Where We Work : Tanzania : Health

BRAC takes a multifaceted approach to delivering essential health care in Tanzania. We focus on the prevention of malaria, tuberculosis (TB), and HIV/AIDS, the reduction of infant and under-five mortality rates. We increase accessibility to healthcare by taking it to the doorsteps of the people and improve utilisation of government and private health facilities.

At the centre of BRAC’s approach are the Community Health Volunteers (CHVs), who are women selected from their microfinance groups and trained to provide basic health care. Every day, 1,645 dedicated CHVs provide basic healthcare services to their communities. Each CHV has overall responsibility for 150 to 200 households in her area that she will visit, all within one kilometre of her home. During each visit, a CHV checks on the health of household members, offers treatment for basic illnesses and checks to see if there are any pregnant women in the house, in which case she refers them for antenatal check-ups. The CHVs earn a small income from selling health-care products, such as insecticide-treated bed nets, contraception and some over-the-counter medicines. For serious cases, she refers patients to health facilities.

CHVs are supported and supervised by Community Health Workers (CHWs), who are staff members responsible for implementing the health programme at the branch level. One of their duties is to help CHVs conduct community health forums on such topics as sanitation, hygiene, HIV/AIDS and malaria. There are two CHWs in every branch, each responsible for 10 CHVs. Area Health Coordinators with nursing diplomas are responsible for five branches.

Programme Description

BRAC’s Essential Health Care (EHC) programme in Tanzania is a scalable model of community health care. The overall goal of the programme is to improve health conditions and increase access by providing basic health services in communities where BRAC has an established microfinance group. One member of each BRAC microfinance group is designated and trained as a Community Health Volunteer. CHVs serve the health needs of the entire community, with particular attention to poor women and children.

Programme Objectives

To increase reproductive health care services by raising awareness, ensuring antenatal care (ANC) and post-natal care (PNC) visits, and facility based deliveries.

• To reduce the incidence of malaria, especially among pregnant women and children, by enhancing control and prevention
• To bring positive behavioural change for prevention of HIV/AIDS and ensuring access to HIV/AIDS services through community sensitisation and participation
• To develop a community based approach to increase and sustain TB case detection and cure rate as per the Millennium Development Goals
• To improve basic sanitation and hygiene by bringing behavioural change and ensuring access to safe water and latrines
• To mobilise women and disseminate information through village meetings and home visits
• To collaborate with the government to further facilitate and strengthen the implementation of national tuberculosis, malaria and immunisation programmes.

Programme Components

Reproductive Health Care

One of BRAC's primary concerns is to improve reproductive health care awareness and service utilisation. To fulfill this objective, CHVs identify pregnant women during their household visits and refer them to nearby government or non-government health facilities. The CHVs raise awareness on pregnancy care and antenatal danger signs and follow up to ensure that ANC and PNC visits are made to the health facilities.

The CHV keeps a check on whether her clients have taken their Tetanus Toxoid (TT) doses and completed the Intermittent Presumptive Therapy (IPT) course, which is a promising treatment against childhood malaria in Africa. She also raises awareness on the importance of Voluntary Counselling and Testing (VCT) for HIV/AIDS, and Preventing Mother to Child Transmission of HIV (PMTCT).

Malaria Control

During household visits, the CHV identifies suspected cases of malaria and refers the patients to the nearest government health centres. She follows up to determine test results and to see if the patient is taking their anti-malarial medication. A relative of the patient is put in charge of supervising the drug intake according to their prescription. The CHV then conducts a follow-up visit to check on the patient's recovery and to make sure that the patient has not developed further complications. The CHV keeps records of all information in her household visit register.

The CHV sells Insecticide Treated Nets (ITN) in the community and promotes the concept of every family member sleeping under a net. She ensures that nets are treated every six months and sells K-O TABS, which are insecticides that are dissolved in water and sprayed on mosquito nets to restore potency.

TB Control

CHVs implement a well-tested, community-based approach for increasing and sustaining TB case detection and treatment. During household visits, CHVs ask simple questions related to suspected TB cases (based on symptoms such as fever and/or cough for more than two weeks, excessive night sweats, noticeable weight loss and coughing up bloodstained sputum). When a suspected TB victim is identified, the CHV motivates that person to be tested at a nearby government facility. She explains the dangers that TB can pose to the sick person as well as the rest of the family. She then follows up on the patient to determine the test results. If the patient tests positive, the CHV can also act as a Direct Observation Treatment Short Course (DOTS) agent. DOTS involve second party observation of a TB infected person taking a prescribed course of medication so that the patient does not default on taking their medications, which can result in drug resistance.

Family Planning

During regular household visits, the CHV mobilises and motivates women to use modern methods of contraception. She provides clients with birth control pills and condoms. For other temporary and/or permanent methods, couples are referred to government health care facilities.

Community Health Initiatives

BRAC takes a multi-pronged approach to community health education. We offer community health forums on issues such as malaria, TB and HIV prevention, maternal health, family planning and sanitation.

Basic Curative Services

CHVs are trained to diagnose and treat some basic ailments such as diarrhoea, dysentery, common cold, helminthiasis, anaemia, ringworm, scabies, hyperacidity and angular stomatitis. They refer individuals with more complicated conditions to local public and private health facilities. CHVs earn a small income by selling health commodities such as sanitary napkins, condoms, oral rehydration salts, soap, mosquito nets, etc. to people in their communities.

Ten Components

BRAC Essential Health Care

• Health and nutrition education
• Safe water, sanitation and hygiene
• Family planning
• Immunisation and Vitamin A supplementation
• Basic curative care
• Respiratory tract infections (e.g. pneumonia)
• Pregnancy related care
• Malaria control
• Tuberculosis control
• HIV/AIDS