The nutritional status of pregnant women has significant influence on fetal, infant and maternal health outcomes. Nutrition education and counselling during pregnancy improve maternal nutrition and reduce the risk of poor health outcomes in both mothers and their children. Health, Nutrition and Population Programme of BRAC initiated an innovative approach of providing nutrition education to pregnant women under its Improving Maternal, Neonatal and Child Survival (IMNCS) project.
This project developed a daily meal plan with recommended dietary allowance of 2500 kcal for pregnant women and had piloted that in Nilphamari district. In this project, along with nutrition counselling the community health workers also demonstrated the pregnant women the quality of the diet and which foods and what quantities they need to consume in order to achieve optimal dietary intake.
It was found from a smalll study conducted in the pilot areas that the approach of nutrition counselling through demonstration was well accepted by the pregnant women. This approach not only helped in improving their knowledge, but also helped them to practice that in their real life.
Inspired by the findings from this study, BRAC Health, Nutrition and Population Programme in collaboration with the Alive & Thrive project of FHI360, with the financial support from the Department of Foreign Affairs, Trade and Development (DFATD) of Canada, has taken an initiativee of conducting a rigorous scientific testing of the package of maternal nutrition interventions in its existing rural MNCH program. This implementation study has started in October 2014 with an aim of developing a packages of maternal nutrition intervention along with service delivery model to increase uptake of recommended diet by pregnant women and lactating mothers through behaviour change communication as part of a large scale MNCH program, and test its operational feasibility.
Ten sub-districts from Kurigram, Lalmonirhat, Rangpur and Mymensingh districts have been selected to offer maternal nutrition interventions to the pregnant women and lactating mothers. Another 10 sub-districts from the same two districts have been selected as control for evaluation. It is expected that a total of 120,000 pregnant women will receive maternal nutrition intervention in the intervention areas.
BRAC Health Security Programme (BHSP)
Despite remarkable achievements in selected health indicators such as immunisation, maternal and child health - current health services in Bangladesh are still fragmented and skewed towards health MDGs - lacking continuity across levels of care. Access to quality health services still remains inadequate and expensive for a large segment of the population, leading the poor not to access care when needed. Out-of-pocket health expenditure in Bangladesh is one of the highest in South Asia, often resulting in medical expenditure impoverishment.
To work as an integral part of the national health financing strategy to achieve universal health coverage in Bangladesh.
i. Design a national model for healthcare financing to jump-start the journey towards universal health coverage in Bangladesh
ii. Encourage a practice of pre-payment and co-payment by the community for access to health services at all levels of care
iii. Improve access to healthcare from appropriate and reliable providers
iv. Reduce financial constraints for seeking healthcare for the low-income households
Project location: Gazipur city corporation
Project duration: Two years
Service provision period: Up to three years from the beginning of the project
Target group: All household members in the Manoshi catchment area (focus on poor)
• Annual health check-up and screening for non-communicable diseases (NCDs)
• Outdoor consultation by both general and specialist doctors (with provision for drugs and diagnostics)
• Hospitalisation, including pregnancy and all surgeries.
• BRAC’s Manoshi project, BRAC Clinic, empanelled hospital, public facility
Sustainable Clubfoot Care in Bangladesh:
In Bangladesh an estimated 5,000 children a year are born with clubfoot deformity. Access to standard care treatment using the appropriate method, (Ponseti Method) is limited in Bangladesh. Neglected clubfoot causes life-long disability, limits educational and earning opportunities, and is a major cause of the developmental challenges of ill health and poverty. Ponseti clubfoot treatment (serial casting, Achilles tenotomy – minor outpatient surgery under local anaesthesia – and serial bracing) has high efficacy in correcting the deformity. Sustainable Clubfoot Care in Bangladesh (SCCB) is a Global Affairs Canada (GAC) funded partnership initiative between the University of British Columbia (UBC), the Government of Bangladesh and BRAC. BRAC is the key partner in Bangladesh and will work with local stakeholders and collaborating organisations, including the Ministry of Health and Family Welfare (MoH&FW), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), National Institute for Traumatology and Orthopaedic Rehabilitation (NITOR) and the Bangladesh Orthopaedic Society (BOS) to improve access to and promote adherence for clubfoot care.
To eliminate neglected clubfoot development which causes musculoskeletal disability and poverty in Bangladesh, by treating these cases and therefore returning children born with clubfeet to the same life trajectory as their peers.
• To build capacity and integrate Ponseti clubfoot treatment within the Bangladesh healthcare system (trained staff, network of clubfoot clinics, treatment integrated within primary care) thereby enabling access to treatment for all children born with clubfeet;
• To strengthen the capacity of Bangladesh’s medical, paramedical, and nursing schools to impart skill and knowledge to Bangladesh’s future healthcare workforce, in a manner suitable for Bangladesh’s social, cultural, and economic context;
• To perform evaluations designed to assure quality of treatment using the Ponseti method by ensuring the improvement of the teaching of this treatmentin Bangladesh.
• To improve the status of women (by reducing the burden of care of the disabled child, improving marriage potential and reducing potential for abuse of afflicted females)
This project will be implemented through establishing a network of Ponseti Training Centres/Ponseti Clubfoot Clinics in 23 government hospitals (18 Medical college hospitals including NITOR and 5 district hospitals), ensuring treatment for children with clubfeet
Using the existing platform of BLBC, EHC & MNCH programmes this project will perform the following activities:
• Capacity building: train the trainers, staff and community health workers;
• Increasing the capacity of government institutions and NGOs to treat and train healthcare workforces (medical, paramedical and nursing) for clubfoot management at a primary care level
• Developing national guidelines on Ponseti method treatment;
• Community mobilisation and awareness building; Community engagement and ownership;
• Early identification of foot deformity, timely referral to clubfoot clinics for treatment, and regular follow-ups
• Establishing network of clubfoot clinic at GoB hospitals and ensuring treatment for clubfoot correction –(serial casting and bracing)
• Ensuring that Ponseti clubfoot care will be ongoing
• Knowledge and awareness of the community and parents will increase;
• The deformity should be routinely recognised and the affected children referred to recognised clubfoot clinics staffed with healthcare workers trained in the Ponseti Method
• Treatment should result in the clubfoot being fully corrected without undue complications
• Evaluation will be performed to ensure treated children have functional feet as measured against their peers
• Barriers to clubfoot recognition and treatment will be identified and reduced, and effectiveness of teaching about Ponseti clubfoot treatment will be ensured
Project Period: October 2013 - September 2017
Marketing Innovation for Health (MIH)
Social Marketing Company (SMC) signed a four year Cooperative Agreement with USAID for implementing the Marketing Innovation for Health (MIH) Programme to provide a comprehensive range of products and services to the target populations in Bangladesh. The partners in this programme include BRAC, CWFD, PSTC,Shimantik and Engender Health (EH) and Population Services International (PSI). The programme will increase access to affordable family planning (FP), health products and services nationally, expand use of FP particularly of long acting methods, and improve health practices through extensive marketing and BCC campaigns. In addition it will enhance quality of health services delivered through training and capacity building of private sector providers. The Four Community Mobilisation Partners of MIH will be implementing community mobilisation and advocacy activities in the 19 priority districts in the country. These districts have less than the national average of Contraceptive Prevalence Rate (CPR) for any modern method and/or have comparatively higher under-five child mortality.
To contribute to sustained improvements in the health status of women and children in Bangladesh by increasing access to and demand for essential health products and services through the private sector.
• Social Mobilisation with Female (Female Health Forum): For Non users of MWRA(Married Women of Reproductive Ages) and Care givers of U-5 children.
• Social Mobilisation with Husbands of MWRA (Male Health Forum).
• Adolescent boys’ and girls’ education programme (School Quiz).
• Community Influencers Meeting.
• Advocacy meeting both at District and Sub-district level.
• Reaching MWRA(Married Women of Reproductive Ages) through group meeting/IPC
• Reaching care givers of children <5 through group meeting/IPC
• Husband of MWRA(Married Women of Reproductive Ages) through group meeting/IPC
• Adolescent Boys and Girls (10-19) will be reached through School quiz sessions with adolescent health package of message through school programme.
• Shasthyashebikas (SSs) who are attending delivery and other Birth Attendants orientation will be held on healthy pregnancy package of message.
• Community advocates will be reached through Community Influencers meeting.
• Government stakeholders, NGO stakeholders and other stakeholders will be reached through Advocacy meeting both District and Sub-district level.
• Workplace workers will be reached with healthy pregnancy message.
The MIS and Quality Assurance Unit (MIS) provides support to improve the quality of the BRAC Health, Nutrition and Population programme (HNPP) . Aligned with the monitoring & evaluation (M&E) framework, the MIS unit was formed in 2006 by combining MIS units of different programmes, namely of HNPP and Quality Assurance Cell of EHC. In 2007, a monitoring unit was formed for IMNCS, followed by WASH, Manoshi and Alive & Thrive programmes. In October 2014, the unit was renamed the ‘MIS and Quality Assurance Unit’. This unit has two cells – the MIS cell and the Quality Assurance Cell.
The MIS Cell looks after the data of all 14 Health Nutrition and Population programmes. The Shasthya Shebika (SS) monthly performance report (MPR) is generated at field level by Shasthya Shebika (SKs). The Programme Organisers (Pos) compile MPRs of SKs under their supervision. The next compilation is done by a Sub-district Manager/ Branch Manager. The Sub-district Managers send their MPR to District Managers (DMs) and the DMs send their reports to Regional Managers (RMs). In city corporations, Branch Managers (BMs) send their reports to RMs. RMS send their reports to the MIS Cell, based in Head Office (HO). . Feedback given at HO level is transmitted to different levels based on the nature of feedback. This feedback can reach up to SK if needed.
The main task of this cell is to compile data and generate MPR for each programme. This cell also generates quarterly, half-yearly and annual performance reports. In addition, special reports are also generated according to the programmes’ demand.
The Quality Assurance (QA) Cell comprises of five teams are responsible for maintaining internal quality of EHC, IMNCS, Manoshi, Nutrition and SHIKHA programmes. QA is usually done on process, input and output indicators; and financial issues. Besides, QA teams also conduct sample surveys on different issues as per programmes’ need. Upon completion of survey, findings are shared at branch/sub-district, district/regional and HO levels. At HO level, findings are shared with programme personnel just upon compilation of data by QA teams. Reports/ are submitted to programmes after analysing the data
Sub-district/Branch Managers take immediate actions upon receiving feedback from QA team. DM/RMs follow-up the action taken by Sub-district/Branch Managers for their respective district/division/city corporations. HO managers provide directions to different layers of field management based on QA findings. Reports are also used as reference data for donors and external agencies.
BRAC facility based care 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. Although more focus was given to offer services to vulnerable groups, particularlyvwomen, adolescents and children,these health facilities offer a range of services to all groups of the population including males.
BRAC Clinics are not just traditional clinics or hospitals but are emerged from the needs of the community and ensuring the availability of and accessibility to services. They utilise BRAC’s existing community network, infrastructure and trained manpower. At present, BRAC runs 3 Clinics. BRAC Clinics provide both outdoor services and indoor services to patients. Major indoor services provided are caesarean section, normal deliveries, MR/ post-abortion care, major general surgery and major gynaecology surgery.
To support the physically disabled population with rehabilitative aids and services, BRAC is operating BRAC Limb and Brace Centre (BLBC) which provides low-cost appropriate technology. At present, BRAC runs 2 BLBCs. Major services provided are braces, physiotherapy, below knee prosthesis and above knee prosthesis.
Non-communicable diseases (NCDs) commonly occurring amongst the people of 35 years and above, require a large quantum of health and social care, irrespective of socio-economic status. Most NCDs are chronic debilitating disease associated with a range of severe complications. Bangladesh has a large number of people living with NCDs. BRAC is going to undertake NCD pilot initiatives in 3 sub-districts of two districts (Narayanganj and Narsingdi) under EHC and 8 sub-districts of 5 districts under Leeds University COMDIS study project. Initially there will be screening, referral and follow up of hypertension and diabetes patients in the community.
To reduce the burden of chronic NCDs by promoting healthy lifestyles and reducing the prevalence of common risk factors through community based health care approach.
To provide an easy access for diagnostic, preventive and curative services of chronic diseases (especially diabetes, hypertension, chronic respiratory illness and cancer) by an integrated evidence-based suspicion with a referral backup support.
The frontline community health workers (CSWs) –shasthyashebikas and shasthyakormis will perform screening of hypertension and diabetes in the community. They will refer the patients with high blood pressure and high sugar to the hospital for confirmation of diagnosis and treatment; and perform post-treatment follow-up.
The CSWs will inform and educate people through door-to-door health education. They will also educate about healthy ageing, nutritional requirements, and lifestyle and behaviour changes during their regular household visit and follow-up.
Vision Bangladesh Project (VBP) is a joint venture of Ministry of Health and Family Welfare (MoH&FW) of Bangladesh, BRAC and Sightsavers to eliminate the cataract backlog from Sylhet division by 2013.
Elimination of avoidable blindness from Bangladesh by the year 2020.
Elimination of the backlog of cataract blindness from Sylhet Division by the year 2013.
• Increase demand for eye care services particularly for cataract in the community
• Increase accessibility to quality eye care services especially cataract particularly for the poor
• Develop efficient HR of service providing eye care facilities
• Manage 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 at 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 mobilise the community people through different forums 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.
Reading Glasses for Improved Livelihoods
In Bangladesh, about 20 percent people suffer from presbyopia which deprives them of contributing to household activities and in the national economy as well; and 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 organisation based in the USA.
The mission of VisionSpring is to reduce poverty and generate opportunity in the developing world through the sale of affordable eyeglasses, and it is consistent with the mission of BRAC, which is to 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 mobilises people who suffer from eye problems, using forums like village organisation (VO) meetings, group health education meetings, etc. For a broader coverage of the programme, camps are also held in different project areas. After testing the subject groups’ visions, the SS offers reading glasses of proper magnification to the presbyopic clients at affordable costs. Patients with other eye complaints are referred to district eye hospitals. The Shasthya Kormis and programme organisers support the SS in screening and referral. Upazila Manager and other supervisors provide periodic supervision and follow-up.
Vision Bangladesh Project: Phase II
The Vision Bangladesh Project (VBP) is a joint venture of National Eye Care-DGHS (under the Ministry of Health & Family Welfare (MoH&FW) of Bangladesh), and BRAC to eliminate the backlog of cataract sufferers from slums in the cities of Bangladesh by the year 2015. In addition, the project seeks to address the incidental cataract cases and to reach the unreached. The project will also work in the Sylhet Division until 2015.
The elimination of avoidable blindness in Bangladesh by 2020.
Purpose of the Project:
To eliminate the backlog of cataract blindness in the slums of Bangladesh by 2015.
1. To Increase knowledge and awareness of eye care services within slum communities
2. To build capacity for and institutionalise eye care within the Bangladesh healthcare system; thereby enabling access to quality, affordable treatment for disadvantaged people affected by cataract blindness.
3. To strengthen the capacity of eye care facilities’ service through collaboration between the partners, in a manner that is suitable for Bangladesh’s social, cultural, and economic context.
• Prepare action plan for patient screening programme
(PSP) with hospital partners
• Develop plan for community mobilisation activities
• Orientation of staffs on primary eye care
• Dissemination of eye health messages, patient detection, referral to eye care facilities and follow-up treatment
• Follow-up of operated patients and referral of complicated cases to partner hospitals for appropriate treatment
Malnutrition is a major public health concern in Bangladesh. To address 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
More information can be found by following the links below.
Bangladesh Maternal Infant and Young Child Nutrition (MIYCN)- Home Fortification Programme
Improving Maternal and Child Nutrition (IMCN)
BRAC USI (Universal Salt Iodisation) RTK (Rapid Test kit) Project: A new initiative
Bangladesh Sprinkles Programme
Malaria is a major public health problem in some parts of Bangladesh, particularly in 13 districts in the north-east & south-east areas which border India and Myanmar. Among them are the Chittagong hill tracts (CHT) districts which highly endemic and Cox’s Bazar which is moderately endemic. The other districts are categorised as low endemic areas as fewer numbers of cases have been reported there. Sporadic incidences occur in other parts of the country.
The National Malaria Control Programme (NMCP) established an effective partnership with a consortium of 21 NGOs led by BRAC. This partnership has leveraged the programme and increased the access to malaria treatment, prevention and awareness raising activities within communities, including the hard-to-reach areas.
In partnership with the National Malaria Control Programme (NMCP), BRAC successfully secured a grant from the GFATM to strengthen and expand national malaria control activities to all endemic districts working directly and through other NGOs. BRAC is directly implementing malaria control activities in all sub districts of CHT, two sub districts of Moulvibazar, and through 20 partner NGOs in other districts which are monitored and supervised by BRAC.
To reduce the overall burden of malaria (morbidity and mortality) by 60 percent from baseline year 2008 in 10.9 million populations in 13 high endemic districts of Bangladesh by 2015.
To reduce the overall burden of malaria (morbidity and mortality) in the 13 high endemic districts of Bangladesh by 60 percent, by the year 2015.
• To expand the use of Long Lasting Insecticidal bed Nets (LLIN)( two nets per household), to achieve 100 percent coverage in the three malaria endemic districts and to maintain 80 percent coverage with Insecticide Treated bed Nets (ITN)/LLIN in the remaining districts.
• To expand and improve the quality of diagnosis and treatment of malaria cases to 90 percent.
• To further strengthen programme management and partnership coordination surrounding malaria control.
BRAC’s community based model has been applied in malaria programmes to promote health education, empowerment and home based services. BRAC’s shasthyashebikas and shasthyakormis diagnose malaria patients using a Rapid Diagnostic Test (RDT) kit, therefore providing treatment at a household level They also refer patients to the nearest government health facilities in case of pregnant women, children under five kilograms of weight and severe malaria cases. In addition, 121 laboratories and sub-centres have been established in remote areas to strengthen early diagnosis and prompt treatment (EDPT). LLINs are distributed in the community free of cost as one of the most important methods of preventing the transmission of malaria.
Various sensitisation and advocacy meetings are conducted among the different stakeholders of the community to make them aware of malaria symptoms and to engage them in the effort to identify patients, increase utilisation of LLIN and to create early care seeking behaviour. The stakeholders include local figures, religious leaders, headmen, karbaris, teachers, village doctors, pharmacists, private practitioners and hotel owners/ managers.
Since May 2007 to June 2014, a total of 3,067,663 cases of fever were examined nationally by RDT and/or microscopy, of which BRAC and its partner NGOs performed 1,822,086. Out of 318,649 confirmed malaria cases, 228,233 (72%) were treated at the community level in the same period. In addition, death due to malaria was reduced by 90 percent (15) in 2013 in comparison with the baseline year 2008 (154). Since the beginning of the programme, a total of 3,735,905 LLINs have been distributed among the beneficiaries in the malaria endemic areas.
Tuberculosis (TB) has been a major public health concern for Bangladesh for decades. According to the World Health Organization (WHO), Bangladesh ranksseventhamong the 22 highest TB-burdened countries. BRAC initiated the tuberculosis control programme in 1984 in one district as a pilot. In 1994, BRAC became the first NGO in the country to sign a memorandum of understanding with the government to expand directly observed treatment short course (DOTS) services across the country. BRAC also became a principle recipient (PR) of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), along with the government. The aim of the programmeis to reduce the morbidity, mortality and transmission of TB until it is no longer a public health problem.
BRAC's shasthyashebikas(frontline community health worker) play a pivotal role inconnecting individuals with TB control services during household visits and health forums. They disseminate TB-specific messages to the community, identify presumptive TB patients and refer them, for sputum examination, to the governmen tsub-district health complex or peripheral laboratories of BRAC. The frontline health workers also ensure regular intake of medicine for identified TB patients through DOTS. They refer complicated TB patients to health facilities for further treatment and for proper management of side effects and other complications during TB treatment.
BRAC's approach towards the diagnosis and treatment of TB focuses on community level education and engagement. The programme conducts orientation with different stakeholders of the community to engage them in efforts to identify TB patients, ensure treatment adherence, and reduce stigma surrounding TB. The stakeholders include cured TB patients, local religious leaders, school going children, girls' guides and scouts, other NGO workers, formal and non-formal care providers like graduate private practitioners, village doctors and pharmacists.
Currently, BRAC covers 297 sub-districts from 42 districts, 7 city corporations with a population of 92.9 million people including 31 academic institutes, 41 prisons, 405 peripheral laboratories and 26 external quality assessment centres. BRAC is leading a group of 42 local NGOs who are the sub -recipients (SRs) of the GFATM under the same umbrella of NTP. BRAC supervises, monitors, guides and provides technical assistance to the SRs,to ensure that the quality of the service delivered is uncompromised.
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