Health, Nutrition and Population Programme
BRAC’s Health, Nutrition and Population Programme (HNPP) promotes a broad concept of health among
disadvantaged communities through a combination of preventive, curative, rehabilitative and promotional health
services. Healthcare interventions have been an integral aspect of BRAC’s holistic approach to development.
Taking b irth weight of a newborn baby in a village of Gaibandha district, Bangladesh.
Discussing
basic health
issues in a health
forum in a village of
Jamalpur district,
Bangladesh
Aim is to • Improve reproductive,
maternal, neonatal, child
health and nutrition
• Reduce vulnerability to
communicable diseases
and common ailments
• Combat non-
communicable diseases
• Enhance quality of life
Its unique approach through
the frontline community
health workers, namely,
Shasthya Shebika and
Shasthya Kormi brings
health, family planning and
nutrition services closer at
doorsteps, promotes health,
creates demand and links
community with government
and private health sectors. Essential Health Care Evolved as BRAC’s core
health intervention, the
Essential Health Care
(EHC) offers basic, low-cost
essential health services
through community health
workers since 1991.
Special health care is given
to ultra-poor families using
EHC infrastructure. Maternal, Neonatal
and Child Health
Programme Started in 2005 as a pilot
initiative in Nilphamari
district, BRAC’s MNCH
services have been
expanded across 10 rural
districts and 8 city
corporations providing
access to quality MNCH services to rural and
urban slum populations Tuberculosis
Control Programme As the principal recipient
of the Global Fund to Fight
AIDS, TB, and Malaria,
At a glance (Jan2013-Dec2013)
BRAC HEALTH PROGRAMME Coverage 64 districts
Population 120 m Shasthya Shebika 97,000 Shasthya Kormi 10,008
Programme Organiser 4,224 District Manager 194 Medical Officer (Field) 53
ESSENTIAL HEALTH CARE Coverage 64 Districts Population 120 m Contraceptive acceptance (Modern method) 24,385,756 CHWs assisted
immunisation 1,344,612 Ultra poor
received treatment 188,601
www.health.brac.net
BRAC has been working along
with the government to offer
service for TB control. In
addition to providing 42 partner
NGOs with technical support
and supervision, BRAC directly
implements TB related activities in 297 sub-districts since 1998.
Malaria Control
Programme The National Malaria Control
Programme works with 20 NGOs
led by BRAC to implement control
activities in affected areas. As a
principle recipient for the NGO
component, BRAC provides
support to other NGO partners
and directly impliments
programme in high endemic
Chittagong Hill Tract districts and
in Moulvibazar. Nutrition Programme The Infant and young child
feeding practices (IYCF) are
being promoted through Alive &
Thrive project to address under-
nutrition of U2 children. Evidence
of IYCF practices has been
replicated in MNCH programmes
and gradually expanded to 50
sub-districts by adopting 1000
days approach. Micronutrient
powders are also promoted to
address childhood anemia. Eye Care Interventions Vision Bangladesh (2
nd phase)
aims to eliminate the backlog of cataract blindness from
urban slums by 2015. Vision Spring Aim is to combat presbyopia
which results difficulty in near vision and reduces
productivity of adults over
the age of 35 years.
Facility Based Services BRAC facility based initiative was
established by linking community
with good quality curative and rehabilitative services
at affordable costs to
general population. mHealth (mobile Health) Intervention mHealth was initiated in urban
slums of Dhaka to address
quality maternal, neonatal and
child health services through
mobile phone based
technological platform by
providing patient care and
emergency management
support and ensuring
monitoring and supervision. A
comprehensive digital echo- system has been created,
tested and equipped for
scale-up to ensure quality of
care in low resource setting.
BRAC Healthcare Innovations Programme (bHIP) bHIP aims to jump-start the
journey toward universal health
coverage in Bangladesh by
providing a transformative
option for the health care
consumer. It will provide access
to comprehensive, good quality
care that minimizes the risk of
economic compromise and will
integrate three major lines of innovation in healthcare related
to service provision, financing
and information management.
MATERNAL, NEONATAL AND CHILD HEALTH PROGRAMME Rural Urban Coverage 12 dist. 9 city corp. Population 21.2 m 6.9 m 4+ ANC 377,412 99,435 Hospital delivery 134,658 75,487 BRAC Delivery centre delivery - 32,216 Immunisation 390,974 107,270 TUBERCULOSIS CONTROL PROGRA MME Coverage 42 districts Population 92.9 m TB symptomatic tested 120,480 TB case detected and treated 89,983 Treatment success rate
of smear positive case 93 MDR-TB patients diagnosed 193 MALARIA CONTROL PROGRAMME Coverage 4 districts Population 2.18 m Long Lasting Insecticidal
Mosquito Nets (LLIN)
distributed and in use 120,100 Malaria patients treated 11,428 NUTRITION PROGRAMME Coverage 104 sub districts Population 26.5 m Exclusive breastfeeding 911,219 Timely & appropriate
complementary feeding 173,832 Sprinkle sachet distributed
(61 districts) 14.5 m
EYE CARE INTERVENTIONS Vision Bangladesh Suspected patient examined 451,199 Cataract surgeries done 42,082 Vision Spring Person examined for eye problem 531,278 Glasses provided 104,289
FACILITY BASED SERVICES
BRAC Health Centre 18 BRAC Clinic 13 BRAC Limb and Brace Centre 2
Although ev ery effort has been made to include and verify the accuracy of relevant inf ormation in this fact -sheet, users are urged to check independently on matters of specif ic interest.
Report any discrepancies/suggestions to [email protected]. This document was last updated on March, 2014, is revised quarterly and made available on www.brac.net/visitors.
SOCIAL MOBILIZATION ATTENDED FOR THE MONTH OF APRIL- JUNE 2012
DEMOGRAPHY
District 47
Upazila 363
Population 53 million
HUMAN RESOURCES
District Manager 99
Upazila Manager 379
Program Organizer 1,815
Shasthya Kormi 4,204
Shasthya Shebika 48,842
HEALTH AND NUTRITION EDUCATION
Group health education forum 3,089,891
WASH PROMOTION
Slab latrines installed 172,728
IMMUNIZATION
Under 1 children fully immunized 846,368
Pregnant women received TT 783,794
FAMILY PLANNING
Contraceptive acceptance (Modern)
6,360,085
PREGNANCY RELATED CARE
4 or more antenatal care 497,291
Skilled attendance at birth 619,716
BASIC CURATIVE CARE
Common ailments treated by SS 3,909,235
Patients referred by SS 195,700
TUBERCULOSIS CONTROL
Sputum microscopy for TB 1,123,642
MALARIA CONTROL
Symptomatic malaria case tested 164,785
MANAGEMENT OF PNEUMONEA
U5 pneumonia managed 257,062
MANAGEMENT OF DIARRHOEAL DISEASES
U5 diarrhea managed by ORS 321,669
NUTRITION
Early initiation of breastfeeding (within one hour)
762,556
ESSENTIAL HEALTH CARE PROGRAMME At a glance’ 2013
Initiated in 1991 Essential Health Care (EHC) has revolutionized the primary health care approach in Bangladesh reaching millions with low cost basic promotive, preventive and curative services through the frontline community health workers – Shasthya Shebikas and Shasthya Kormis. Goal Improve access to essential health services through delivering community care and organizing a bridging network with public health care system Objectives
Promote positive health, nutrition and hygiene behaviors and create demand for public and private health services
Mobilizing children and women for preventable vaccination, deworming and vitamin A supplementation
Improve domiciliary access to non-clinical contraception and referral for clinical ones
Ensure early screening for pregnancy complications, appropriate referral in emergencies and facilitation of safe home delivery
Provide home based management with referral for common symptoms, including diarrhea and pneumonia
Provide early recognition, diagnosis and supervised treatment for infectious and common non communicable diseases
Provide screening support for presbyopia and cataract and arrange for correction
Strategy Shasthya Shebikas (SS) and Shasthya Kormi (SK), the frontline community health workers are locally recruited women and trained as health providers to deliver door-step health service. They prevent and promote health activities through health education and dissemination of health and nutrition messages through health forums, household visits and meetings with the wider community. In addition, basic curative services are provided at doorsteps of target populations. In collaboration with the government, BRAC is working in areas of immunization, family planning and basic pregnancy related care. More importantly, major interventions, such as, tuberculosis, malaria and maternal, neonatal and child health and nutrition programmes are founded on the basic structure of
EHC.
SOCIAL MOBILIZATION ATTENDED FOR THE MONTH OF APRIL- JUNE 2012
PROFILE
District 42
Upazila 297
City Corporation 7
Population 92.9 million
Rural: 88.2 & Urban: 4.7 million
HUMAN RESOURCES
Shasthya Shebika involved in DOTS
63,810
Program Organizer (Lab) 508
Program Organizer (Field) 1,153
SETUPS AND PLACES COVERED
Peripheral laboratories 392
DOTS corner at hospitals 27
Prisons covered 41
Port hospital covered 2
EPZ covered 1
Work places covered 776
TRAINING PARTICIPANTS
Basic training on TB 276
Health management training 45
Capacity building on M&E 68
Training on PSM, PMDT, IC, PAL, TB/HIV
340
Training on Child TB 2,138
Training on PAL (Practical Approach to Lung Health)
324
Training of lab technicians 240
Orientation of interns & private practitioners
2,1,354
Training on MDR TB 1,179
Training of multipurpose health staff of SRs
196
SOCIAL MOBILIZATION PARTICIPANTS
Religious leaders 32,195
Village doctors 31,874
Factory workers 19,581
Scouts and girls guide 2,089
Cured TB patients 31,281
Women group members 8,120
TB/HIV NGO workers 1,213
PERFORMANCE
New smear positive cases 71,674
New smear negative cases 30,497
New extra pulmonary cases 18,309
Symptomatic tested for MDR TB
2,220
MDR TB patients diagnosed 193
INFORMATION SR (SUB RECIPIENT)
Total number of SRs 42
Population coverage 57 million
Human resources 986
Map of Bangladesh indicating districts supported by NGOs (excluding metropolitan city areas)
In Bangladesh, tuberculosis (TB) is a major public health problem and a leading cause of adult mortality. The WHO ranks Bangladesh the 6th among 22 high burden TB countries. Every year around 76,000 people die of TB in Bangladesh. BRAC is the first NGO to sign a MoU with the Government of Bangladesh in 1994 to expand the Directly Observed Treatment Short course (DOTS) services nationwide. Along with the government, BRAC is the principal recipient of Global Fund to Fight AIDs, Tuberculosis and Malaria (GFATM) to strengthen health system and expand DOTs across Bangladesh. BRAC and 42 NGOs are implementing TB interventions in partnership with the government. Goal To reduce morbidity, mortality and transmission of TB until it is no longer a public health problem. Objectives To achieve and sustain at least 70% case detection and 85% treatment success among smear-positive TB cases under DOTS. BRAC’s approach for TB diagnosis and treatment focuses on community level education and engagement. BRAC conducts orientation with different stakeholders of the community to engage them in efforts to identify patients, ensure treatment adherence, and reduce stigma. The stakeholders include: cured TB patients, local opinion and religious leaders, girls’ guides and scouts, other NGO workers, village doctors, pharmacists and private practitioners. The Shasthya Shebika (SS), the first frontline community health worker, plays a pivotal role of connecting individuals with TB control services during household visits and health forums. They disseminate TB messages, identify suspects, refer them for sputum examination to Upazila Health Complex (Government sub-district health complex) or BRAC laboratory services, ensure daily intake of medicine for identified TB patients through DOT and refer for proper management of the side effects during TB treatment.
TB CONTROL PROGRAMME At a glance’ 2013
Epidemiology
District 13
High Endemic Districts (Chittagong Hill Tracts) 3
Moderate Endemic Districts 1
Low Endemic Districts 9
Upazila 70
Risk Population 13.1 million
Number of Malaria cases in 2012 29,518
Number of Malaria deaths in 2012 11
P. Falciparum: P. Vivax 96:4
Information about BRAC
Working Areas 27 Upazilas
Population Coverage 2.18 million
Shasthya Shebika involved in Malaria 3,132
Shasthya Kormi involved in Malaria 686
Programme Organizer (Lab) 73
Programme Organizer 160
Training participants
Laboratory Technicians trained on malaria microscopy
40
Staff trained on reporting documentation and m -health
101
Staff trained on Logistic Management Information System
48
Staff trained on Public Health Management 44
Staff trained on ACSM 49
Health Workers trained on Diagnosis and Treatment
320
Staffs trained on Malaria Management 20
Performance
Blood slide examination 89,354
Rapid Diagnostic Test (RDT) 55,465
Malaria cases diagnosed 11,569
P.falciparum diagnosed 11,419
P. vivax diagnosed 150
Malaria cases treated by community service providers
11,428
Severe malaria referred 15
Social Mobilization
Popular theatre shows held 507
Folk song events organized 507
Peoples oriented on malaria through BCC 8,327
Village Doctors oriented on malaria 2,583
LLINs distributed 120,100
Information about SR NGOs (Sub-Recipient)
Number of SRs 20
Working Areas 47 Upazilas
Population Coverage 10.92 million
Health Workers 1,037
Other Human Resources 261
Malaria is a major public health problem in 13 districts of Bangladesh, of which Chittagong Hill Tracts (CHTs), Cox’s Bazar and Chittagong are highly endemic.
Sporadic incidence occurs in other parts of the country. In partnership with the National Malaria Control Programme (NMCP), BRAC successfully secured a grant
from the GFATMto strengthen and expand national malaria control activities to all endemic districts working directly and through other NGOs.
Goal To reduce overall burden of malaria (morbidity and
mortality) by 60% from baseline year 2008 in 10.9 million populations in 13 high endemic districts of Bangladesh by 2015
Objectives To expand use of LLIN, 2 nets per household, to
achieve 100% coverage in 3 high malaria endemic districts and maintain 80% coverage with ITN/LLIN in the remaining districts
To expand and improve quality diagnosis and treatment to 90% of malaria cases
To further strengthen program management
capacity, and coordination and partnership in malaria control
BRAC’s main approach for malaria control is to inform
and educate people at community level, promote use of insecticide treatedbed nets andincrease early diagnosis and prompt treatment of malaria. BRAC also enhances
referral of symptomatic cases for diagnosis by RDT or BSE, ensure treatment, and reduce stigma. The Shasthya Shebikas and Shasthya Kormis (Health
Workers) are responsible for providing diagnostic and treatment services at community level. They also refer patients to the nearest government health facility and pay
special attention to pregnant women, children under 5 kg of weight and severe malaria cases.
Malaria Control Programme At a glance’ 2013
DEMOGRAPHY (12 Districts)
District 12
Upazila 82
Union 788
Village 14,106
Population 21.2 million
House hold 5,081,566
STAFFING PATTERN (12 Districts)
District Manager 25
Program Organizer 902
Paramedic 46
Shasthya Kormi 3,180
Shasthya Shebika 33,884
Newborn Health Worker 17,157
Community Skilled Birth
Attendant (CSBA) 752
MATERNAL HEALTH (10 Districts)
Contraceptive acceptance
rate (Modern method) 64%
Antenatal care by SK 2,244,721
Total delivery 402,405
Facility delivery 134,658 (33%)
Delivery by skilled birth
attendant 168,923 (42%)
C-section 69,725 (17%)
Four or more antenatal care 377,412 (94%)
Postnatal care within 48
hours of delivery 242,660 (91%)
Three or more postnatal care 314,635 (88%)
Maternal mortality ratio 182
NEONATAL HEALTH (10 Districts)
Live birth 392,347 (98%)
Low birth weight 73,241 (21%)
Initiation of breast feeding
within one hour of birth 363,642 (96%)
Birth asphyxia diagnosed 12,712 (3%)
Birth asphyxia managed by
SS 7,553 (59%)
Neonatal sepsis referred 8,291 (87%)
Neonatal mortality rate 30
CHILD HEALTH (10 Districts)
Exclusive breast feeding 213,436 (55%)
Fully immunized children 390,974 (99%)
Pneumonia managed by SS 154,792 (88%)
Diarrhea managed by SS
with ORS 272,971 (97%)
IMPROVING MATERNAL, NEONATAL & CHILD SURVIVAL PROJECT At a glance’ 2013
Goal To reduce maternal, neonatal and child mortality and morbidity, particularly, among the poor and socially excluded populations Objectives Increase knowledge and practices related to maternal,
neonatal and child health Improve provision of quality maternal, neonatal and child
health services at household and community levels Increase availability and access to quality continuum of
maternal, neonatal and child health care and services at facilities
Increase participation, accountability and responsiveness to communities’ voice in maternal, neonatal and child health services
Community health workers (CHW), namely, Shasthya Shebika, Newborn Health Worker, Shasthya Kormi and Community Skilled Birth Attendant (CSBA) are the frontline workers catering family planning, pregnancy related care, newborn and under five child care at door steps. Behavior change towards healthy practices in terms of reproductive health, nutrition, hygiene and sanitation is the strategy to preventive and promotive care. CHWs offer basic care e.g., antenatal care, delivery care, postnatal care, newborn care and management of birth asphyxia, diarrhea, ARI and some common ailments. CSBA attends home deliveries to ensure safe maternal and neonatal outcome at birth. A well-structured referral system is in place to reduce delays in accessing health care by bridge gaps between community and facility during emergencies. UNICEF is working with the government at hospitals and health facilities to improve health care. In essence, a continuum of care is provided to mothers, neonates and under-five children.
Improving maternal, neonatal and child survival (IMNCS) project
is a comprehensive community based health intervention focusing
on preventive and curative care with a group of trained community
health workers under structured supervision and monitoring
system. This comprehensive undertaking is uniquely designed to
address the bottlenecks of demand and supply side for ensuring
continuum of care from home to hospital. About 21.6 million
populations living in rural areas of 12 districts are being reached
with maternal, neonatal and child health services.
DEMOGRAPHIC PROFILE
City corporations 09
Regions 13
Branches 72
Delivery centers 375
Population 6,857,955
House hold 1,920,657
STAFFING
Regional Manager 13
Branch Manager 72
Program Organizer 289
Manoshi Midwives 157
Shasthya Kormi 981
Shasthya Shebika 6,789
Urban Birth Attendant 805
MATERNAL HEALTH
Contraceptive acceptance rate
65%
New pregnancy identification
193,176
Antenatal care (ANC) by SK 824,178 (93%)
Total delivery 123,080 (81%)
Facility delivery 75,487 (61%)
Delivery at “Delivery Center” 32,216 (26%)
Delivery by skilled attendance
85,197 (69%)
C-section 41,359 (34%)
Four or more antenatal care 99,435 (81%)
Postnatal care (PNC) within 48 hours of delivery
122,624(100%)
Three or more PNC 95,871 (94%)
Maternal mortality ratio 130
NEONATAL HEALTH
Live birth 120,979 (98%)
Initiation of breast feeding within one hour of birth
118,531 (98%)
Low birth weight 15,779 (13%)
Birth asphyxia diagnosed 3,614 (03%)
Neonatal sepsis diagnosed 6,346 (05%)
Neonatal mortality rate 17
CHILD HEALTH
Exclusive breastfeeding 60,110 (60%)
Fully immunized children 107,270 (99%)
In Bangladesh, about one-third of the populations live in urban areas with worse health situation in slums and squatters of Bangladesh. To improve health status of slum population particularly women and children, BRAC started Manoshi, a community based health care programme in 2007 in urban slums of six city corporations in Bangladesh through the development and delivery of an integrated, community-based package of essential health services . Goal To decrease illness and death in mothers, newborns, and children in urban slums of Bangladesh Objectives
Increase knowledge of individuals, households and community
Increase skills and motivation of human resources to offer services at household and community levels
Improve and strengthen referral system for management of complications
Strengthen and sustain linkage with government, NGO and private health facilities
Develop a supportive network to support communities and individual households to sustain services
Facilitate scaling up of successful approaches Manoshi envisages improvements in health status of poor urban mothers, newborns and children by bringing healthcare services at their doorstep via our community frontline health workers (CHWs). The Shasthya Shebikas and Shasthya Kormis provide household level antenatal and postnatal care and essential newborn care (ENC) and child health care. They use behavior change communication interventions to motivate, educate and prepare expectant mothers for delivery, highlighting an array of health issues including maternal and neonatal dangers signs, maternal and neonatal nutrition, etc. BRAC Delivery Centers are established within slums to provide intra-natal care to mothers and immediate care to newborns. Emergency obstetric, neonatal and child health complications are referred to the hospital through an established referral system from slum to hospital or health facilities strengthening linkages, and ensuring continuum of care. Community is connected with health facilities via an innovative mobile phone based referral system. After expanding to two additional city corporations in 2012, Manoshi is currently being implemented in 9 city corporations.
MANOSHI At a Glance’ 2013
ALIVE AND THRIVE PROFILE
District 16
Upazila 50
Union 413
Population 1,05,73,320
UNDER 2 CHILDREN PROFILE (Monthly on an
average)
0-6 months 284,124
7-12 months 318,513
13-24 months 659,740
Under 2 children / district 289,557
Under 2 children / upazila 92,658
Under 2 children / union 11,218
Under 2 children / PK 4,282
Under 2 children / SS 648
ALIVE & THRIVE INFORMATION
Shasthya Kormi 633
Shasthya Shebika (health
volunteer) 7,154
Pushti Shebika 2,517
Pushti Kormi (IYCF promoter) 1,082
Po (A&T) 100
PERFORMANCE
Live birth 152,877
Early initiation of breast feeding 140,078 (92%)
Exclusive breast feeding 911,219 (92%)
Timely initiation of CF 173,832 (97%)
Information on CF:*
Appropriate amount 453,826 (81%)
Proper frequency 495,900 (88%)
Animal food 498,004 (89%)
Orderly placed hand washing
station 406,222 (72%)
*information on CF is for 8-12 months
of children
SOCIAL MOBILIZATION
School teacher & guardians 14 (278)
Village doctors 285 (5,540) Fathers of 7-8 months children 1,445 (27,096)
Graduate doctor orientation 47 (866)
Popular theater 3,144
(1,131,980)
ALIVE AND THRIVE At a Glance (January to November’2013)
Alive & Thrive (Community Component) initiative aimed to develop scaled up models for preventing child malnutrition through improving Infant and Young Child Feeding (IYCF) practices. A&T’s intervention focuses on achieving behavior change in IYCF through counseling, coaching and demonstration at household level by trained community health workers. Core Interventions: Home visits Where SSs, and PKs provide mothers of children 0-24 months of age IYCF counseling, coaching, demonstrations, problem-solving, and referrals. Home visits provide the opportunity to:
Provide timely and targeted counseling on recommended IYCF practices
Ask about barriers to recommended practices and ways of overcoming them
Teach and demonstrate skills such as positioning and attachment of the baby to the breast and combinations of household foods to improve the quality of complementary food.
Solve feeding problems or refer for assistance Social mobilization Social mobilization sessions on IYCF raise awareness and seek commitments to action by influential members of the community. This provides an overview of the nutrition situation and the importance of providing optimal nutrition for children during the vulnerable first two years and to acquaint stakeholders with the objectives and activities of Alive & Thrive. Participants at this orientation include government and nongovernment officers, political and religious leaders, health officials, alternative health care providers, teachers, adolescents, and other respected members of the community.
PROJECT PROFILE
District 17
Upazila 104
Population 26,505,166
STAFF INFORMATION
Shasthya Shebika 16,213
Pushti Shebika 5,008
Shasthya Kormi (Pushti) 2,532
PO (Nutrition) 213
UNDER 2 CHILDREN PROFILE
0-24 Months 8,26,842
0-6 Months 2,08,493
7-12 Months 2,08,887
13-24 Months 4,09,462
PERFORMANCE
Live birth 1,47,760
EIBF 74%
EBF 76%
Timely initiation of CF 85%
Animal food consumption 78%
Hand washing 52%
PREGNANT WOMEN AND ADOLESCENT INFORMATION
# Of pregnant women counseled
on maternal nutrition 364,492
# Of lactating women counseled
on nutrition 9,422,709
# Of adolescent girls counseled
on nutrition
313,314
SOCIAL MOBILIZATION
Religious leader 437 (8,740)
Village doctors 430 (8,600)
Gob health & FP staff 412 (8,240)
GoB health & FP staff 102 (2,040)
Fathers 765 (15,300)
NUTRITION PROJECT At a glance’ 2013
The Nutrition Project of BRAC is based on BRAC’s experience
over many years in providing nutrition intervention addressing the
determinants of malnutrition. The program aims to reduce
malnutrition among pregnant-lactating women, adolescent girls,
and young children in order to reduce mortality and morbidity,
particularly among poor and socially excluded populations.
Focusing Area:
IYCF, Maternal and Adolescent Nutrition.
Core Interventions:
Home visits
Where SSs, and SKs provide mothers of children 0-24
months of age IYCF counseling, coaching,
demonstrations, problem-solving, and referrals
SSs and SKs provide counseling on maternal diet
diversity for pregnant and Lactating mothers
Court yard meeting with a group of adolescent girls on
nutrition, balance diet, anemia: causes and prevention,
menstruation management and UTI.
Social mobilization
Social mobilization sessions on IYCF, maternal and adolescent
nutrition raise awareness and seek commitments to action by
influential members of the community. This provides an overview
of the nutrition situation and the importance of providing optimal
nutrition for the vulnerable groups like, children under two years
of age, pregnant women as well as adolescent girls with the
objectives and activities of Nutrition Project. Participants at this
orientation include government and nongovernment officers,
political and religious leaders, health officials, alternative health
care providers, teachers, adolescents, and other respected
members of the community.
DEMOGRAPHY
District 61
Upazila 455
Population 100 million
UNDERNUTIRTION IN BANGLADESH
Children 6-59 Months Old 15.4 million
(100%)
Underweight Children 5.5 million
(36%)
Anemic Children 9.9 million
(64%)
STAFFING
Shasthya Shebika 82,959
Shasthya Kormi 8,000
Program Organizer 494
MNP DOSE AND SCHEDULE (WHO 2011)
1 Sachet daily 2 months 60 Sachets
4 months gap
1 Sachet daily 2 months 60 Sachets
4 months gap
Total 1 year 120 Sachets
SACHET DISTRIBUTION
Distribution (Jan-Dec’13) 14.5 million
Distribution since launch 41 million
To prevent and control iron deficiency anemia and other
micronutrient deficiency, Bangladesh Sprinkles Programme
was launched in 2010 by BRAC in collaboration with Global
Alliance for Improved Nutrition (GAIN) and Renata Ltd.
BRAC currently promotes and makes micronutrient powder
(MNP)/Pushtikona available through its network of
community health workers for children 6-59 months.
Mothers are given demonstration how to follow correct
procedures for home-based food fortification with
Pushtikona. MNP dosage is given according to WHO
protocols and compliance monitored by BRAC health
workers. Families buy Pushtikona sachets but BRAC
provides free sachets to the very poor families through
BRAC’s Ultra Poor Programme.
Pushtikona is integrated into BRAC’s many different health
interventions for improving anemia situation:
Rural platforms
Essential Health Care (EHC)
Maternal, Neonatal, and Child Health (MNCH)
Alive and Thrive (A&T)
Challenging the Frontiers of Poverty Reduction:
Targeting the Ultra poor (CFPR-TUP)
Urban platforms
Manoshi (MNCH-Urban)
BANGLADESH SPRINKLES PROGRAMME At a glance’ 2013
Sprinkles Available
No Sprinkles (Malarial Regions)
Bangladesh Total: 64 Districts Sprinkles Coverage: 61 Districts
PROFILE
Category Number
BRAC Health Center 18
BRAC Clinic 13
BLBC 2
Doctor 76
Nurse 121
OUTDOOR SERVICES AT BHCs / CLINIC
Category Patients
Outdoor 71,779
Indoor 10,970
PREGNANCY RELATED CARE AT BHCs / CLINIC
Services provided Attended
Antenatal care (ANC) 22,753
Postnatal care (PNC) 2,206
INDOOR SERVICESAT BHCs / Clinic
Services Patient
MR / post-abortion care 2,807
Normal deliveries 3,680
Caesarian section 3,522
Major surgery (Gynecology) 106
Major surgery (General) 129
SERVICES IN BLBC
Services Patient
Total Patient
1,843
Above Knee prosthesis 81
Below knee prosthesis 170
Brace 1,097
Physiotherapy 194
COST RECOVERY (BHCs/BLBCs/Clinic)
BHC BRAC Clinic
BLBC
Cost recovery 50.86 50.30 91.29
BRAC facility based care has started its journey in 1995. To
meet the need of the community, the static health facilities
have emerged to offer a package of curative, promotive and
rehabilitative health services through a sustainable and
comprehensive approach at a reasonable cost.
Recently, BRAC has revisited the approach of facility based
services and classified it into three categories: BRAC Health
Center (BHC) (basic outpatient services and normal delivery);
BRAC Clinic (comprehensive outpatient and inpatient
services) and BRAC Hospital (all services facilities).
At present, BRAC runs a network of 31 BHCs (n=18) and
Clinics (n=13). Further to offer quality services, BRAC is in
the stage of establishing three hospitals in Rangpur, Hobigonj
and Gazipur by upgrading the existing ones into 50-bed
Hospitals. BRAC is also enhancing lab facilities turning those
into BRAC Diagnostics.
To support the physically disabled populations with
rehabilitative aids and services, BRAC is operating two BRAC
Limb and Brace Centers (BLBCs) providing low-cost
appropriate technology.
BRAC FACILITY BASED SERVICES At a glance’ 2013
DEMOGRAPHY
District 7
Upazilla 37
Union 380
Population 16 million
PERFORMANCE
Patient screening programme
(PSP) held
886
Persons examined 451,199
Refraction error identified 22,460
Presbyopia identified 15,125
Glasses sold 5,868
Cataract identified 45,526
Cataract operated 42,082
SOCIAL MOBILIZATION
Folk songs 87
Advocacy meeting with municipality 6
Upazilla coordination meeting 44
Meeting with local Govt. bodies 36
Meeting with religious leader 156
Meeting with primary school teachers 261
VISION BANGLADESH PROJECT At a glance’ 2013
Vision Bangladesh Project (VBP) is a joint venture of Ministry of
Health & Family Welfare (MoH&FW) of Bangladesh, BRAC and
Sightsavers to eliminate the cataract backlog from Sylhet
division by 2013. Besides, National Eye Care and BRAC have
jointly initiated the 2nd phase of Vision Bangladesh Project from
July 2013-December 2015.
Goal
Elimination of avoidable blindness from Bangladesh by 2020
Specific Goal
Elimination of the backlog of cataract blindness from Sylhet
division by the year 2013 and from slums of cities by the year
2015”.
Objectives
Increased demand for eye care services particularly for
cataract in the community
Increased accessibility to quality eye care services
especially cataract particularly for the poor
Developed efficient HR of service providing eye care
facilities
Managed programme efficiently and effectively
This project is undertaken in close partnership with the
government health sectors under the leadership of the Civil
Surgeon. All BRAC staffs are trained in prevention of blindness
in the intervention areas. The activities include dissemination of
eye health message, patient detection, referral to eye care
facilities and follow-up of the patients BRAC staff mobilize the
community people through different forum to attend patient
screening programme (PSP) for eye care services. The
community health workers are trained to identify suspected
cataract patient and carry out the activities by visiting houses.
They refer suspected patients to the PSP for screening. The
diagnosed cataract patients are referred to specially selected
eye hospitals. The operated patients are followed up at home. If
any complications occur, respective eye care hospitals are
immediately informed for appropriate management of the
patients. Local government stakeholders are also involved in the
programme.
Sylhet Division
Barisal C.C.
Khulna C.C.
Dhaka C.C.
DEMOGRAPHY
District 54
City Corporation 7
Upazila 407
Target population 16.1 million
TRAINING INFORMATION
District Manager 74
Upazila Manager 464
Program Organizer 2,223
Nurse / Paramedic 23
Shasthya Kormi 2,788
Shasthya Shebika 16,679
PERFORMANCE
SS involved in eye screening 12,172
Persons screened 531,278
Identified as presbyopia 368,159 (69%)
Identified with other eye problems
80,976 (15%)
Referred (other than presbyopia)
53,661 (66%)
Identified as no eye problem 82,143 (15%)
Total glasses sold 104,289
a) Single Vision 65,620 (63%)
b) Bi-focal 37,041 (36%)
c) Sunglasses & Eye Protector
1,628 (2%)
R A N G A M A T I
S Y L H E T
T A N G A I L
B O G R A
B A N D A R B A N
K H U L N A
C O M I L L A
P A B N A
D I N A J P U R
N A O G A O N M Y M E N S I N G H
S U N A M G A N J
C H I T T A G O N G
J E S S O R E
S A T K H I R A
H A B I G A N J R A J S H A H I
R A N G P U R
N E T R A K O N A
N A T O R E
D H A K A
S I R A J G A N J
B A G E R H A T
K U R I G R A M
B H O L A
F A R I D P U R
N O A K H A L I F E N I
K U S H T I A
J A M A L P U R
M A U L V I B A Z A R
G A Z I P U R
G A I B A N D H A
K I S H O R E G A N J
J H E N A I D A H
K H A G R A C H H A R I
C O X ' S B A Z A R
C H A N D P U R
N I L P H A M A R I
S H E R P U R N A W A B G A N J
N A R A I L
R A J B A R I
T H A K U R G A O N
G O P A L G A N J
M A G U R A
M A N I K G A N J
B A R I S A L
B R A H A M A N B A R I A N A R S I N G D I
P A N C H A G A R H
S H A R I A T P U R M A D A R I P U R
L A K S H M I P U R
C H U A D A N G A
L A L M O N I R H A T
J O Y P U R H A T
M U N S H I G A N J
P A T U A K H A L I
M E H E R P U R
P I R O J P U R B A R G U N A
N A R A Y A N G A N J
J H A L O K A T I
Plan for expansion
Present coverage
READING GLASSES FOR IMPROVED LIVELIHOODS At a glance’ 2013
In Bangladesh about 20% people suffer from presbyopia and
are deprived of contributing to household activities and in the
national economy as well, so it has become a major public
health problem.
This project aims to combat presbyopia - a chronic eye
problem, which results difficulty in near vision and reduces
productivity of adults over the age of 35 years. It has been
implemented in partnership between BRAC and VisionSpring
which is a non-profit organization in the USA.
The mission of VisionSpring is to reduce poverty and generate
opportunity in the developing world through the sale of
affordable eyeglasses is consistent with the mission of BRAC
which is bring positive changes in the quality of life of people
who are poor.
The activities on reading glasses have been incorporated in
the normal work schedule of the Shasthya Shebika (SS).
Before conducting vision screening in the community the SS
mobilizes people who suffer from eye problems. She uses
forums like village organization (VO) meeting, group health
education meeting etc. For a broader coverage of the program
camps are also held in different project areas. After testing
vision the SS offers reading glasses of proper magnification to
the presbyopic clients at affordable cost. Patients with other
eye complaints are referred to district eye hospitals. Shasthya
Kormi and Program Organizer support the SS in screening and
referral. Upazila Manager and other supervisors provide
periodic supervision and follow-up.
DEMOGRAPHY
District 40
Upazila 222
Population 850,608
HUMAN RESOURCES
Regional Manager 3
District Manager 37
Program Organizer (Branch) 326
HEALTH AND NUTRITION EDUCATION
Household visited 129,000
Eligible couple mobilized for family planning
68,283
REPRODUCTIVE AND MATERNAL HEALTH
Contraceptive acceptance (Modern) 48,531
Delivery by skilled birth attendant 2,053
Four or more antenatal care 3,504
Pregnant women protected against tetanus
1,430
CHILD HEALTH CARE
Early initiation of breastfeeding within one hour of birth
4,072
Under five children with diarrhea managed by ORS
3,166
Under five children with pneumonia managed
5,018
Children benefited through micronutrient supplements
99,028
WATER AND SANITATION
Slab latrine installed 10,901
Tube-well installed 248
MORBIDITY TREATED
Morbidity episodes treated 188,601
CAPACITY DEVELOPMENT
Regional managers - TUP 90
District mangers - STUP 89
Upazilla manager 214
Programme Organizer - TUP 786
Capacity development on IYCF for PO 315
Shasthya Kormi 926
Shasthya Shebika 4,8
4,895
ESSENTIAL HEALTH CARE PROGRAMME FOR CFPR-TUP At a glance’2013
In Bangladesh, 8% of populations are suffering from extreme poverty. Their health status lags far behind than general populations. Essential Health Care (EHC) services for ultra-poor under CFPR-TUP (Challenging the Frontiers of Poverty Reduction – Targeting the Ultra Poor) program is a specially designed programme to meet the needs of extremely poor households, who are unable to access or benefit from traditional development interventions. Goal To reduce the vulnerability of the poor and ultra-poor to sudden health shocks and to prevent them from sliding back into the vicious cycle of extreme poverty The program aims to increase access to health services, through demand-based strategies and by providing a package of basic health services with a special focus on meeting the needs of the ultra-poor. The strategy involves social mobilization, raising health awareness and provision of basic health care services for all, especially for the targeted ultra-poor. Financial constraints are major impediments to accessing the available health services by the ultra-poor. To address this problem of financial constraints to health care, BRAC has introduced the provision of providing financial assistance to the ultra-poor so that they can access medical care from Government or other health facilities. Community participation is ensured in the program through community forum (Gram Daridro Bimochon Committee) which forms an organized network for the improvement of health and social status of rural poor in each village. Committee members actively provide motivation and financial support to the ultra-poor for accessing different health services.