In Bangladesh, about one-third of the population lives in urban areas with worse health situation in slums and squatters in cities. To improve the health status of the slum population, particularly women and children, BRAC started Manoshi, a community based healthcare programme, in 2007 at urban slums of nine city corporations around Bangladesh through development and delivery of an integrated, community-based package of essential health services.
To decrease illness and death in mothers, newborns, and children in urban slums of Bangladesh
• 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 improvement in the health status of poor urban mothers, newborns and children by bringing healthcare services to their doorstep through our frontline Community Health Workers (CHWs). The shasthya shebikas and shasthyakormis provide antenatal and postnatal care, essential newborn care (ENC) and child health care. Through behaviour change communication interventions they motivate, educate and prepare expectant mothers for childbirth, highlighting an array of health issues including maternal and neonatal danger signs, maternal and neonatal nutrition and so on. BRAC Delivery Centres 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.The community is connected to health facilities via an innovative mobile phone based referral system. Manoshi is currently being implemented in eleven city corporations.
m-Health (Mobile Health)
Currently piloted in the urban slums as Manoshi (MNCH Urban) Programme, the initiative intends to digitise the health services by collecting, recordingandpreserving household information.Thusit createsa real time virtual database. The database helps to speed up service delivery process to the target population.
Read the book on Manoshi approach
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. We are reaching around 25 million people living in rural areas of 14 districts (Nilphamari, Rangpur, Gaibandha, Mymensingh, Kurigarm, Lalmonirhat, Faridpur, Rajbari, Madaripur, Magura, Pirojpur, Joypurhat, Shaerpur and Shariatpur) with maternal, neonatal and child health (MNCH) services.
To reduce maternal, neonatal and child mortality, particularly among the poor and socially excluded populations
• Increase knowledge of 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 a quality supplyof maternal, neonatal and child healthcare
• Increase participation, accountability and responsiveness to the voice of communities in maternal, neonatal and child health services
Community Health Workers (CHW): namely, shasthyashebika, Newborn Health Worker, shasthyakormi and Community Skilled Birth Attendant (CSBA) are the frontline workers catering to family planning, pregnancy related care, childcare of newborns and children under fivein the household.. A change in behaviour towards healthy practices in terms of reproductive health, nutrition, hygiene and sanitation is the strategy to preventive and promotive care. CHWs offer basic care eg, antenatal care, delivery care, postnatal care, newborn care and management of birth asphyxia, diarrhoea, ARI and some common ailments. CSBA attends home deliveries to ensure safe maternal and neonatal outcome at birth. By bridging gaps between community and facility during emergencies,a well structured referral system is put in place to reduce delays in accessing health care 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 children under-five.
The programme intervention started in 2005 as a pilot initiative in Nilphamari district. The intervention is mainly aimed at providing basic primary healthcare at the community level, working with village health committees to motivate behaviour change in the committee by addressing issues of pregnancy, newborn and child health, and facilitating access to obstetric and newborn care at public and private facilities.
Aligned with the growth of the programme, the MNCH Programme has been divided into two components: ‘Manoshi’, MNCH (Urban), which currently works in city slums of nine city corportations and IMNCS (MNCH Rural) which currently works in 14 defined districts.
Essential health care (EHC) is the foundation of BRAC's health programme, combining promotive, preventive and basic curative services. EHC has revolutionised the primary healthcare approach in Bangladesh, reaching millions with low cost basic health services through BRAC's frontline community health workers.
EHC aims to improve reproductive, maternal, neonatal and child health along with the nutritional status of women and children. The programme further aims to reduce vulnerability to infectious, communicable diseases and non-communicable diseases. The programme provides primary healthcare services including maternal and child healthcare, basic treatment for acute respiratory infections (ARIs) and promotes family planning methods and safe delivery practices. Use of proper sanitation, safe drinking water, hygiene-specific messages are also disseminated among communities.
The EHC programme has partnered with different government agencies under the Ministry of Health and Family Welfare to observe national health-specific days and events of instruction across the country. Collaboration with the government to promote family planning, immunisation of children and distribution of vitamin A capsules within communities are a few of the many successes of the programme.
Currently the programme is operating in all 64 districts of the country and delivering healthcare services to over 120 million people, in turn serving as a platform for other health interventions.
Essential Health Care Programme for CFPR-TUP
In Bangladesh, 8 per cent of the population is suffering from extreme poverty. Their health status lags far behind that of the general population. Essential Health Care (EHC) services for the ultra-poor under Challenging the frontiers of poverty reduction – Targeting the ultra poor programme (CFPR-TUP) is specially designed to meet the needs of extremely poor households unable to access or benefit from traditional development interventions.
The goal of the programme is to reduce the vulnerability of the poor and ultra-poor to sudden health problems and to prevent them from sliding back into the vicious cycle of extreme poverty
The programme aims to increase access to health services, through demand-based strategies and by providing a package of basic health services which meets the needs of the ultra-poor.
The ffinancial constraint of the ultra pooris a major impediment in accessing available health services. To address this problem BRAC has introduced the provision of 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 programme through community forums (Gram Daridro Bimochon Committee) which form an organised network for the improvement of health and the social status of the rural poor in each village. Committee members actively provide motivation and financial support to the ultra-poor for accessing different health services.
Bangladesh has made remarkable strides in healthcare in the four decades since independence. Since the 1990's maternal mortality has dropped from 574 to 194 deaths per 100,000 live births, and child mortality from 133 to less than 32 per 1,000 live births. Over four decades, the contraceptive prevalence rate has gone up seven to eightfold. In the 1980's, when immunisation coverage was two per cent, the shared roles and activities of BRAC and the government improved the status to 70 per cent within the last four years. The current status of fully immunised children is at 86 per cent. Despite the achievements, Bangladesh still suffers a high burden of deaths and diseases. Over 70 per cent of people seek care from informal health care providers and 62 per cent of those health providers practicing modern medicine have little or no formal schooling. One thirds of births take place at home, mostly assisted by unsupervised, untrained birth attendants. Recognising these problems, we have created a pool of frontline community health workers, the shasthya shebikas and shasthya kormis, who strive to address the crisis of human resources in the health sector by playing a substantial role in providing accessible and affordable services to the majority of the population.
Initiated in 1991, Essential Health Care (EHC) has revolutionised the primary healthcare approach in Bangladesh reaching millions with low cost basic promotive, preventive and curative services through our cadre of frontline community health workers. The goal of EHC is to improve access to essential health services through delivering community care and organising a bridging network with public healthcare system. Shashtyashebikas and shasthyakormis are mainly part of Essential Health Care (EHC) Programme. In fact, EHC is the basic platform of Health, Nutrition and Population Programme. All health interventions of BRAC are fundamentally based on the platform of EHC programme. To provide these services to the doorstep of millions of people would have required huge investment in the traditional system because of the large number of employees involved in the system. However, EHC developed a very innovative entrepreneurship model where the primary service deliverer (shasthyashebika) provides voluntary service. Although they do not receive any salary or monthly stipend, they are provided with financial incentives on the sale of basic medicines and selected health commodities to their community. This low cost innovative service delivery strategy has attracted various donors and partners in BRAC’s health programme because BRAC can deliver the service very effectively with a much lower cost.
We have started maternal, neonatal and child health (MNCH) programmes in 2005 as a pilot project and has been scaled up to 11 city corporations and14 rural districts in partnership with the government, UKAID and Australian High Commission. We have demonstrated that with limited resources, it is possible to change behaviour and practices to lower the incidences of maternal and neonatal deaths within a short period. With the active engagement of community health workers and birth attendants, we ensure high coverage of antenatal and postnatal care while supporting skilled birth attendance. More importantly, an innovative referral system is developed which facilitates transfer of acute emergency cases to hospitals. Within three to four years, we have observed a decline in maternal and neonatal deaths in both urban slums and rural districts.
Bangladesh has made a remarkable progress toward tuberculosis control since the inception of the Directly Observed Treatment Short- course (DOTS) strategy in 1993. In 1994, BRAC became the first NGO in the country to sign a memorandum of understanding with the government and expanded DOTS services across the country through its diversified partners. The national TB control programme in Bangladesh has established effective partnership with the consortium of 43 NGOs led by BRAC to implement the programme throughout the countries. BRAC has been working in 297 sub-districts of 42 districts with the coverage of 93 million population. In BRAC supported areas, all forms of TB case notification rate has increased from 105 to 129 /100,000 population per year. From 2004 to 2013, more than 1.5 million TB patients have been treated; yielding present treatment success rate 93 per cent in BRAC supported areas which has exceeded the national target (85 per cent) and is the second highest treatment success rate in the world Bangladesh has also improved case notification for child TB, smear negative TB, extra-pulmonary TB and drug resistant TB. The contribution of shasthya shebika in detecting presumptive TB cases, collecting sputum for lab diagnosis and DOTS for TB is tremendous. The Global Fund plays important role to control TB programme in Bangladesh. Growing challenges like TB/HIV co-infection, TB/diabetes are also being prioritised. More initiatives will be taken to address vulnerable communities including people with high risk behaviour and marginalised socially excluded people for TB care services. Urban TB programme is also given special attention for further strengthening of the programme.
The malaria control programme is on track in terms of MDG targets and has shown considerable success among the people at risk from malaria. The National Malaria Control Programme (NMCP) established an effective partnership with the consortium of 21 NGOs led by BRAC to implement the programme in 70 sub-districts of 13 endemic districts. Through the funding of The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and Health, Population and Nutrition Sector Development Program (HPNSDP) of government of Bangladesh, the malaria control activities were scaled up and the quality of preventive, diagnostic and treatment services have been improved. BRAC is directly implementing the programme in high endemic three Chittagong hill tracts districts and in 2 sub-districts of Moulvibazar. BRAC’s community based models applied in malaria programme using a large workforce of local shasthya shebikas and shasthya kormis in managing malaria patients at doorstep, raising awareness on malaria prevention and health service utilisation. Malaria cases were reduced by 68per cent in 2013 comparing to baseline year 2008 and whereas death was reduced by 90 per cent at the same time. A total of 3,735,905 long lasting insecticidal nets (LLIN) were distributed and 4,231,689 ordinary bed nets were treated with insecticide in the same period. Recent malaria prevalence survey conducted in 2013, documented the decreasing of point prevalence of malaria from 4 in 2007 to 1.41 in 2013 per 1,000 populations based on RDT in malaria endemic districts. A good utilisation rate (>85 percent) of insecticidal bed net was observed among pregnant women and children under 5 years of age.
Malnutrition among children is one of the major problems of our country. To mitigate this problem, BRAC’s nutrition programme has been working at household and community level for creating awareness on nutrition. BRAC’s shasthya shebika and nutrition promoters visit households in their communities and provide counselling, coaching and demonstration. Moreover, they offer community-based management of acute malnutrition (CMAM) service to mother and child of 6 to 59 months who are affected by moderate accurate malnutrition by providing supplementary food. Nutrition programme creates awareness about adolescent girls’ nutrition and encourages mothers and family members about many issues like intake of healthy and various types of food, early initiation of breast feeding, exclusive breast feeding till 6 months, breast feeding for at least two years and initiation of complementary feeding after six months. Moreover, to prevent child malnutrition and anaemia, micro-nutrient powder sachets are distributed under maternal, infant and young child nutrition (MIYCN)home fortification programme. It helps to prevent anaemia of 6 to 59 months old child by providing required iron, vitamin and minerals.
In Bangladesh, around seven hundred thousand people suffer from cataract blindness. Moreover, around one fifty thousand people are becoming blind every year. BRAC started ‘Vision Bangladesh’ project with the aim to remove the backlog of cataract blindness. In this programme, cataracts are identified through local eye camp and patients are sent to various government and private hospitals for operation. Community health workers visit household in their community and aware people about eye problems. And if there is any complex case, they send the patients to nearby hospitals or health centres. Moreover, BRAC’s ‘Reading Glass for Improved Living’ project has been providing reading glasses to the people whose vision has become blurred due to age.
Over half of the Bangladeshi population is engaged either directly or indirectly in agriculture. In recognition of the vital role of farming to the country's development, BRAC has three special projects in microfinance designed to empower farmers and strengthen sector-wide farming practice.
Each project provides access to finance, training, productive inputs and business support, enabling farmers to set up sustainable agricultural enterprises. In doing so, they help to ensure stable livelihoods, improved health and nutrition, and lessened dependency on exported food products. The projects also promote gender equity by strongly encouraging participation from women farmers.
Over the past 12 years, BRAC's microfinance projects in agriculture have reached approximately 660,000 farmers, and have disbursed over USD 280 million. Each project achieves a loan repayment rate of 98%.
Borgachashi Unayyon Project (BCUP)
A large proportion of farmers are borgachashis - poor and landless tenant farmers who share crops with landowners in return for the right to cultivate on their land. BCUP works with borgachashis to give poor farmers the support they need to build and sustain productive enterprises.
The project takes a 'credit plus' approach that combines access to customised loans of USD 200 - 1500, savings products, and technical training. It supports ventures ranging from vegetable cultivation, livestock, duck and poultry farming, aquaculture, as well as investments in land, and agricultural machinery.
North-west Crop Diversification Project (NCDP) and Second Crop Diversification Project (SCDP)
NCDP and SCDP promote the use of high value crops, such as fruits and vegetables, to help farmers reap greater financial returns and promote better access to nutritional food products.
The two projects offer access to credit services and savings products, including loans of USD 100 - 4,000, as well as training on improved technologies, and marketing support such as linking of small farmers to markets.
NCDP is based in 10 districts in the north-west region of Bangladesh. SCDP marks the expansion of the project into another 27 districts where BRAC identified potential growth for high value crops.
BCUP, NCDP and SCDP are part of BRAC's broader strategy to develop the agriculture sector. For more information about BRAC's work in agriculture please visit Agriculture and Food Security Programme.
Research - Tenant Farmers Access to Credit and Extension Services: BRAC Tenant Farmer Development Project
In 2010, we established a research and development unit. Its main functions include:
The research and development unit is a small group that works closely with larger operation teams and BRAC’s social innovation lab. They spend much of their time observing field operations and gaining insights from other staff. In some cases, opportunities come from external groups, who are interested in partnering with BRAC for research, new products or to work for the inclusion of special population groups.
Our activities are constantly changing. See this presentation for examples of a selection of our current projects.
Learn more about our work:
“Innovating for the poor” in Ashoka Fellow Connect (October 2013)
A customer service assistant speaks to a BRAC microfinance client
Due to an increasing supply of microfinance products, there is an urgent need for increased attention to financial education and client protection. We piloted the financial education and client protection project in 2012, with an objective to enable our borrowers to make better decisions, such as evaluating financial institutions and properly using financial services.
Our financial education curriculum covers a range of important topics including: terms and conditions of products, rights and responsibilities of clients, dangers of over-indebtedness, the value of regular record keeping, benefits of saving and how to access BRAC’s grievance redress mechanism.
The lack of financial education is not just an individual issue. It affects entire households and communities. Our aim, therefore, is to raise awareness and build knowledge at many levels. BRAC’s approach to promoting financial education and client protection is not to stress an increase in knowledge, but also to help unaware people adopt financial behaviours that facilitate their wellbeing.
We use a variety of strategies to increase financial education:
• Pre-disbursement orientation of clients on basic financial awareness, rights and responsibilities of clients
• Reinforcement of key messages by frontline staff at regular group meetings
• Sharing information at other key gatherings, such as community action meetings and parents’ meetings at BRAC schools
To increase client protection, we have taken a number of steps. The clients’ rights and responsibilities are explicitly mentioned in the staff code of conduct. Managers are expected to be accessible to clients as issues arise, and we are strengthening other resources for clients by establishing call centres and a grievance redress mechanism.
PLANS FOR EXPANSION
To significantly enhance client experience, we are rolling out frontline customer service assistants to all branches. These women will provide customised information and support to all clients who come for services. They will also conduct sessions on financial education in nearby communities.
In addition, BRAC is working on pictorial materials and entertainment-filled education that will combine local stories, visual humour and role playing to draw and sustain the attention of the target audience which will be used in the training sessions for clients. Customer service assistants and staff can incorporate many of these tools into their training sessions and interactions with clients.
• Starting from BDT 25,000
• 6, 12 and 18 month tenures
• Annual 26% declining balance interest
• No processing fees, service charges or savings
• Repayable through monthly instalments payable at
BRAC branch offices or through bKash
• Bangladeshi national/citizen
• Minimum 18 years of age
• Working for present organisation (in Bangladesh) for at
least 1 year
• Minimum monthly gross salary: BDT 10,000
• Must have a bank account
• 1 colour photograph and a copy of National ID of the
applicant and the guarantor**
• Employment certificate
• Bank statement (for loans over BDT 1 lakh)
For more information please call 16241 (from 11am to 7pm, Sunday to Thursday)
*Document checklist is subject to change
**One guarantor required
Branch locations and contact information
In Bangladesh, limited employment opportunities for a growing working age population means that many young men and women move overseas to work. Although often a worthwhile investment, the initial costs of going abroad are considerable, costing the average household USD 3,000 for going to the Middle East.
BRAC provides workers seeking employment abroad with migration loans, designed to meet the financing needs of migrant workers in a way that is manageable and affordable. The microfinance programme also checks the validity of contracts and travel documents to ensure clients are not victims of fraud by informal agents. This is complemented by a range of services available from BRAC’s safe migration programme such as pre-migration orientation and post-migration re-integration.
As of June 2016, BRAC has helped fund 194,000 migrant workers find employment abroad.
BRAC provides additional support to migrant households in the form of remittance loans. These loans are designed to offer additional flexibility to households who rely on monthly remittances sent from a family member earning overseas.
These loans enable households to access lump sums of money in order to make large investments or expenditures, while they wait to receive and save remittances sent from abroad. These are safe bets for the household and for BRAC because clients have a secure flow of income with which to steadily pay off instalments each month.
Between June 2014 and June 2016 BRAC offered this service to over 40,000 households.