The Essential Health Care (EHC) programme offers a basic package of health services to approach health issues comprehensively. Notably, BRAC provides critical services in reproductive health and disease control, mobilises women and disseminates information through village organisation meetings, meetings with community members and household visits, and collaborates with the Government of Bangladesh to help implement national programmes, such as the tuberculosis, malaria, immunisation and sanitation programmes. Most critically, EHC pays particular attention to the poorest and most vulnerable members of the community in both rural and urban settings. EHC covers 31 million population all over the country.

BRAC's community health volunteers called Shastho Shebikas (SS) play a critical role in EHC programme components. All SSs are members of BRAC's Village Organisations (VO) and each SS is assigned for about 300 households. The SSs provide health education, sell essential health commodities, treat basic ailments, collect basic health information and refer patients to health centres when necessary. Though the SSs work on voluntary basis, they are able to earn some money through selling of essential health commodities. They receive Taka 500 (US$ 8.50) to participate in a revolving fund that allows them to sell some essential drugs. Selling of drugs and other goods gives them the opportunity to earn some money. The SSs also provide assistance to the government health initiatives. They distribute vitamin-A capsules and help organise satellite clinics. They also identify and mobilise targeted children and pregnant women for immunisation and assist in the management of government immunisation centres and satellite clinics.

In recent years a cadre of female community health paramedics, called Shastho Karmis (SK), have been recruited and trained to strengthen work of the SS. In addition to monitoring of the targeted households and providing pregnancy-related care, each SK supervises ten SSs. The Sks conduct health education meetings in the community, where health topics such as immunisation, family planning methods or sanitation installation are addressed. They maintain coordination with government health and family planning workers at the community level.

Health and Nutrition

The SK organises monthly health education meetings with the assistance of the SS in the community. The topic of the meeting varies each month, but topics include information and education on family planning, pregnancy-related care, immunisation, water and sanitation, personal hygiene, child health, nutrition and tuberculosis. Information is also provided by the SS during their household visits. They discuss nutrition, including information on important natural sources for Vitamin A and appropriate diet during pregnancy and lactation. The SSs also motivate the community to cultivate vegetables and fruits in their homesteads to ensure food security. The SSs distribute various types of vegetable seeds to the community members twice a year. Additionally, every pregnant woman receives iron and folic acid from the SK during antenatal care. BRAC also helps to distribute Vitamin A capsules & de-worming tablets to children during the National Vitamin A plus campaign, during which the SSs also work at the outreach centres.

Water and Sanitation

The provision of safe water and good sanitation facilities play a vital role in promoting health and improving hygiene status at the community level, thus increasing the productivity and well-being of the nation. Inadequate provision of safe drinking water and sanitation are directly related to the spread of communicable diseases, increased health risk and poor health and environmental pollution.

BRAC emphasises increasing awareness and developing capacity at multiple levels. The SS and SK work to generate demand for safe water and sanitation facilities through household visits and health education forums on sanitation problems. The SKs use promotional materials like flip charts, posters, and leaflets to communicate their critical messages. In addition, information is also disseminated through popular theatre, workshops, rallies and campaigns as well as through the orientation of teachers, religious and community leaders. Another feature of this programme is the promotion of private sector involvement in service delivery. BRAC provides interest free loans of Taka 10,000-15,000 (US$ 167-250) to local entrepreneurs for manufacturing slab latrines. A total of 100 slab ring production centres were established and 346,532 slab latrines were installed with the assistance of BRAC.

BRAC is working closely with other NGOs and the government to achieve 100% sanitation by 2010. To achieve this goal BRAC is running a sanitation programme in Shibpur upazila (sub-district) under Narsingdi district and Bogra district for 100% sanitation. Sanitation coverage achieved in Shibpur upazila was 93% and 58% in Bogra district. BRAC received a national award from the local government division for 100% sanitation coverage in Masimpur union, Shibpur upazila of Narsingdi district and Nandigram sadar union, Nandigram upazila of Bogra district for the year 2004.

Family Planning

The SSs and SKs educate women regarding use and benefits of modern contraceptive methods during their household visits. The SSs also provide birth control pills and condoms and refer women to the government's secondary and tertiary facilities for other temporary and permanent contraceptive methods. The SSs monitor side effects and refers women to health centres for side effect management.

Immunisation

BRAC plays a key role in immunising infants and pregnant women. The SSs and SKs play critical roles in supporting the Expanded Programme on Immunisation (EPI) programme. Both types of workers are responsible for educating women about the importance of immunisation. They also provide information regarding the location of immunisation centres and monitor for any immunisation-induced side effects. During reporting period measles coverage was 87% in EHC areas. They also mobilise the community during National Immunisation Day (NID) for polio eradication and distribute Vitamin A capsule to children.

Pregnancy Related Care

BRAC provides pregnancy related services through community-based ante and post-natal care to rural women. The Shastho Shebikas (SS), health volunteers identify all pregnant women in the area and the Shastho Kormis (SK), health workers register them. The SKs then visit the pregnant women and collect information regarding present and past pregnancies. Thereafter the SKs provide the pregnant women with health and nutrition education, which address topics such as good hygienic practices, clothing, and the need for light exercise. The SKs also track the pregnancy, record weight and height, as well as taking measurements for anaemia, jaundice, oedema, blood pressure, temperature, and albumin and sugar levels in the urine. The SKs also perform an abdominal examination to determine the height of the uterus and position of the foetus. The SKs motivate pregnant women to receive Tetanus Toxoid (TT) immunisation, provide iron and folic acid (IFA) tablets, and promote breast feeding and family planning. The SKs advise the mother to use a trained birth attendant in the case of a normal delivery and refer mothers to the hospital if complications arise.

Basic Curative Services

Illness is a major cause of income loss for the poor. About 60%-70% of all common diseases can be treated at the community level through basic curative services. The Shastho Sebikas (SS) have therefore been trained successfully to diagnose and treat some basic health ailments found in the general population such as anaemia, diarrhoea, dysentery, common cold, helminthiasis, ringworm, scabies, hyperacidity, angular stomatitis and goitre. Additionally, the Shastho Sebika (SS) are able to refer individuals with more complicated conditions to the local public and private health facilities. The efforts made by the SSs ensure affordable curative services to the poor and vulnerable at the grassroots level.

Tuberculosis

The tuberculosis treatment programme has expanded since its introduction in 1984. The SS implements the programme through information dissemination, identification of suspect cases, administration of Directly Observed Treatment Short course (DOTS), patient followup, and referral.

Essential Health Care for Specially Targeted Ultra Poor (STUP)

STUP programme is running in seven districts. The provision of health care services for the specially targeted ultra poor involves two distinct strategies in addition to normal EHC services. First, the programme provides health awareness and basic health care services to all STUP, irrespective of their health status. Second, STUP diagnosed with mild and severe morbidity are provided with financial assistance for their clinical care.

An essential component of the implementation strategy is to undertake a health survey on mild and severe diseases among STUP households during household visits by the Programme Organiser (PO) and to take necessary steps for clinical care.