Manoshi Change in Action: Evolution of a Health Worker

BRAC Photo Essay

The Evolving Role Of The Community Health Worker

Introducing Moyna Begum, a Model Manoshi Shastya Shebika.

Moyna - a Model Shastyo Shebika

Moyna Begum was always a good student, but dropped out of high-school during her final year due to an early marriage. She works part time to supplement her family’s income and hopes to see her children with a university education before marriage. While working as a self-employed seamstress, the opportunity to work with BRAC’s Manoshi programme arose. In 2008, she became a Shastyo Shebika, giving her a new role in the community, higher earning potential, and basic healthcare skills. Two years later, she was chosen to participate in the Model SS programme.

Manoshi Medicine Shelf

The whole family shares one room which Moyna divides into a living space and an office for her Manoshi medicine cabinet and her sewing machine. As a working mother, she manages to overlook her children’s studies while also fulfilling her role as a model SS. During the visit, Moyna’s son was studying for upcoming high school exams. He is not the only one learning. Moyna’s four week training is accompanied by monthly refresher training. She disseminates health information, administers basic tests, and sells over the counter medications door to door. She records all her business meticulously in a Manoshi ledger which she regularly submits to a supervisor.

Community Work Combined With Family Work

Through the extra income Moyna generates by working as a Model Shastyo Shebika, she is able to support her children in their studies. The desire to provide for her children and make sure they have a bright future has been a driving force for Moyna. She’s particularly proud of her daughter who currently studies English literature in a local university. Moyna is also proud of her new status in the community that her newly acquired skills have given her, and she is confident she can now provide better quality services.

Looking after her family

In addition to her sewing and community health work, Moyna also looks after her family’s every day needs, including preparing food at the communal stove. One of the key benefits of working as a Model SS for Moyna is the flexibility it gives for working mothers.

Visiting Households

During her rounds in the community, Moyna circulates through the 200 households she is responsible for, including homes that are hard to reach. She visits about 10 each day, meaning that each family within her area gets visited at least once a month.

Pregnancy Test

The main role of the Model SS is still to identify pregnant women and let them know about their birthing choices, a programme such as Manoshi has brought with it, as well as provide overall health information and services to the community. Here, Moyna is administering a pregnancy test to Jasmene Begum, who she suspects is pregnant. Her supervisor is present, in case Moyna’s suspicion is correct, she can immediately provide the first pre-natal check. Jasmene’s 2-year old daughter was born in the Manoshi delivery center, and as long as everything goes as planned, she hopes to deliver her next child there too.

Family Planning

Moyna regularly provides family planning information, particularly to newly wed women, as well as sells the necessary contraceptives. Forida Begum just recently had her first child, and is now considering her contraceptive options. Ideally she doesn’t want to have another child until her daughter turns five.

Working in the Community

One of her regular customers is Wahida Begum, who has low blood pressure and lower back pains. Wahida used to go regularly to the local pharmacy to get her blood pressure measured, but she prefers paying a small fee to receive the service at home. Moyna is trained in basic danger signs; if anything changes with Wahida’s blood pressure, she knows where to refer her for qualified medical help.

Eye Test

Elderly Rehana Begum has limited mobility and rarely leaves her home and immediate neighbourhood. Before the Model SS were given training to provide these basic eye-sight examinations, Rehana would have been unlikely to seek help for her worsening eyesight outside of the slum community.

Selling Medication

Parvin’s two-year old boy has been sick with diarrhoea, and Moyna’s visit to check on the boy and sell much needed saline solution is a welcome break in the mother’s day. Through selling basic medication such as saline solution and micronutrient sachets containing basic nutritional supplements for growing children, Moyna is also able to complement her own income.

Proud to be Part of Manoshi

“Respect in the community”, is one of the key things Moyna says being a Model SS has given her. Going through the Manoshi Model SS training gave her the chance to connect with her neighbourhood in a new way. “Everyone in the neighbourhood knows me now, and they affectionately call me doctor,” Moyna says. She adds that working with Manoshi has given her a lot more confidence in her own abilities and she was even able to recognise the early signs of a stroke in her husband, getting him in to treatment in time.