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.