is conceptualized based on time and perspective. It starts with the vision of the leader, develops as an ongoing cycle and definitely adjusts and adapts with changing time.

Can entrepreneurship programmes transform the lives of the poor?

The following article was originally posted by Anik Ashraf on the International Growth Centre (ICG) website. The video was created by ICG based on recent research initiative lead by Robin Burgess to assess the success of BRAC's Ultra Poor programme in Bangladesh.

A new way of helping the world’s poorest people is proving to be a staggering success and is spreading throughout the developing world. Recent research co-authored by Robin Burgess of the LSE and Executive Director of the IGC finds that the scheme led to an increase in people’s incomes of around 35% after two years. For anyone this would be a big jump, but these are women who had previously struggled to feed themselves and their families.

The ‘Challenging the Frontiers of Poverty Reduction, Targeting the Ultra Poor’ (CFPR-TUP) programme targets the poorest 10% of people in Bangladesh, focusing on women. Run by Brac, the world’s largest NGO, the programme has two aims: to help these women ‘graduate’ from being ultra poor to have the basic skills, income, and confidence to begin fending for themselves, and to have enough stability to gain access to the mainstream development programmes, such as microfinance.

The programme starts with a temporary stipend to give the women involved short-term stability and breathing space while they are taught basic livelihood, healthcare and personal finance skills . They are then given an ‘asset’ such as a goat or a small plot of land that they can use to make money for themselves, whether by raising goats to sell milk or cultivating land to grow vegetables. Throughout, the women receive regular support through weekly visits, coaching and guidance. The programme ends with an invitation to join a microfinance scheme and further expand their business. Atiur Rahman, Governor of the Central Bank of Bangladesh said of the programme: ‘The ultra poor who have never been getting any kind of support are now becoming entrepreneurs.’

Click here to read the full article.

Behind the scene

As parents, we are always curious about examination results, how we can get admission for our children in good schools and how to give education through private tuition etc. Second and third generation students’ parents can think in this way, but what about those students who are the first in their family to be going to school? An untrained teacher in a classroom can not provide good education facilities for them. There needs to be a strong educational foundation to empower these first generation students to join the mainstream education system. 

"In the old days [in Bangladesh], Panditmoshai (teacher) used to send the Sardar (class captain) to bring students who were absent. In today’s world we still feel the need of ‘sardar’", said Syed Shamsul Huq, an award-winning Bangladeshi author and poet, in his speech.

With the changing era, we have realised that, students will take interest in study if we can create a learning environment for them. Attendance rate and drop out rate in secondary schools are quite high in Bangladesh. Only 2% of secondary schools in Bangladesh are directly managed by the government. The majority of the schools, known as non-government secondary schools, are owned and managed by local communities, even though about 90% of teachers’ salaries and maintenance expenses are paid by the government.

To bring qualitative change in secondary education, BRAC started training secondary school teachers. While giving the training, BRAC focused more on how to make students more active and participative in classroom. At this age, students follow their peers. BRAC realised that we should create structure which will be managed and run by secondary school students. Mentoring Programme was introduced with this very thought. Mentoring is an initiative to work with those students who are the first generation in mainstream education system.

Is the mentoring programme really an effective initiative by BRAC?

On 21st April 2012, in Shilpakala Academy, Professor Mahbuba Nasrin, Sociology department of Dhaka University, presented her research paper on BRAC's initiative. Ten schools from each of the Mymensingh, Sylhet, and Rajshahi districts, 15 from Jessore, and 5 from Rangamati districts were selected randomly for study purposes. She discussed the scenario before introducing the mentoring programme in secondary schools, and the current scenario after implementing the mentoring programme. In those secondary schools, SSC examination pass rate has increased from 56% to 83%. Attendance rate has become 69% to 76%. Her team found that, students have become disciplined and are having positive attitude towards life & participating in co-curricular activities. like 91% are participating in debate and contributing to the wall magazine. Students are now concerned about cleanliness of classroom.

Now questions may be raised on how these activities can reduce drop out rate and increase attendance rate?

The answer is, mentoring programme also teaches how to create group for group-study. Usually meritorious students lead each group. In group discussions, comparatively weaker students try to resolve their problems by sharing it with peers. When they can not solve the problem by themselves, they share it with their teachers.

“We used to do chitchat in our free time. After going through the mentoring programme, we have learned how to utilize time and group discussion for study”- This is how Shima from Narshingdi shared her opinion about this programme.

In city schools we see these activities are run by school’s own initiatives, but the numbers of these schools are very few. Dr. Mohammad Niaz Asadullah, Reading University, mentioned that students are not responsible for dropping out from school or being absent in classroom. Total school system is the main reason for this situation.

Samir Ranjan Nath, Research Coordinator, Educational Research Unit- BRAC, mentioned that we cannot measure learning outcome by CGPA or marks. We have to create the environment in school and make learning sessions more enjoyable.

BRAC has learned secondary education system, its barrier, issues with its experiences. Now BRAC wants to start a few standard model secondary high schools which can serve as good examples in the country. Dr. Mahbub Hossain, Executive Director of BRAC, mentioned this at the end of the event and also added that hopefully by the end of this year, BRAC will open 10 more secondary schools in rural areas.

Gordon Brown: “When I ask the mothers what they want most for their families, they say with one voice: education for their children.”

This post was written by former UK Prime Minister Gordon Brown after his visit to BRAC's education programme in South Sudan and originally posted on the Gordon & Sarah Brown blog.

Celina stands at the door of her hut hugging her one year old daughter Dokia, who is dying of malaria. Her son Efon stands by her side, unable to go to school because he must help care for his one year old twin siblings.

This is the picture I will remember from our visit to the newest state on earth. South Sudan is one of the world’s poorest – and in danger of being forgotten.

Of the 1,000 people living in the tents, huts and shacks that make up the village of Hai-Kugi, over 350 are children. But only 30 have schooling thanks to the one class room school hut constructed by the Bangladeshi charity BRAC.

18 girls and 12 boys are taught English, Science, Social Studies and Mathematics but outside looking in are dozens of children who have been turned away from the school. The next nearest school is miles away and while BRAC’s hut offers lessons free of charge, the 1,000 strong church school has to charge fees.

A mothers’ group meets in another hut. Thanks to money from the World Bank they are being taught about the potentially harmful impact of early marriage and ill health in childbirth. For some it is too late – one mother told me she was married at the age of 12, another age 14 – the majority had married before they were 18. But when I ask them what they want most for their families, they say with once voice: education for their children.

Click here to read the rest of the post.

Click her to learn more about BRAC's education programmes in South Sudan.

Mothers saving mothers

The following was originally posted by BRAC USA Program Manager - Communications Michelle Chaplin on the Half the Sky website.

Mother's Day is about being thankful for one of the most important women in your life: your mother. She gave birth to you (one of the most dangerous things a woman can do), fed you, clothed you, and made sure you went to school (and did your homework), among many other things.

Even before becoming a mother herself, Sweety Akter was intimately aware of the dangers of childbirth – both for mother and child. Sweety’s younger brother died soon after he was born because of complications resulting from childbirth, which the untrained birth assistant was unable to address.

“From my childhood I have always heard about the death of my brother. My poor mother always remembers him and I see tears in her eyes every time she talks about him,” says Sweety. “Whenever I heard this and similar stories, I longed to do something for such mothers and to save the lives of their young babies.”

Click here to read the rest of the story.

Private schools for the poor

The following is an excerpt from and article by Josh Kwan published in the Spring 2012 issue of the Stanford Social Innovation Review.

First, the good news. More children in places of poverty are attending school than ever before.2 Thanks to a major push by governments and donors, many countries have built a slew of schools, eliminated tuition for public schools, and mandated primary education for all their citizens. In India, for example, the April 2010 Right to Education Act legislated, for the first time, a constitutional right to free schooling for every child age 6 to 14.

Through public-private partnerships, giant education strides have been made in countries as diverse as Colombia, Turkey, and Bangladesh. Escuela Nueva has changed the way teachers reach children in rural communities and transformed Colombia’s national education policy. BRAC is operating the largest private, secular education system in the world, replicating a low-cost model for teaching children who had never enrolled in or had dropped out of primary school in Bangladesh, Afghanistan, Pakistan, southern Sudan, Uganda, and Haiti. Nearly 5 million children, the majority of them girls, have graduated from BRAC schools.

Click here to read the full article on education initiatives for the poor.

Click here to learn more about BRAC's education programmes.

Key assessment of BRAC Uganda's bed net program

Malaria is the most deadly disease in Uganda. It is responsible for 25-30% of under five deaths in the country, resulting in 70,000-100,000 deaths annually. While children under five are most at risk, only 28% of them sleep under bed nets. Even fewer of these children are sleeping under nets that are properly treated (or retreated) with the necessary insecticides.

BRAC Uganda recently conducted a study to assess the performance of its bed net distribution program. Since February 2008, BRAC Uganda has been distributing long lasting insecticide treated bed nets through its volunteer community health promoters.

One of the key objectives of the study was to determine the possession and usage of insecticidal nets. The study found that about 40% of surveyed households in the Kampala area and 60% surveyed in Eastern districts did not even have insecticidal bed nets. Much graver was that only 14% of household members claimed to have used their bed nets the night before. This finding demonstrated insufficient distribution by NGO's and agencies working in this space. Additionally, there was clearly a lack of comprehensive understanding as to the importance of bed nets and a critical need for greater public education on the issue.

Related to this was a finding that many respondents claimed allergies and aversion to the chemicals used for treating the nets. Public education is needed to curve this belief and reinforce the importance of chemical treatment. Others were washing their nets out too frequently, depleting the active chemicals on the nets and requesting early retreatments. BRAC Uganda does not currently have a program for this, however the results of the study suggests this is necessary.

Another key issue BRAC must contend with is that other agencies are offering bed nets for free. BRAC might consider an arrangement by which it does the same, or perhaps lowers the price it is currently charging. It was shown, however, that users often did not value bed nets if given for free.

Overall, the study was a great success, bringing to light fundamental shortcomings in the program and on-ground realities that were not initially accounted for. Impacting the spread of Malaria is vital and BRAC Uganda will work on the basis of its findings to improve its efforts.

Healthy, happy and wise: nutrition for under five

On a gloomy morning, Rabiya (4) sat with her legs crossed on the front yard of her parents’ mud hut. A pot of steaming white broth made of rice water laid innocently beside her lap, and she was carefully blowing on it to cool it down.

The rice water, with its dull flavour and gluey consistency, would have been too plain for most of our tastes. Besides, who would fancy such a bland liquid meal that is nearly devoid of all nutrients? But for Rabiya, this happened to be the scrumptious version of an ultimate breakfast. Moreover, she was too hungry to complain and it was not like she had any option for our regular eggs and bacon/ roti-chapati.

At noon it gets better, she thought. Her mother would cook rice and boil edible leaves that she always collected from the riverside, and she would then garnish them with green chilies and onions. Rabiya liked chilies, unlike most of the children of her age, because they were hot and made it easier to overlook the tastelessness of the plain meals she ate.

She loved eggs, and despite the abundance of chickens at their house she was hardly ever allowed to have one, as her mother sold eggs for money to pay her debts to the local landlord. But Rabiya barely complained. She was too young to understand any of this, and may be because of that, she hadn’t had the faintest idea why she was so short of her age, or why despite being underfed she had a bloated belly. She could not even understand why she had problems seeing in faint light, or why she fell sick so often.

Rabiya didn’t have any idea of the fact that she was unjustly malnourished, and neither did her parents.

This scenario could be seen in almost every corner of the rural geo-space in Bangladesh. A study conducted in 2007 found that one in 15 children born in Bangladesh dies before reaching their 5th birthday. According to a World Bank study in 2004, malnutrition rates in Bangladesh were among the highest in the world. Approximately 50 percent of children under the age of five had been stunted and underweight.

During infancy, the risk of dying in the first month of life (37 per 1,000) is nearly 2.5 times greater than in the subsequent 11 months (15 per 1,000). Death in the neonatal period accounted for 57 percent of all under-five deaths. It all became too obvious, and it was about time someone step in and make some essential changes in this extremely important socio-cultural phenomena. That is the when BRAC health programme started the Alive and Thrive project.

The first phase of Alive and Thrive was initiated in three sub districts and one slum in order to test and refine the model. The results were promising, so we extended the to many other districts and sub districts in 2010, following the advice of the Gates Foundation and the AED/FHI 360.

Currently, the project is active in 16 districts across the country, and is providing nutritional care to 1.9 million children under two years of age. The front line workers of Alive and Thrive the infant and young child feeding promoters (pushti kormis in Bengali), the community health workers (shasthiya kormis in Bengali), and the health volunteers (shasthiya shebikas in Bengali). At present, a total of 1,082 promoters, 633 community health workers and 7,154 health volunteers are providing infant and young child feeding services in their communities.  The front line health workers are recruited carefully and are expected to develop and improve the community-based Alive and Thrive initiative.

The health workers are trained by BRAC in order to counsel, coach and show the mothers how to breastfeed their children as well as on how to give them cost-effective proper meals with complete nutrients. Mothers of children less than 12 months of age are prioritised because infancy is a vulnerable period for all children.

The health promoters also demonstrate how to make age appropriate meals for children, for example, mashing the food, or removing a portion from the family’s food for the children before adding spice, etc. The parents and caregivers are not only enlightened about the different consistencies of food needed for children at various ages, but also about the importance of personal hygiene and hand washing before and after meals and after using the toilet.

Different social groups, such as religious spokespersons, village doctors and the government health workers are also involved with this nutrition project, providing with their unconditional support to communities.

Sabina Yasmin is a infant and young child feeding promoter in the village of Zinari, who was recruited by BRAC after completing her high school-level education. Initially, it was a challenge for her to convince parents and caregivers on how to provide proper nutrition to their little ones, because no one paid attention to a young girl teaching them about proper and improper means of feeding, and it takes time for people to learn and adopt new behaviours.

However, things eventually started changing, especially when a mother complained that her two-month-old son Yasin was sick and fatigued due to an intake of powdered milk that she gave him as she was not providing him enough breast milk. When Sabina showed her how to breastfeed properly, correcting her positioning and the way of holding the baby, the mother found out that she was in fact producing enough breast milk. Thanks to Sabina's advice, Yasin is alive and thriving now.

A thousands health promoters and health workers are working relentlessly countrywide just to ensure that the infants and children are receiving proper nutrition and growing up healthy, and the BRAC family is proud of them.

By Miftahul Jannat Chowdhury
Intern
BRAC Communications

Click here to learn how you can support mothers and their children in Bangladesh.