UNICEFBangladeshIssue 6, May 2007

Children carrying the water they have collected in avillage of the Chittagong Hill Tracts, a remote areaof South-East Bangladesh, which is difficult toaccess due to its mountainous terrain, but home to11 of the country's ethnic groups.

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The UK Department for International Development(DFID) has pledged US$62.8 million towards a newSanitation, Hygiene Education and Water Supply inBangladesh (SHEWA-B) project that was formallylaunched on 21 March, 2007, in Dhaka.SHEWA-B will implement programmes to improvesanitation and hygiene for 30 million people in 34 of thepoorest districts across Bangladesh. Almost 5.1 millionpeople from these communities will benefit from yearround access to adequate supplies of safe drinking water.The project will be run by UNICEF, the Department ofPublic Health and Engineering (DPHE) and theGovernment of Bangladesh, with UNICEF contributingUS$9 million and the Government of BangladeshUS$16.9 million.Advisor to the Ministry of Local Government, RuralDevelopment and Cooperatives, Mohammed AnwaralIqbal, inaugurated the project. He said, "This hygiene-focused project will boost the current initiative with thedemand driven community-led approach. It will reducemortality, morbidity and malnutrition due to water andexcreta related diseases and will also improve access tosafe water in un-served and under-served areas includingarsenic affected areas."UNICEF Representative in Bangladesh, Louis-GeorgesArsenault, said, "At the heart of this project is promotinggood hygiene practices. We know that changing people'sbehaviour is difficult, but history also shows us that it ispossible with perseverance and creativity. What I findexciting about this project are the new approaches thatwill be used over the next 5 years to engagewith people around the country - to interactwith school children, urban and ruralpopulations, mothers, fathers…in factmillions of ordinary Bangladeshis."SHEWA-B is an expansion of the successfulRural, Hygiene, Sanitation and Water Supplyproject that was implemented with DFIDsupport in 37 upazilas or sub-districts andended in December 2005. It is designed intwo phases. The first phase, from 2007-2009,will cover 60 upazilas in 16 plains districts aswell as 300 paras or villages in the threedistricts of the Chittagong Hill Tracts (CHT).The second phase will add 44 more upazilasin 12 additional districts and another 300paras in the CHT. The programme will alsocover slum areas in the major towns of theprogramme districts.Meanwhile, the school component ofSHEWA-B will provide both separate andappropriate toilets for boys and girls and willincorporate hygiene education into thecurricula to help address the challenges

Bangladesh faces in school retention rates. Manyadolescent girls miss one in four weeks of school becauseof a lack of facilities to deal with menstrual hygiene.Though Bangladesh has made significant achievements inlowering infant and child mortality, almost 100 childrenstill die each day from diarrhoea, caused by poor hygieneand sanitation. Lack of access to safe sanitary options canalso cast a negative impact on children's, especially girls'school attendance and academic performance. There are72 million people (out of a population of about 150million) who still do not have access to improvedsanitation. SHEWA-B is expected to reach 30 million or42 per cent of people living without adequate sanitation,increasing total coverage to almost 70 per cent.The SHEWA-B programme will ensure water supply forjust over 5 million or 15 per cent of those without safedrinking water and reduce arsenic risk for half of these(2.5 million people).Speaking at the SHEWA-B launch, DFID SeniorProgramme Manager, Tom Crowards, said, "InBangladesh there are 36 million people without access tosafe and adequate drinking water. For those who are inextreme poverty, getting clean water and good sanitationis almost impossible. DFID will continue to providesubstantial support, around 40% of DFID aid, to basicservices for the poor including water and sanitation. Weare very pleased to be partners in this important project."Donor: UK Department for International Development(DFID)

Water and sanitation project to benefit30 million people across Bangladesh

Improving hygiene practices is a major part of the SHEWA-B programme as poorhygiene and sanitation contributes to the 100 children who die each day from diarrhoeain Bangladesh.

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28 million people to be reachedthrough bird flu trainingA massive training programme covering every district inBangladesh is underway to train both rapid responseteams on how to respond in the event of a human case ofavian influenza and front-line workers on awarenessbuilding within the general public. This training initiallystarted in February, prior to the avian influenza outbreakin March this year, and through different levels oftraining it will soon filter down to the community levelwhere over 28 million people will be reached.

The UNICEF-supported training given by the Institute ofEpidemiology Disease Control andResearch (IEDCR) involves theorientation of 60 national mastertrainers who are currently training704 district managers. 462 districtmanagers will then train 5 upazila(sub-district) managers each,resulting in about 2300 peopletrained at upazila level in total.Following this stage, the upazilarapid response teams will traincommunity members who willcarry out awareness buildingactivities by conducting house tohouse visits.

The training is essential to preparehealth workers, livestock officersand community members on theactions to take if there is a humancase of HPAI/H5N1 and how theseactions will impact on the spreadof the virus. As Dr Alamgir, anIEDCR trainer, explains, "Healthworkers must realize that a patientwith bird flu will need to beisolated immediately; manyhospitals do not have an isolation ward so they will needto prepare one to use in case this happens."

Dr. Nuron Nahar, a civil surgeon from the Bogra district,was half-way through her district manager training whenshe spoke about her involvement in the programme. Shethought the training was an excellent method to getinformation on how to deal with a human case of avianinfluenza to the community in a systematic way.

"Everyone in Bangladesh needs to know about this newvirus, not only health workers, because people must beinformed on what to do if there is a suspected case ofbird flu in their family," said Nuron. "This is a new virus

that we have not learnt about before so it's important toknow how to control the disease, why we must provideinformation and report any case to health authorities andhow we can use personal protection equipment, such asmasks and gloves, to prevent the spread of the virus."

Dr. Iqbal Ansary Khan, from the Institute of PublicHealth, believes the training will give front-line workersthe knowledge required to control the spread of avianinfluenza. He said, "When health workers at the villagelevel are provided with training then not only will they

provide health services in thevillage, but they can also manage ahuman case and report itimmediately. These workers canact quickly to contact the rapidresponse team who will informpeople at the national level andinternational level so that there istime to manage the spread of thevirus."

The training provides a guidelineon avian influenza andconcentrates on the issues ofinfection control, management ofcases, front-line workers' role indealing with HPAI/H5N1, how toprotect themselves from infectionand the importance ofcommunication to control thespread of avian influenza,particularly at the community level.

UNICEF, on behalf of the UN, isleading the communication efforton avian and pandemic influenza inBangladesh. In conjunction with itspartners, the Government of

Bangladesh, FAO and WHO, UNICEF has developedand implemented communication activities to inform thepublic, and other priority stakeholders, on necessaryactions to help limit the spread of the disease. In additionto these communication materials, UNICEF has alsosupported the training of key spokespeople and morethan 1200 journalists on how to report to the public onavian influenza. Folk theatre productions emphasisingavian influenza prevention in local dialects are also beingrolled out across the country through 1000 performancesat the grass roots level.

Donor: Government of Japan

A poster explaining ways to prevent the spread ofbird flu.

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The Netherlands Minister for Development Cooperation,Kees Beemsterboer, and UNICEF Representative forBangladesh, Louis-George Arsenault, signed anagreement on 27 March in Dhaka to support theGovernment of Bangladesh in promoting a sustainableand functional birth registration system.

This agreement gives support to the Universal BirthRegistration system, implemented by UNICEF and theLocal Government Division, which aims to achieve totalbirth registration by the end of 2008. The Netherlandsgovernment will contribute US$3.5 million for two yearsfrom January 2007 to assist in achieving this goal ofuniversal birth registration. The strategy is based on anew legal framework that entered into force in July 2006.

In Bangladesh, birth registration is a vital tool in ensuringnot only that every child is registered and accounted forbut also in providing an access mechanism to other childrights. At a rate of 7-10 per cent, the registration ofBangladeshis remains low and in the absence of afunctioning birth registration system it becomes a majorchallenge to realise other child rights, such as theprevention of child marriage.

Ara Yoo, a UNICEF child protection officer, says, "Birthregistration is an official acknowledgement that giveseverybody the right to a name. It paves the road for therealization of many rights and allows access to otherservices, giving people the right to education and health,

as well as enabling adults to gain passports, drivinglicences or register to vote.

"Birth registration has an added impact of being aprotection tool for children. If a juvenile offender isarrested by the police and is suspected of committing acriminal offence then they are often not considered achild if they have no birth certificate. The child will beprosecuted with adults and tried as an adult if there is nocertificate to prove their age. Birth registration also helpsprotect children under 18 from becoming involved inchild labour because if they are able to state their age thenspecific laws provide protection. Children are moreadequately protected from child marriage, trafficking,sexual exploitation and becoming victims of abuse andviolence through birth registration."

Girls are legally not permitted to marry before the age of18 in Bangladesh, however without legal documentationto prove one's age, many marriage registrars regularlyflout this law and register under-age girls. Almost 70 percent of girls are under 18 years of age when they marry.

Birth registration is also important to ensure that childrenare enrolled in age appropriate schooling, and assistshealth workers in diagnosing their patients moreaccurately. In relation to the State, registration is essentialfor national planning and also as a demographic base tobuild effective strategies.

The biggest obstacle facing birth registration inBangladesh has been the extremely low level ofawareness on the importance of birth registration, whichhas led to the low demand of certificates. As Ara Yooexplains, "For many Bangladeshis it is not seen asimportant to obtain a certificate. They are more concernedwith getting clean water, having enough food and thesurvival of their families. It's incredibly important that weget momentum for the campaign so that these people canbe registered for free by the end of 2008."

The Universal Birth Registration strategy adopted by theGovernment of Bangladesh in 2006 provides freeregistration for two years aiming to register all by 2008.To achieve this UNICEF is working closely with thegovernment to provide advocacy, legal reform,communication and training of those who will facilitatethe registration process. In order to ensure the system'ssustainability, the project engages the support of othersectors, in particular health, education and NGOs.

Donor: The Netherlands Government

Agreement signed to support UniversalBirth Registration in Bangladesh

UNICEF Representative in Bangladesh, Louis-George Arsenault (left), andNetherlands Minister for Development Cooperation, Kees Beemsterboer (right),after signing the birth registration agreement with Ashok Madhab Roy, DeputySecretary, Local Government Division..

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It is a rare occasion, the chance to gain a personal insightinto the lives of the women and children of theChittagong Hill Tracts (CHT). These indigenous peoplelive in a remote area of South-East Bangladesh, which isdifficult to access due to its mountainous terrain, buthome to 11 of the country's ethnic groups. Approximately90 per cent of these people live in rural areas, withoutadequate access to basic facilities and services.

So it was that we were able to get that personal insightthrough a UNICEF exhibition, "The Hill Children ofBangladesh," organised with MAP photo agency andfeaturing Bangladeshi photographer Mahmud's collection.It was opened by UNICEF Representative in Bangladesh,Louis-Georges Arsenault, in Dhaka on March 3 at theDrik Gallery. The images representing most of theindigenous groups and communities of the CHT weretaken over a period of five years, between 2001 and2005, near the main hill towns and in the remote villages.

Louis-Georges Arsenault, UNICEF Representative, said,"This exhibition showcases the beauty and culturaldiversity of the CHT, but also reminds us of thechallenges that are yet to be faced and overcome.

"The situation of the CHT has improved over the last fewyears regarding access to and utilisation of basic socialservices such as education, health, nutrition, water andsanitation. But a lot more is still required and needs to beaddressed in the near future as the CHT, despite its richarray of lifestyles, cultures, languages and customs, isstill home to many disparities."

Mahmud has spent many years capturing images thatportray the lives of children in Bangladesh. He explains,

"Children are always on the agenda as I concentrate onsocial documentation with my photography. Whether theyare street children, river children, indigenous, plain, hill,fishing or gypsies: children are at the forefront of what Ido.

"While I was working in Bandarban, Rangamati andKhagrachari - the three districts of CHT - I wanted totake specific photos of children, to give them a face. So Icovered all aspects of their daily lives, from thebeginning with newborns to a focus on the education,health, religion and cultural practices of the olderchildren. The CHT children are so easy to photograph,

Photo exhibition highlights plight ofCHT children

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they don't run after the camera, they are not camera shyand they are less curious of the camera, it's possible toget a much more original photo in these remote areas."

The CHT communities experience many difficulties intheir day-to-day lives. Children still suffer from vaccine

preventable diseases, such as measles and neonataltetanus, while malaria related deaths in the CHT are thehighest in the country.

The prevalence of anaemia in women and children ishigher than the national average and access to safedrinking water is challenging due to the geographicalarea. Often available safe water options are costly and

require specific technical support not easily found in theCHT. Access to primary schools remains difficult assometimes students must make a hilly trek, or boat trip,simply to get to school. Once there, the text books are inBengali and the teacher may or may not speak the locallanguage.

UNICEF supports 2220 para centres in the CHT, whichserve 150-200 people each. These centres are a one-stopdelivery point for the people of the CHT who find itdifficult to access mainstream services, mainly because ofa mix of their independent languages, cultures,geographical isolation and remaining tensions from morethan 20 years of civil conflict that officially ended in1997. More than 70 per cent of the para centres are inindigenous communities whilst the remaining are inBengali communities or serve mixed Bengali andindigenous groups. By 2010 it is expected there will be3500 para centres serving more than 500,000 people.

"The Hill Children of Bangladesh" exhibition providedan excellent opportunity to focus attention on the CHT, aunique area of Bangladesh, while highlighting thechallenges that these hills communities are still trying toovercome. UNICEF, together with the Government ofBangladesh, will continue to support activities that willallow these people greater access to basic essentialservices.

Donors: UK Department for International Development,Government of Bangladesh and Netherlands Embassy.

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The Reuters Foundation conducted two workshops onApril 9 and 10 in Dhaka to provide spokespeople withthe communication skills needed to respond to an avianinfluenza emergency. Participants in the training includedrepresentatives from the government, Department ofLivestock Services, WHO and Institute of EpidemiologyDisease Control and Research (IEDCR).

The training, which was supported by UNICEF, gavespokespeople the skills to recognise the real threat fromavian or pandemic influenza and acknowledge the needfor organisation and coordination between all theagencies involved, both national and international.Participants had the opportunity to learn and practise themechanics of handling media in the event of a crisis, planand practise what they should (and should not) saypublicly at each stage of an outbreak and assess theimpact of their actions at each stage of the crisis.

Lindsay Williams, a Reuters Foundation trainingconsultant, has been involved in media training for thepast four years following a successful journalism career.She said, "The training is vital for people in business ornon government organisations to give them disciplinewhen talking to journalists. It's important that they don'tget led astray, even if a journalist is not beingmischievous; it's possible for them to get the wrong story.

"When spokespeople talk to the public it's important thatthey are able to use newspapers, radio and TV effectively.We teach them what journalists are looking for, how tocraft their own messages, what to report, the need for an

international language without technical terms or jargonso that they are easy to understand as well as evidencefor what they are saying. If they tell stories about realpeople the audience is able to relate to the message beinggiven more easily."

Reuters Foundation is a charitable company funded bythe world's largest international multimedia news agency,Reuters. It was created in 1982 to support media indeveloping countries and to share Reuters fact-basedreporting skills. In addition to training more than 3600journalists from 168 countries, the Foundation runsregular courses for aid organisations keen to learn how tohandle the media.

There have been many lessons learned from othercountries on the benefit of media training for keyspokespeople during emergencies, such as naturaldisasters, public health crises or political unrest. Theability for a speaker to get a clear message across to thegeneral public during these situations is paramount inorder for a community to remain calm and realize thatactions are taking place to control the situation.

Jeremy Toye is the lead trainer on a series of more than70 workshops undertaken by the Reuters Foundation forUnited Nations agencies. He said, "I have done trainingfor UN organisations on different issues from polio in thesub-continent to malaria in East Africa and children'smalnutrition in Latin America. The techniques that themedia training teach are universal and there are commonelements that can be used in different cultures."

Jeremy realized that the mediatraining workshop on avianinfluenza was dealing with asensitive issue following therecent outbreak in Bangladesh.For this reason, he said it was atest to get the participants to talkopenly and admit their worries.However, the course succeededin giving the spokespeople thenecessary skills to tell their storyin the best way possible andprovide the public with relevantinformation on how theirorganisations, the UN, orgovernment were dealing withthis health crisis.

Reuters training for key avianinfluenza spokespeople

Lindsay Williams, a Reuters Foundation trainer, provides spokespeople with theskills to talk to the media about bird flu.

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Dhaka Sheraton Manager getsinvolved in polio NIDTrevor McDonald, Sheraton hotel manager in Dhaka, hasbeen closely associated with UNICEF during the pastfour years while living and working in Bangladesh. Theglobal partnership between the Sheraton hotels andUNICEF is ongoing and fundraising efforts from thehotel, through its Check out for Children campaign, havecontributed significantly to UNICEF's immunisationprogrammes.

For the first time in April, Mr. McDonald was happy tobe given the opportunity to visit various immunisationsites during a special polio National Immunisation Day(NID). Accompanied by UNICEF staff, he visited bothurban and rural sites to observe what it takes to make acampaign succeed in reaching 22 million children acrossthe entire country. This 8th NIDround, held on April 8, combinedthe polio vaccination with Vitamin Asupplementation for children aged 1to 5 and chewable dewormingtablets for those aged 2 to 5 years.

From one of Dhaka's major busstations to a tiny clinic in a crowdedslum area, we saw volunteersworking tirelessly throughout theday to ensure all children under 5received their vaccinations. Whilevisiting the Kalampur slum area inDhaka to see one of the urbanvaccination sites, we met a younggirl, Muni, who told us she was 16years old. She had brought her threeyear old daughter, Lamia, to theclinic that day for her polio vaccine,Vitamin A and deworming tablets.

Muni said, "I found out about theNID last year when I saw the TVadvertisements telling everyone totake children for the polio vaccine.So I found this clinic because I live nearby with myhusband who is a rickshaw-wallah and I brought Lamiafor the vaccine."

Later in the day we watched a continuous stream of busespull in at the Jamuna Bridge toll gate about three hoursnorth of Dhaka while UNICEF staff monitored thistemporary vaccination site. If there were no under 5 yearolds then the volunteers gave the bus driver the go aheadto continue his journey. Whenever they spotted a childunder 5, this boy or girl would quickly be given hervaccination on the bus steps with a bus-load ofpassengers looking on with interest.

Mr. McDonald was amazed at the logistics involved for aNID campaign to reach every child in the country. He

said, "The infrastructure required is enormous with somany thousands of volunteers needed to provide thesevaccinations across the entire country. I think it'sremarkable to see the number of young people who givetheir time to work at these vaccination sites and I'vereally enjoyed meeting the people, seeing the kids andtheir parents - everyone realizes the importance of theNID."

It involves approximately 700,000 volunteers nationwideat 120,000 sites to make the NIDs happen in Bangladesh.These volunteer vaccinators and vitamin dispensers boardeach bus crossing a toll gate. There are teams that travelto remote tea estates, islands and into the hills. Childrenwaiting at airports, land-borders and bus and train

stations are also covered. Streetchildren are targeted throughteams at bus and train stations andthrough NGOs that work withthese especially hard to reachchildren.

The partnership between Sheratonhotels and UNICEF began morethan 10 years ago and involves thesuccessful Check Out for Changeprogramme. As Trevor explains,"We invite all our guests tocontribute US$1 when they checkout from any of the Sheraton andStarwood hotels worldwide andthen every year this money isgiven to UNICEF to support theirimmunisation programmes."

It was discovered in March 2006that polio had returned toBangladesh after being polio-freefor five years. Since then, afurther 18 cases of polio havebeen confirmed. For every case of

paralysis, there are 200 to 1000 undetected cases of polio.Because of this, the World Health Organisation regardsjust one case of paralysis as evidence of an epidemic.

UNICEF supports the Government of Bangladesh withthe NIDs and the general Expanded Programme onImmunisation. Part of this work is through the GlobalPolio Eradication Initiative, which works withgovernments around the world to reduce the incidence ofpolio.The GPEI has reduced the incidence of polio bymore than 99 per cent since its launch in 1988, from350,000 annual cases to 2000 cases in 2006.

Donors: Rotary International, WHO, Government ofJapan, USAID, DFID, CIDA, CDC, Australian NationalCommittee, Netherlands National Committee.

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Trevor McDonald administering the poliovaccine at the Marie Stopes clinic in theKalampur slum area of Dhaka.

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"Ek, dui, tin, char. Ek, dui, tin, char (1, 2, 3, 4)." As weenter the small tin shed it sounds like any otherclassroom with the teacher calling to the children to getinto their groups. The children quickly sit down on theconcrete floor, paper and pencil ready. There is onedifference though. Most of these children had neverstepped inside a classroom until this learning centreopened six months ago. All the children in this learning centre are either working,or have been forced to drop out of their normal schools towork at home. The centre and its curriculum are speciallydesigned for working children to attend for a few hourseach day and learn basic literacy, numeracy and otherskills. Many of these children are given a few hoursrespite at the centre, possibly the only chance they willget that day to truly be a child.Jan Nordlander, Swedish Ambassador for Human Rights,visited this learning centre in Kuril, Dhaka, on April 9 toobserve the UNICEF Basic Education for Hard to ReachUrban Working Children (BEHTRUWC) project. InBangladesh there are 42.4 million children aged from 5-17 years and out of those, 7.9 million are estimated to beworking children.One of the students, Ronju, 10, said "I think I am tenyears old but my mother knows better how old I am. I'vebeen at this school for a long time, maybe three to fourmonths and I am happy because now I can read andwrite. After school finishes I go home and prepare thefood for my family, my mother is busy working inanother house so I have to do the work in my house."Another student, Rashida, 10, also works at her ownhome when she is not at the learning centre. "I cook therice for all the family members and help with all thehousehold chores," she explained. "I never used to go to

school but then my teacher came to our house,talked to my parents and enrolled me at thisschool. Since then I have come here and I likeschool; I like my Bangla lessons. I want tostudy a lot so that I can become a schoolteacher when I am older."Many of the girls in the class work asdomestic workers, one of the most vulnerablegroups in Bangladesh as they are hidden inprivate homes. Shila, 10, works as a childdomestic worker with her mother. "When I getup in the morning I go with my mother to herwork so that I can help her with all the chores.I clean the plates, handwash the family'sclothes and help with the cooking. Afterschool I go home and do the same chores atmy house because my mother is still at work."During his visit to the learning centre, JanNordlander spoke to the students about theireducation and how pleased he was to see

them attending their lessons. He said, "I am happy to seeyou all studying and paying attention to your teacher. Thestudy you are doing will give you good opportunities anda better future. And because you are working, coming toschool gives you a chance to laugh a little, have fun andyou all deserve that as well."There are now about 2000 learning centres across all thecities run by the Government of Bangladesh throughNGOs with UNICEF support. By 2008 it is planned therewill be 8000 centres benefiting 200,000 children. Thebasic curriculum at these centres gives the children theequivalent of grade 5 in Bangla and grade 3 inMathematics, but the children also learn life skills, oftenthrough role playing. These life skills range from raisingawareness about their rights to negotiating skills and selfesteem.Jan Nordlander said his visit was a great opportunity forhim to see how the BEHTRUWC project operates andwhat was being done to address the issue of workingchildren in Bangladesh."It was heart rending to go to the school and meet thesechildren who have so much responsibility in their livesbut it was also an interesting experience to see howdespite their difficulties, at school they really have achance to behave like other children. The Swedishgovernment will continue to support UNICEF in its aimto meet all the rights of the child. If there are no rightsfor the child, then how can children grow up to dosomething positive in their lives?"Donors: Swedish International Development Agency(SIDA), Canadian International Development Agency(CIDA), Italian National Committee

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Swedish Human Rights Ambassadorvisits learning centre for working children

The Swedish Ambassador for Human Rights, Jan Nordlander, talks to astudent at the learning centre, Ronju, with UNICEF project officerShamima Siddiky.

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Essential medications for under-5 yearold children Anxious faces peer through the open doorway. Mothers,fathers, and young children line up in the narrow hallwayoutside the medical room, their voices echoing down thehall, only to be drowned out by the occasional childcrying. Inside health workers call the next mother in andbegin a thorough examination of her child to see if theyare ill, require treatment, perhaps hospitalisation, orsimply home care.

The Savar Upazila Health Complex (UHC), an hour northof Dhaka, is one of the many Primary Health Care (PHC)centres in Bangladesh that operate an IntegratedManagement of Childhood Illness (IMCI) programme forunder-5 year olds. This UNICEF-supported programmeprovides a one-stop health centre where children canreceive free treatment, mothers are educated about homecare and care-seeking, and the follow-up consultationsare provided for children who are suffering from aserious illness, such as pneumonia.

Dr. Md. Nujibur Rahman Khan, Residential MedicalOfficer, explains, "We check the child's problem, if it isARI (Acute Respiratory Illness), then we first treat forARI. The number of children with pneumonia is lowbecause we give them treatment in the early stages.

"Also we check for other complaints: whether they aremalnourished, if they have fever, do they needimmunisation, is there a feeding problem. And then themother can have counselling on how to use anymedication or home care for her child."

The medications at these clinics are supplied through theEssential Health Commodities (EHC) project. They areprovided to all sub-district and union level health centresin Bangladesh, which is made possible through theCanadian International Development Agency's (CIDA)funding.

Many families who could otherwise not afford to buyessential medicines are given the appropriate medicationfree-of-charge at a PHC centre if needed. The antibioticprescribed for treating pneumonia in the PHC centresthroughout Bangladesh is a special paediatric one forchildren. Without access to this antibiotic, parents wouldbe forced to pay much more for a high-cost medicine, asthe paediatric formulation of this low-cost medicine isnot available from pharmacies.

Mrs Reema Akhter, 24, visited the Savar UHC with hertwo year old son, Ali Islam Juboray. She says, "Ali hasbeen coughing for two days and he has an itchy rash onhis body. So I came here today and first registered, wherethey gave me a ticket, and then I came to the children'scorner to wait for my ticket number to be called. Thedoctor examined Ali, checked his weight, temperatureand asked about his problem.

"She prescribed some medication to stop the itching andtold me how it needs to be used. I often come here as Ihave two children and it is close to my house. I am happywith the treatment my children receive here and all theservices are free. I could not pay to take them to a privateclinic."

Md. Jasim, 35, brought his daughter, Sarona, 1, to theSavar UHC as his wife was busy working at a nearbygarment factory. "Sarona has had a fever and cough fortwo or three days," he tells me, "I live nearby and havethree children so I come to the hospital when the childrenare sick and also for their vaccines.

"All the facilities are here and we are happy because wedo not need to pay for any treatments. Today the doctorgave me two syrups, one for the fever and one for thecough and she told me how often I need to give it toSarona. As the doctor says it is not a severe form ofpneumonia, we will be able to care for her at home."

UNICEF supports the government to run the upazila andunion level health facilities for child health services in all64 districts of Bangladesh by supplying essential drugs,vaccines and equipment funded through the EssentialHealth Commodities (EHC) project. The facility-basedIMCI programme operates in 125 sub-districts (upazilas)and in these areas, the number of children accessinghealth services has increased by 13 per cent and thequality of care provisions has increased by more than 50per cent. These centres have made a major contribution tocommunity health in a country where one child in fivesuffers from acute respiratory illness (ARI).

Donor: CIDA

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Joyesree Dowri, Senior Staff Nurse, counsels ReemaAkter on the home care (medications, nutrition) neededfor her son, Ali Islam Juboray.

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A group of eight men sit in a semi-circle on the bedroomfloor of a local poultry farmer's house in Gazipur, justnorth of Dhaka. They almost look as if they are at school,waiting for their teacher to begin the lesson. However,these men are not here to study, instead they are playingan important role in the pre-testing stage of an avianinfluenza television spot that will educate the publicabout the danger of migratory birds.

SURCH, a survey and research section of DhakaUniversity, works with UNICEF to carry out research tohelp determine whether avian influenza campaignmaterials will be effective in educating the generalpublic. Currently the SURCH teams are pre-testing 50items, including TV and radio spots, throughout bothurban and rural districts of Bangladesh.

These materials are part of an avian and human pandemiccommunication strategy which is led by UNICEF, inconjunction with its partners, the Government ofBangladesh, FAO and WHO. The communicationactivities aim to inform the public on necessary actions tohelp prevent and limit the spread of the disease.

Plabon Rozuirao, 21, owns a poultry business and waschosen randomly to participate by the research teamwhen they arrived in his village. He says, "Thisawareness programme is a really good idea, it will createa better environment for the Bangladeshi people. The TVmessage is quite clear; people will understand that theyshould not catch migratory birds."

The research officers' role is to see how many times anaudience would need to view the televisionannouncement before they understand the message. It is a

positive sign when the men in Gazipur realize themessage immediately, after listening to the dialogue onlyonce. "Migratory birds are our guest in Bangladesh,"explains Johny Purification, 24. "They come fromanother country so we should not touch them. Theysometimes carry a serious disease so if we catch the birdsthe disease can spread from our hands to the domesticbirds."

Shahanaj Parvin, from SURCH, talks through the script,line by line, to gain feedback from the participants. Sheasks for the men's opinions on the TV spot story board,the sequence of the pictures, whether the pictures matchthe dialogue and any other ways in which the publicservice announcement could be more effective. Even aminor detail, such as the colour of a woman's sari, is notleft out of discussion.

Their opinions range from whether one of the charactersshould wear a sweater because migratory birds arrive inwinter, to the age of the characters, and why there are noother animals pictured in the village scenes. The men allagree that the best time to broadcast the message wouldbe at night, preferably before the news, because everyonewould be too busy with work during the day.

Following the pre-testing of the TV spot, the researchteam choose eight women from the village and this timediscuss a radio spot on the same theme, that migratorybirds should not be handled. Gita Mozumder, 30, ahousewife, says, "The common people in Bangladeshneed to be given this message. I have told my childrenbefore not to play with the migratory birds."

Director of SURCH, Muhammad Shuaib believes the pre-testing is essential to get the right message to the public.The report they provide UNICEF gives an overall pictureof what changes are recommended in order for thecommunication materials to be understood by the greatestnumber of people.

"The most frequent thing we notice from the research isthe selection of words might not be appropriate for allpeople. Sometimes a sophisticated word is used but themore colloquial word might be better for people tounderstand. It is important to make the TV and radiospots appropriate for the everyday people."

The National Communication Strategy, which will informthe public and stakeholders on necessary actions to helpprevent and limit the spread avian influenza, has beenapproved by the Bangladesh government.

Donor: Government of Japan

Pre-testing of avian influenzacommunication materials in rural village

© U

NIC

EF/

Cat

e H

einr

ich

Women from a Gazipur village listen to and discuss a birdflu radio spot with the research team.

13

For most women, giving birth is adifficult enough experience evenwhen they have transport to thehospital, a labour room available anda doctor on duty to deliver the baby.The woman will usually have had aseries of check-ups during herpregnancy to ensure that both motherand baby are healthy. In Bangladesh,this is rarely the case where almost90 per cent of women still give birthat home, with no skilled birthattendant present. When they dodecide to access health services,often there is no transport to thehospital, there might not be abirthing room available and therewill usually be a delay before adoctor can attend to them.

Sharoti, 32, is fortunate that she lives in Fatehpur village,about six hours south-west of Dhaka, and close to theChowgacah Upazila Health Complex (UHC). This healthcomplex has been recognised by UNICEF and theDirectorate General of Health Services as a "womenfriendly hospital" where services such as ante-natal care,maternal care, breastfeeding education, management ofviolence against women and emergency obstetric care(EmOc) are available.

In January, Sharoti suffered from a pregnancycomplication that almost took her life. She didn't evenknow that she was pregnant. "I have three childrenalready, they are 16, 14 and 9 years old," Sharoti tells me."I never had any problems when I gave birth and Idelivered at home here in the village." Sharoti pointsbehind her to show us inside her house where herchildren were born.

However, not everything went as smoothly a few monthsago. "I didn't understand what was happening," saysSharoti. "My period had been a little irregular but thatwas all. One night I had a fainting attack and then Iexperienced severe pain in my lower abdomen thatcontinued all night. So early the next morning I went tothe health assistant's home, which is here in my village."

One of the ways in which Chowgacah UHC reachespeople at the community level is through health assistantswho provide support within their own villages and assistpeople to access healthcare services.

When Sharoti reached the home of the Fatehpur healthassistant, Subol Chandra Biswas, she spoke to his wifewho is a skilled birth attendant. She advised Sharoti to goto the hospital for an ultrasound examination and thenSharoti left their home. Later in the morning, Suboldecided to check on Sharoti to see if she had gone to thehospital. "I found Sharoti in a lot of pain and agony,"

says Subol. "Her husband was working atthe time and out fishing, her childrenwere at school and there was no one totake her to hospital. Also, the family isvery poor and Sharoti did not have anymoney so she had decided not to go."

Subol took Sharoti to a Jessore hospitalan hour away so that she could have anultrasound. It was only then that Sharotidiscovered that not only was she twomonths pregnant, but that it was anectopic pregnancy that had ruptured.

While she was transferred immediately toChowgacah UHC for an emergencyoperation, Subol contacted all the suitableblood donors in his village to collectblood for her transfusion. He also paid forSharoti's ultrasound himself and later

raised money from village donations to pay for heroperation. Following a second operation to remove theblood that had collected in her abdomen when it ruptured,and treatment for a further infection, Sharoti is now fullyrecovered.

Dr. Monira Parveen, a UNICEF maternal health projectofficer, says actions to prevent maternal mortality mustfocus on the three delays. "The first is the delay indeciding to seek treatment because of the low status ofthe women within the family, a poor understanding aboutillness or complications and the family's economic oreducational status. The second delay occurs in reachingthe services because of the long distance to the centre, thelack of transport and the cost of transport. The third delayhappens once women reach the health centre and mainlyrelates to the quality of care."

The community leaders and health assistants play animportant role in informing women about the servicesthat are available at the UHC. They teach women that it'simportant to visit the hospital for check-ups duringpregnancy and to go to the hospital to have a safedelivery. UNICEF supports the improvement of maternalhealth through development of community supportsystems, strengthening emergency obstetric care services,accrediting hospitals like Chowgacah as women friendlyhospitals and piloting Prevention of Parent-to-Childtransmission of HIV (PPTCT).

"This health assistant did not know me," says Sharoti."But he came twice to my house to make sure I wasalright, he took me to the Jessore hospital and also stayedwith me during the operation. I am still alive todaybecause of this man."

Donors: Department for International Development(DFID), European Commission, Canadian InternationalDevelopment Agency (CIDA).

Sharoti's story: "This man saved my life."

Sharoti is lucky to be alive aftershe suffered from an ectopicpregnancy.

© UNICEF/Cate Heinrich

By Cate Heinrich

Editor: Kirsty McIvor (kmcivor@unicef.org), Contributor: Cate HeinrichCover photo: © Mahmud/Map/UNICEF, Design: Makhles/UNICEF

May 21 Arsenic Symposium in DhakaA presentation to be given on new findings concerning the sources andhealth effects of arsenic exposure and the current arsenic mitigationactivities in Bangladesh will be discussed.

May 27-28 Joint UN Chittagong Hill Tracts missionUNDP, WFP, UNICEF, UNFPA and UNESCO will visit the Chittagong HillTracts on a joint mission.

June 6 UNICEF mid-year review

June 8-12 AusAID missionThe Director General of AusAID will visit Bangladesh to observe UNICEF'seducation and health projects.

July 3 National Birth Registration Day

July 7 MDGs mid-way point

August 13-16 Australian National Committee and Starwood Alliance visitMembers of the Starwood Alliance and the Australian National Committeewill visit immunisation projects in Bangladesh.

Coming Events