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BRAC Annual Report 2010 Health BRAC Annual Report 2010 9BRAC ProgrammesHealth Improving health and providing essential healthcare Our Health programme combines promotive, preventive, curative, rehabilitative health care. We focus on improving maternal, neonatal and child health, combating communicable diseases and common health problems. BRAC’s Health programme is the result of an integrated approach, including several interventions, to provide a health service that supports human development and works in partnership with our comprehensive approach to development.

The key areas of the programme are

essential health care;

tuberculosis and malaria control;

maternal, neonatal and child health;

health facilities and limb and brace centres.

Our Approach An awareness of the changing health needs, adaptation of technology, cost effectiveness, sustainability and delivery through Achievements

partnerships with communities and Government are key features in our approach to providing health care to poor people.

Essential Health Care We have adopted an epidemiology-experimentation-expansion 100 million people reached across 64 districts evaluation model in how we develop and deliver the programme. 1,650,673 patients treated by our Shebikas Lessons learned from our experiences in public health, like the 31,174 Ultra Poor patients given health care

bare-foot doctors of the 1970s, Oral Therapy Extension and Child subsidies

Survival programmes in 1980s,

Women’s Health, Reproductive Health and Disease Control programmes in 1990s,

\have enabled Maternal, Newborn and Child Health us to expand sustainable and accessible health care to more than 100 million people across Bangladesh.

We also collaborate on 5.7 million people served in urban areas national projects such as Vitamin-A supplementation and family

8,317 deliveries made in birthing huts planning initiatives.

426 delivery centres in urban areas By choosing health volunteers, or Shasthya Shebikas, from our 11 million population reached in rural parts Village Organisations (VOs),

we are making effective use of resource and are able to ensure sustainability unlike other programmes in the Tuberculosis Control health sector. Volunteers receive basic training and provide door-to-

89.5 million people reached door health education, treat basic illnesses, refer patients to health  cases diagnosed centres and provide essential health items and medicines; which 92% patients cured contribute towards an income for the volunteer.

Our Shasthya Shebikas are assessed and monitored by Shasthya Reading Glasses Kormis who are paid a monthly salary to supervise 10-12 Shebikas. 7.9 million people covered Kormis conduct monthly health forums and provide antenatal 36,739 people screened and postnatal care. Around 7,000 Kormis are supervised by 9,573 glasses sold Programme Organisers who are supervised by the Upazila and District Managers. Medical officers provide overall technical Vision Bangladesh supervision whilst Kormis are supported by a team of public health professionals. 612 cataract surgeries completed First spread Parul receives an ante-natal check-up from a BRAC health worker in Gazipur.

1. 6.  11Programme Components Manoshi: Maternal, Newborn and Child Health Initiative (Urban) launched in 2007 in Dhaka and provides communityEssential Health Care (EHC) forms the core of our health based maternal and child health care services in urban slums, withprogramme, combining preventive, promotive, basic curative the support of slum volunteers, skilled community workers andand referral care, aimed at improving the health of poor people, Programme Organisers based in nearby hospitals for emergencyespecially women and children. EHC has seven components: cases. Birthing huts provide clean and private birthing places forhealth and nutrition education; water and sanitation; family slum women who usually live in small shacks, with large numbers ofplanning; immunisation; prenatal care; basic curative services and family members, which offer unhygienic conditions for giving birth.tuberculosis control. In 2002, EHC was adapted to fit the needs Each of our huts have two birth attendants, covering around 2,000of the Ultra-Poor, our poorest members, by offering basic health households (approx 10,000 people), whilst community midwivescare and health awareness services as well as financial assistance are on hand to provide skilled care during deliveries.towards clinical care. Shushasthya (Health Centres) provide accessible and quality outpatient and inpatient services, general laboratory investigationsMalaria Control Programme operates in 13 districts across and essential life-saving drugs to the local community. We haveBangladesh including the Chittagong Hill Tracts (CHT). Our also upgraded nine centres to offer emergency caesareanShasthya Shebikas receive a 3-day training course on malaria section or newborn care and advanced diagnostics such astreatment and prevention to help achieve early diagnosis and electrocardiograms and ultra sonograms.prompt treatment of cases. Limb and Brace Fitting Centres provide low cost, accessible,Tuberculosis Control Programme using a community based quality artificial limbs and braces. We provide physiotherapyapproach, our Shasthya Shebikas are trained to provide DOTS services and education and counselling to patients and their familytreatment (Directly Observed Treatment Short-Course), diagnose members. Our work aims to improve the livelihood capabilities ofcases, distribute information on TB and refer suspected cases the physically challenged and help their integration into mainstreamto nearby outreach smearing centres. Medical Officers initiate society. We currently have centres in Dhaka and Mymensingh.treatment, whilst the Shebikas conduct the DOTS treatment of TBpatients, either at their own home or during home visits. Our TB-HIVcollaborative project also offers HIV screening tests for TB patients. Reading Glasses for Improved Livelihoods working with Vision Spring, covering 15 districts, specially trained Shasthya ShebikasImproving Maternal, Newborn and Child Survival Project use simple charts to identify near-vision deficiency. They sell ready-to-use spectacles at a nominal price, educate people on eye Shomola Khatun, a Shasthya Shebika from the village of Chankanda in(Rural) has been successfully scaled up to ten rural districts across Jamalpur explains how to use contraceptives to the women in her community.Bangladesh since its launch in 2005; working with the Government problems and are trained to refer complicated cases to medicaland UNICEF. This project aims to provide quality maternal, newborn professionals.and child health care using a community based approach to reachthe rural poor. Major interventions include capacity development Vision Bangladesh is a partnership programme between BRAC Challengesof community health resources, empowerment of women and Sightsavers aiming to eliminate preventable blindness in Sylhet New Initiativesthrough support groups, provision of maternity and child health by 2014. To date, 1,300 poor people have undergone cataract There is an emerging need to tackle the increase in non-related services and referrals to nearby health facilities. Shasthya operations and 7,000 people have been successfully screened. communicable diseases, alongside the ongoing burden of We have developed a Mobile Health Project, in partnership withShebikas, Shasthya Kormis, newborn health workers and skilled communicable diseases, coupled with a lack of accessible and Click Diagnostics Inc, where Shasthya Kormis can use mobilebirth attendants all work together to deliver these services to the Alive and Thrive is an initiative to reduce malnutrition in children quality health care and medical facilities in Bangladesh. Lack of phones to share real-time information about their patients, mainlycommunity. Preventive and curative practices are promoted through under the age of two by promoting exclusive breastfeeding coverage, skilled workers and accessibility to remote parts of pregnant women and newborns, helping to improve the processtargeted household visits. Our approach has significantly improved and healthy feeding practices. This includes community level the country continue to present major challenges in how we can of diagnosis and treatment.pregnancy identification and antenatal care as well as ensuring safe counselling, coaching and demonstrations. Following a successful provide health care to poor people. Developing effective referraland clean deliveries in rural communities. year long pilot this initiative has been expanded to 50 rural Upazilas. facilities with adequate human resources and logistics will prove Working in partnership with GE Healthcare, we plan to introduce essential in reducing maternal and newborn mortality. a portable oxygen support device, at community level, in an Micro-Health Insurance is a sustainable community health effort to fight birth asphyxia in newborns. The pilot will launch in financing model, to empower and improve the well being of poor January 2011. Future Plans women and their families, giving poor people access to affordable and quality health care. Our approach in developing community based interventions recognises that workplaces and urban slums are becoming new settings for delivering effective health interventions. Our approach with EHC, continuing as our core health programme, will be adapted to accommodate the emerging needs of non- communicable diseases, elderly health care, climate change and nutritional initiatives. In our shared effort to build a more ‘Digital Bangladesh’ we have identified the mobile phone as a key medium for exchanging information. Using ICT will enhance our ability to provide efficient and effective health care, whilst opening up new channels of communication for a lower cost higher reach service.

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Fazle Hasan Abed

Founder and Chairperson
BRAC (Bangladesh Rural Advancement Committee)

Fazle Hasan Abed claims he is no miracle worker, but most of his colleagues would dispute that. Almost single-handedly, he has helped one of the world's poorest countries — Bangladesh — provide better health care for all its citizens. As founder and chairperson of BRAC (formerly known as the Bangladesh Rural Advancement Committee), Abed has garnered international attention for creating what many experts deem the most effective non-governmental organization [NGO] in the world.

Abed began his pioneering work in 1972, following Bangladesh's war of independence from Pakistan. "We were determined to bring about changes in the lives of poor people," he says. "We felt that whatever we do, we should try and replicate it throughout the nation if we can." Since then, BRAC has fought against poverty, disease, child mortality, and illiteracy by empowering poor rural women through bringing health care and education to their communities.

Scientists working in Bangladesh in the early 1970s had learned that a measured combination of sugar, salt, and water could prevent deaths from dehydration. Since our bodies are 70 percent water, it is dehydration that makes diarrhea the cause of 18 percent of child deaths worldwide. Abed's first major goal for BRAC was to teach mothers to make the lifesaving oral-rehydration solutions. "That involved going to every household in rural Bangladesh — 13 million households," Abed recalls. "And it took 10 years to do it." As a result, BRAC's oral-rehydration program reduced infant and child mortality from 258 deaths per 1,000 to 75 deaths per 1,000.

The majority of Bangladeshis are Muslim, and Abed realized that within each community, women would be most effective in teaching other women, many of whom were not permitted to leave their courtyards. But first, he realized, he had to win over their husbands and the male village chiefs, who would have to give their consent for any such community-wide activity. Achieving good health meant enlisting the political will of those in power. In the two decades since, women have made some gains in gender power in Bangladesh, and BRAC has helped to educate many men on the need for women to be educated and involved in health care and economic activities.

Today, BRAC is active in more than 68,000 villages and has 4.8 million group members. Abed introduced programs and initiatives that have enabled 3.8 million women, who are still the backbone of BRAC's organization, to establish village microfinance organizations that have to this point disbursed more than $1 billion in loans. These loans have allowed women to create small businesses poultry farming, cow rearing, and dairy farming; in addition the production of iodized salt, which helps prevent goiter, is now also possible. Such BRAC enterprises provide 80 percent of the organization's operating costs, with the rest coming from external donors. BRAC also works to control tuberculosis, with a major grant from the Global Fund for Tuberculosis, Malaria and AIDS. Over the years, one of BRAC's most critical contributions has been keeping poor rural children in school, and the organization now runs 31,000 one-room, one-teacher schools.

Abed's adept and tireless leadership of BRAC has brought him international renown and numerous awards. In 2004, he was honored with the Gates Award for Global Health and the United National Development Program's Mahbub ul Huq Award for Outstanding Contribution in Human Development. As evidence of his success, there are now BRAC branches in Afghanistan and Sri Lanka. Abed's strategy has always been ambitious: "We thought nationally, worked locally, and looked for inspiration globally."

(Look for F.H. Abed's story in Program 3: Delivering the Goods.)