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.
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.