A driving force for the poultry sector growth in Bangladesh
When BRAC's Chicken enterprise became a key local supplier of KFC – one of the world's most popular chicken fast food chains which has more than 11,000 restaurants in over 80 countries; it represented a significant accomplishment for what had started as a grassroots experiment in the 1970s to create income generating opportunities for the poor and improve the poultry sector in Bangladesh. Today BRAC's poultry operations include poultry farms that produce high-yield varieties of day-old chicks, commercial broiler farms that produce adult chickens, a broiler processing plant and a poultry disease diagnostics laboratory.
BRAC Chicken was established to meet the growing demand for ready-to-cook chicken in urban areas. Initially a pioneer of the packaged poultry meat market, BRAC Chicken is now one of major players in the processed meat market. BRAC Chicken also strives to create a market for poultry that provides farmers with a fair price. It started out as a broiler processing enterprise in 2004, with the capacity to process approximately 10,000 chickens per day and was the only automated plant of its kind in Bangladesh. BRAC Chicken has also released a variety of processed chicken products, including chicken nuggets and chicken wings.
Given that the demand for poultry meat and eggs in Bangladesh still exceeds the supply, BRAC's poultry operations continue to be an important means of supporting rural farmers in their production, while also driving sector growth by increasing the supply of high-yield variety chicks and processed broiler meat.
Cross-collaboration to serve across rural and urban communities
A highly integrated enterprise that cross-collaborates with a number of other BRAC enterprises, BRAC Chicken acquires 30-40 percent of its supply from BRAC's commercial broiler farms while the remaining supply comes from other independent farms, both rural and commercial. BRAC Chicken sells the pre-prepared meat to a variety of customers including large restaurants, hotels, supermarkets and even individual households. Some of its major vendors include KFC, Westin Hotels, Radisson Hotels, Best Fried Chicken, and BBQ Bangladesh.
BRAC Poultry Rearing Farms purchase day-old chicks from BRAC Poultry. Instead of then directly selling these day-old chicks to individual farmers, BRAC Poultry sells them to dealers who in turn resell the chicks to farmers who rear the chickens, creating a more cost-effective supply model. BRAC's poultry farms use feed from BRAC Feed Mills. The collaboration among the enterprises, namely BRAC Chicken, BRAC Poultry Rearing Farms, BRAC Poultry and BRAC Feed Mills, creates a value-addition chain which allows BRAC Chicken to sell a high quality processed chicken product at a fair price.
Systematic preventive approach to ensure food safety
BRAC Chicken manages the quality of its chicken along each step of the supply chain: BRAC trains chicken rearers on how to vaccinate their chickens and raise them hygienically, and hires veterinarians to handle more complex health issues. The poultry is always under regular supervision of the vets, particularly during the use of vaccines, medicine, antibiotics, etc. If the chickens are injected with approved antibiotics, a time period of at least 72 hours is given to allow the chemicals to leave their system before processing them. At the end of the processing chain, BRAC Chicken sells high quality chicken, achieving HACCP ('Hazard Analysis and Critical Control Point'; a systematic approach to ensuring food safety) certification. In the process, BRAC Chicken also tries to minimise any production activities that may harm the environment.
With consumers increasingly demanding healthy and convenient food options, BRAC Chicken plans to expand its chicken processing operation and introduce more variety in its product line. As the increased demand for poultry meat has spurred an increase in demand for day-old chicks, BRAC Poultry has scaled up its production to ensure sufficient supply to BRAC Chicken. BRAC’s poultry rearing farms also plan to increase their capacity to serve this growing demand.
BRAC Artificial Insemination began in 1987 as a partnering initiative with the government of Bangladesh to provide the rural poor with an access to better quality breeds of cows. While BRAC provided cattle as assets to the rural poor, the situation was not ideal as these cows could only produce an average of 1.25 litres of milk per day (Survey of BRAC Research Department) and this amount of productivity did not help the target groups generate a decent income. BRAC figured that breeding higher yielding dairy cows would help ameliorate this issue. At this time in history, the government alone had access to high quality bulls frozen semen and the rural poor were seldom capable of administering artificial insemination by those semen. Hence, a joint effort by BRAC and the government workers into the field to train a selected number of people on how to administer artificial insemination gave a head start to the project. Initially, 130 people volunteered to be trained as artificial insemination technicians and till today, BRAC has trained 2,141 artificial insemination technicians successfully. Few are waiting to start their activity in the rural areas.
The government had access to two different kinds of semen: liquid and frozen. They provided liquid semen and the proper insemination equipment to the trained BRAC’s AI workers to inseminate the cows of the dairy farmers but with inconsistent electricity supplies in villages, the liquid only lasted two to three days, which, in a holistic way, deteriorated and limited BRAC’s rural development endeavours. In addition, in 1997, the government’s limited resources for frozen semen caused a huge number of drop outs of the farmers from the programme. In an attempt to tackling the matter, BRAC began producing its own bull frozen semen after taking the government’s permission. To preserve the temperature without electricity, BRAC provided liquid nitrogen to the artificial insemination workers.
Transition into an enterprise
In 1998, BRAC officially split its efforts from the government and worked with various other organisations to support its development efforts. Till 2007 it has a development phase and by 2007, the artificial insemination development programme became self-sufficient and BRAC finally established an independent artificial insemination social enterprise.
BRAC Artificial insemination has one bull station in Shambhugonj, Mymensingh, Bangladesh. When it was first built, it held 35 bulls along with growing. Today it holds 73 bulls and 19 Black Bengal goats BRAC is the pioneer of private owned large sized bull and buck frozen semen collection, processing, preservation and distribution centre in Bangladesh. Till date no government and private organization is involved in goat frozen semen production, processing and distribution. Now-a-days, from the bull station, all types of frozen semen gets distributed to depots. BRAC Artificial Insemination has 70 CCA (depots) throughout Bangladesh. Here, artificial insemination workers purchase semen for average BDT 140. Then they charge the farmers BDT 205-250 for the semen and their services. Artificial insemination workers not only inseminate the farmers’ cows, but they also train the farmers to take care for their cows’ on general health (water supplementation, feeding for proper nutrition, housing and management, disease prevention, and cattle breed selection).
When a farmer’s cow goes into heat, the farmers call an artificial insemination workers and the technician inseminate the cow within 12 to 18 hours for proper conception. Farmers eventually benefit from both male and female calves. High quality breeds of male calves grow more quickly and larger than average male calves, making them a better source of beef. If the cow births a female calf, this calf will eventually grow into a high-yielding cow. For making profitable business on dairying the one calf in one year is essential. AI workers are devoted to informing the farmers in that regards.
Today, BRAC Artificial Insemination covers 61 districts across Bangladesh and has inseminated a total of about 1.64 million in 2015. The districts covered also contribute to BRAC Dairy and Food Project. BRAC Artificial Insemination definitely contributes to the success of BRAC Dairy, helping to fuel the demand for milk in Bangladesh.
BRAC’s AI workers are providing different services, in addition to the AI, the FMD vaccination, mastitis test by CMT kits, fodder seed supply, cattle feed sell, mineral mixture (Minamix) and primary health services through health camps organized by veterinary doctors etc. are continuing in the rural areas.
BRAC Artificial Insemination initially targeted the rural poor, helping them generate income. Today, they focus on a community approach. For example, if milk production increases in a community, the poor can make money rearing cows and selling milk. The rich also benefit from milk and meat products. Today, BRAC Artificial Insemination employs 85 staff. Positions include skilled workers with degrees in Animal Husbandry, Veterinary Science studies, Social Sciences and management. They also employ temporary staff about 40 are working in bull station.
BRAC Artificial Insemination has become extremely successful, surpassing the quality of other artificial insemination services in the country. The general practise in the artificial insemination sector is for farmers to transport their cows to insemination centres, where conception rate averages around 46 per cent. BRAC’s artificial insemination workers actually travel to farmer’s door step to inseminate the cows, and at present their conception rate averages more than 65 percent. BRAC credits their success to the calm state in which they inseminate the cows. When in general practise, receives insemination on cows, they are exhausted from travelling in the hot sun. BRAC has the highest quality bull semen in Bangladesh; this quality paired with high conception rates has drawn more farmers to use BRAC Artificial Insemination’s services.
BRAC Artificial Insemination, as a profitable social enterprise, is constantly working on expansion of artificial insemination services throughout Bangladesh and introducing innovations for dairy development. The profits generated also contributes towards funding BRAC education and health and nutrition programs.
A dairy breeding farm with embryo transplantation facilities is currently in the planning phase. They also plan to increase the bull blood level from 50 percent to 100 percent, creating the highest quality bull possible.
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Empowering crafters in a nutshell
As one of Bangladesh's largest fashion retail chains under the umbrella of one of the world’s largest NGOs, Aarong’s flagship outlet also claims the largest retail space in the country as part of its presence in the Uttara district of Dhaka. Fighting to uphold the dignity of the marginalised, this chic brand began as a humble project. After it’s initiation as a project to provide employment for a limited number of rural women through silk production via sericulture and the art of nakshikantha(embroidered quilts) in 1978, Aarong extended its support to rural artisans by investing in their handicrafts for several years into its operations. In the process, it saw the emergence of independent producers and created income generating opportunities for thousands of artisans from communities beyond the reach of BRAC. Weaving together new opportunities for people with the skilled work of their artisans, Aarong has carved out a unique market segment, giving hope to the crafters.
How it all started
When BRAC started its journey in 1972, the initial goal was to serve as a relief operations committee for a designated amount of time. Once its relief operations were underway, BRAC reasoned that providing limited relief to the rural poor was not a lasting solution for them to overcome poverty, as in the newly sovereign Bangladesh almost everything - including the economic infrastructure of the country - was left upturned. After the completion of its relief operations, BRAC shifted its focus to empowering the poor, forming a long term approach to community development. Around 1976, while operating its targeted group approach, BRAC realised that the most disadvantaged groups in poor rural communities were women, and required a route that would empower this group while also providing income generating opportunities.
BRAC began encouraging silk farming by women in Bangladesh’s Manikganj district. Initially, BRAC had a few scattered buyers in Dhaka, with weeks or even months passing between supply and payment. Today, the process is much more streamlined and efficient as BRAC established Aarong, whose artisans represent the cutting edge of social enterprise. Through BRAC’s innovative approach, the global community now has a prime example of how targeted mobilisation of the poor can support sustainable development efforts, while also generating a financial surplus.
The birth of Aarong
BRAC observed that women in Bangladesh were increasingly involved in agricultural activities. It also recognised that it was the male members of families who marketed the crops and reaped the profits, even though women completed about 75 percent of the agricultural work. In order to create an alternative opportunity to earn an income for these women and contribute to the development of a skilled workforce, BRAC established its sericulture project in 1978 under the leadership of the late Ayesha Abed, former executive assistant director of BRAC.
The sericulture project has supported women in the rural areas of Manikganj in producing high quality silk, and women in rural communities of Jamalpur in producing traditional hand-stitched nakshikantha. However, it soon became apparent that the women producing the silk and nakshikantha did not have sufficient buyers for their products, nor were there any stable platforms for them to market their items. Seeing the opportunity that lay in the challenge, BRAC took the initiative to create a platform so that these women could sell their products to the urban market. Thus, Aarong was launched in 1978, creating a linkage between the rural poor and urban retailers.
Since its inception, Aarong, which means 'village fair' in Bengali, has been working towards BRAC’s mission of poverty alleviation through economic development and human capacity building, with a specific focus on the empowerment of women. The retail process follows several steps: first, a design team conceptualises the season’s motives which are then sent to the rural artisans for production. Aarong continuously develops the artisans’ skills through training programmes, and conducts quality control of the completed items before they are bought at a fair price and then sold across retail outlets in urban markets. By evolving the traditional retail process, Aarong strives to provide a uniquely Bangladeshi lifestyle experience while encouraging social change. A newly generated demand for Bangladeshi handcrafted products illustrates that Aarong has achieved this vision, and continues to challenge the retail industry with its sustainable fashion ‘revolution’.
Continuing the legacy through an extended reach
After the death of Ayesha Abed, her family members founded the Ayesha Abed Foundation (AAF) in 1982 in her honour to continue her projects’ operations. AAF gathers and organises both the skilled and previously untrained artisans from various village organisations across the country and provides them with training and employment; its numerous centres serving as Aarong's production hubs. The foundation currently has 13 centres and 541 sub-centres spread across Bangladesh.
The co-existence of Aarong and the Ayesha Abed Foundation, both geared towards the same ambition, made an extensive support system for artisans all over the country a reality. Through this system, independent producers conducting fair trade with Aarong are encouraged to organise other artisans from their communities, including those communities which BRAC’s services have not yet reached. Today, there are almost 800 independent producers active in different corners of Bangladesh and working with them are nearly 30,000 rural artisans. Additionally, more than 35,000 other artisans are working at AAF centres, producing and selling goods to Aarong to support themselves and their families, resulting in a total of over 320,000 direct and indirect beneficiaries.
BRAC, Aarong, and Ayesha Abed Foundation’s assistance to artisans
AAF's current services to the artisans include free skill-building, supply of raw materials for production, transportation of goods, quality control, storage, management, finance, marketing, and microfinance loan options through Aarong. Working mothers have access to day care centres for their toddlers while they work, and senior workers receive a retirement benefit. AAF employees in rural communities also obtain various support from BRAC, including micro-credit services; seeds, agriculture, poultry, livestock, and fisheries inputs; free schooling for their children; subsidised tube-wells and sanitary latrines; health care including free eye check-ups and glasses, free treatment of tuberculosis and severe illnesses and health education; as well as legal awareness and support.
Currently a health security scheme for artisans and their family members is being piloted to protect artisans against catastrophic health expenditures.
In addition to being trained, women recruited by AAF benefit from a living wage and job security. The workspaces are often right at the doorsteps of the artisans, to enable them to mainly work from home while being able to look after their families.
Taking into account the specific needs of its employees illustrates how Aarong through AAF has always infused a conscious effort to address issues such as the environment, gender-specific needs, safety, security and most importantly - the empowerment of women.
Village fairs in urban landscapes
Aarong’s primary customers are mostly from middle and higher socio-economic classes living in urban areas.Aarong’s retail outlet is particularly renowned amongst expatriates and foreign visitors. Today, Aarong owns 15 retail chain outlets in Bangladesh, nine of which are in Dhaka, two in Chittagong, one in Sylhet, one in Narayanganj, one in Khulna, and one in Comilla. Not only has Aarong been a trendsetter in the local fashion industry, with the Uttara flagship store claiming the title of the largest retail outlet of a single brand, but it is also a pioneer of its kind in entering the global market, having opened a franchised outlet in London in 2001, and planning the extension of its e-commerce website to international markets in the near future. Aarong offers a wide variety of products and designs in its outlets including embroidery, block and screen prints, tie-dyes, vegetable dyes, batik, block cuttings, furniture, wall mats, toys, pottery, metal works, jewellery, leather products, candles, handmade paper and paper products.
Merchant of a lifestyle in favour of the environment and sustainable development
Aside from its significant contribution to the expansion and popularisation of the cotton handloom industry, Aarong has given rise to a greater demand for locally manufactured fabrics, which in turn has played a vital role in reviving the almost extinct traditional jamdani (woven cotton fabric), muslin (loosely woven cloth) and nakshikantha. Committed to being environmentally friendly, Aarong has also introduced dyes free from AZO (restricted aromatic which may be harmful to skin) and PCP (used for chlorination, also deemed harmful) in its cotton fabric production.
In addition to redistributing 50 percent of its profits throughout BRAC’s development programmes (keeping the remaining 50 percent to sustain its own operations)Aarong’s own consumption of raw materials sustains numerous artisan communities in Bangladesh; Aarong buys 75 percent of cotton produced in Madhobdi, the core cotton production area in Bangladesh, and over 70 percent of silk produced in Maldaha.
Aarong started out with the goal of supporting poverty stricken rural women so that they could empower themselves by utilising and further enhancing their skills. That goal remains to this day, with its scope having broadened to extend its services to more of the rural poor and urban markets. Aarong plans to launch an international e-commerce site to serve global markets and is looking to expand to more cities domestically and internationally.
1978 – Opened its first retail outlet in Dhaka, Bangladesh
1982 – Established the Ayesha Abed Foundation, a network of production centres
1983 – Opened a retail outlet in Chittagong, Bangladesh
1985 – Opened a retail outlet in Sylhet, Bangladesh
1987 – Entered the export market
1995 – Opened a retail outlet in Khulna, Bangladesh
1999 – Participated in its first international fashion show
2001 – Launched a retail franchise in London, United Kingdom
2003 – Launched its sub-brand ‘Taaga’, women’s western fusion wear
2007 – Received Fair Trade certification from World Fair Trade Organisation
2008 – Celebrated its 30thanniversary with an exhibition series and fashion gala
2009 – Received ‘Best Brand’ award from Superbrands
2011 – Opened its flagship outlet in Uttara, Dhaka, Bangladesh
2012 – Opened a retail outlet in Comilla, Bangladesh, received UNESCO Award of Excellence
2013 – Launch the Artisan Development Initiative, a BRAC holistic development programme
2014 – Opened a retail outlet in Jamuna Future Park, Dhaka, Bangladesh, launched e-commerce website, launched furniture line ‘Rattan’ and product line ‘Maternity Taaga’
2015 –Opened retails outlets in Dhanmondi and Banani, Dhaka, Bangladesh
In 1978, BRAC’s flagship social enterprise, Aarong, was created as a support mechanism to BRAC’s existing sericulture programme so that the hand-spun silk they were creating could be successfully marketed at a larger scale. Aarong was established as a retail distribution outlet that offered a fair price to the rural suppliers while introducing the products to urban markets where both demand and consumers’ willingness to pay were the highest. Today, Aarong has transformed into a high surplus generating enterprise, operating as one of the largest retailers in Bangladesh. Other BRAC enterprises also came into existence at various times in similar efforts to create economic space for the poor. Although most of the BRAC enterprises were formed as programme support enterprises, majority of them currently operate as surplus generating ventures while maintaining their ongoing commitment toward alleviation of poverty via empowerment of the poor. Today BRAC operates 16 financially and socially profitable enterprises, across health, agriculture, livestock, fisheries, education, green energy and retail sectors, making significant contribution to local economy through creation of market linkages, entrepreneurs and employment opportunities. By targeting profitable and scalable businesses, BRAC enterprises are able to fullfill their social missions at a much greater scale while increasing financial surplus that reduce the organisation’s donor dependency and support BRAC’s development programmes and other innovations at a greater level. That is why BRAC enterprises continue to exist, expand and innovate through across multiple sectors.
The BRAC ethos of social entrepreneurship, the '3Ps': people, planet, profit
BRAC Enterprises strive to strike the right balance between financial surplus and social returns in order to achieve the targeted double/triple bottom lines. By operating as a surplus generating organisation that aims to alleviate poverty through its business operations and supply chain, BRAC succeeds in implementing its vision to serve society in a profitable manner.
Although all of the BRAC enterprises are committed toward achieving financial, social and environmental returns, BRAC takes a unique approach in defining its triple bottom line by focusing on three ideals: people, profit and the planet (the '3Ps'). A BRAC enterprise must meet three criteria in order to be considered a successful and sustainable business:
It must serve the needs of poor people
It must be environmentally friendly, and
It must make surplus to help keep BRAC’s development works sustainable
Social enterprise – our objective
BRAC takes a holistic approach in conceptualising and developing each of its enterprises. As BRAC enterprises have expanded from programme support mechanisms to surplus generating enterprises with financial and social missions, each enterprise has ensured that it complies the four fundamental objectives of a BRAC enterprise:
Creating job opportunities
Generating surplus for BRAC in order to minimise donor dependency
Ensuring long-term support and contribution toward the sustainability of BRAC’s development interventions such as microfinance, education and skills development etc.
Becoming viable investments in the long run in order to act as ‘hedge’ against future liquidity
Advantages gained from social enterprises
Through its unique model and integrated operations, BRAC achieves five distinctive advantages across its enterprises:
The integrated network of BRAC Enterprises, Development Programmes and Investments together beget a unique synergy and essentially create a 2 2=5 Effect. The surpluses generated by the social enterprises make BRAC more self-sustaining so that increasing numbers of poor people can become self-reliant.
BRAC enterprises maximise synergy, impact and value by their targeted outreach and integrative products and services across multiple enterprises.
Although BRAC enterprises aim for financial returns while fulfilling the social and environmental missions, not all enterprises are equally profitable. The cumulative surplus from BRAC enterprises combined are used to re-invest in the BRAC enterprises and support the development programmes, on an as needed basis, not on a pro-rata basis across enterprises.
BRAC’s extensive network of enterprises with the capacity to address major social needs allows BRAC to continually identify needs and create innovative solution to fulfil that need and create necessary market linkages.
Because of its integrated network and unique model, BRAC has the advantage, ability and capacity to provide holistic support and truly take care of its stakeholders, i.e. the entrepreneurs involved with the BRAC enterprises.
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