BRAC initiated its health program just nine months after its inception through health care centers. BRAC’s health program provides preventive, curative, and rehabilitative grassroots health services that have proven effective in the past. Today, BRAC offers comprehensive health care to 31 million people, and through its tuberculosis (TB) control program it reaches 82 million people.

ESSENTIAL HEALTH CARE

The Essential Health Care (EHC) program offers a basic package of health services to approach health issues comprehensively. Notably, BRAC provides critical services in reproductive health and disease control, disseminates information through village organization meetings and household visits, and collaborates with the Government of Bangladesh to help implement national programs, such as the TB, malaria, immunization, and sanitation programs. Most critically, EHC pays particular attention to the poorest and most vulnerable members of the community in both rural and urban settings. EHC covers 31 million people all over the country.

Water and Sanitation

The provision of safe water and good sanitation facilities play a vital role in promoting health and improving hygiene status at the community level, thus increasing the productivity and well-being of the nation. Inadequate provision of safe drinking water and sanitation are directly related to the spread of communicable diseases, increased health risk, and poor health and environmental pollution.

BRAC community health volunteers and paramedics work to generate demand for safe water and sanitation facilities through household visits and health education forums on sanitation problems. Information is also disseminated through popular theatre, workshops, rallies, and campaigns, as well as through the orientation of teachers, religious, and community leaders. BRAC is working closely with other NGOs and the government to achieve 100 percent sanitation by 2010.

Family Planning

BRAC volunteers and professionals seek to educate women regarding use and benefits of modern contraceptive methods during their household visits. This includes the provision of birth control pills, condoms, and referrals to secondary and tertiary facilities for other temporary and permanent contraceptive methods.

Immunization

BRAC plays a key role in immunizing infants and pregnant women. Both volunteers and paramedics are responsible for educating women about the importance of immunization and providing information regarding the location of immunization centers, as well as monitoring for any immunization-induced side effects.

Basic Curative Services

Illness is a major cause of income loss for the poor. About 60 to 70 percent of all common diseases can be treated at the community level through basic curative services. BRAC professionals have been successfully trained to diagnose and treat some basic health ailments found in the general population, such as anemia, diarrhea, dysentery, common cold, helminthiasis, ringworm, scabies, hyperacidity, angular stomatitis, and goiter. BRAC’s efforts ensure affordable curative services are available to the poor and vulnerable at the grassroots level.

Pregnancy Related Care

BRAC provides pregnancy related services through community-based ante and post-natal care to rural women. The Shastho Shebikas (SS), health volunteers identify all pregnant women in the area and the Shastho Kormis (SK), health workers register them. The SKs then visit the pregnant women and collect information regarding present and past pregnancies. Thereafter the SKs provide the pregnant women with health and nutrition education, which address topics such as good hygienic practices, clothing, and the need for light exercise.

The SKs also track the pregnancy, record weight and height, as well as taking measurements for anaemia, jaundice, oedema, blood pressure, temperature, and albumin and sugar levels in the urine. The SKs also perform an abdominal examination to determine the height of the uterus and position of the foetus. The SKs motivate pregnant women to receive Tetanus Toxoid (TT) immunization, provide iron and folic acid (IFA) tablets, and promote breast feeding and family planning. The SKs advise the mother to use a trained birth attendant in the case of a normal delivery and refer mothers to the hospital if complications arise.

TUBERCULOSIS CONTROL

The tuberculosis treatment program has expanded since its introduction in 1984. The SS implements the program through information dissemination, identification of suspect cases, administration of Directly Observed Treatment Short course (DOTS), patient follow-up, and referral.

ESSENTIAL HEALTH CARE FOR SPECIALLY TARGETED ULTRA POOR

The Specially Targeted Ultra Poor (STUP) program is running in seven districts. The provision of health care services for the specially targeted ultra poor involves two distinct strategies in addition to normal EHC services. First, the program provides health awareness and basic health care services to all STUP, irrespective of their health status. Second, STUP diagnosed with mild and severe morbidity are provided with financial assistance for their clinical care.

An essential component of the implementation strategy is to undertake a health survey on mild and severe diseases among STUP households during household visits by the Program Organizer (PO) and to take necessary steps for clinical care.

FACILITY-BASED SERVICES

Shushastho (BRAC Health Centre)

Static health centers or Shushasthos were opened in 1995 to serve as a back up to community-based health interventions. The Shushasthos aim to develop a financially and programmatically sustainable model in order to provide clinical services for complicated cases identified in the community. Additionally, the Shushasthos play a role in improving maternal health status by aiding deliveries in high risk birthing situations. Shushasthos are equipped with outpatient and in-patient services, laboratory facilities, essential drugs, and behavior change communications materials and equipment. One upgraded center in each district handles more complex clinical scenarios and emergency obstetric care.

The BRAC Limb and Brace Centre (BLBC) was established in 2000 to provide support to the physically disabled. The centre offers prosthetic (artificial limb) and orthodoctic (braces) services, as well as a physiotherapy service, introduced in 2001. The aim of the centre is to provide low-cost quality devices and services to the disabled people of Bangladesh, with an emphasis on the poor.

To operate and develop this project, BRAC has been working in cooperation with Santakba Durlabhgi Memorial Hospital (SDMH), Jaipur, India a specialized pro-poor health services institution. Since 2001, the International Committee of the Red Cross Special Fund for the Disabled (ICRC-SFD) has been providing artificial limbs and braces, as well as technical support and machinery. The BLBC is also financed by the Jaipur Limb Campaign (JLC) UK; part of this support includes funding for Jaipur prosthetic technology. There are two satellite Limb and Brace Fitting centers in Chittaging and Rangpur.

PARTNERSHIP PROGRAMS

Nutrition

The National Nutrition Program (NNP) is a joint venture between the government and nonprofit organizations that aim to improve the nutritional status of women and children. A key component of the program is that ten nonprofit organizations execute Area Based Community Nutrition (ABCN) programs within their communities. ABCN activities include growth monitoring and promotion, weight monitoring and promotion, food supplementation, micronutrient supply and social mobilization. NNP provides a one-in-a-kind program that combines poultry for nutrition (PFN), household food security through nutrition gardening (HFSNG) and vulnerable group development (VGD) programs with core nutrition programs that function under one umbrella.

This program is financially supported by the government with the assistance of World Bank, Canadian-CIDA, the Dutch government and UNICEF. The aim of the household food security program is to maintain and sustain food supply at household levels and thus, improve nutritional status and income of the target group. At both PFN and HFSNG programs, the main beneficiaries are poor families with less than 0.5 hectare of land.

Tuberculosis

BRAC's TB program began in 1984 as a pilot program in Manikganj sadar upazila in Manikganj district. In 1994, BRAC joined in the implementation of the National TB Control Program in partnership with the Government of Bangladesh, using the Directly Observed Treatment Short-Course (DOTS) strategy.

The Shastho Sebikas (SS), or health volunteers, play a critical role in the implementation of BRAC's TB program. The SSs disseminate information regarding TB and identify suspected patients who have had a cough for more than three weeks through household visits. Sputum from the suspected are examined for confirmation of TB cases. TB cases are also confirmed through other tests by the chest specialists.

Fixed Dose Combination (FDC) drugs are being used for treatment of TB. TB treatment is given following DOTS strategy through the Shastho Sebika (health volunteers), under the guidance of BRAC field level staff and a government or BRAC medical officer. The specialty of BRAC's DOTS strategy is that patients have to deposit Taka 200 (US$ 3.50) prior to treatment and sign a bond with two witnesses for guarantee of treatment completion. If the patient is unable to pay, then the patient seeks support from the community to pay on his behalf. If the community fails, the individual is given an exemption from the bond money. On completion of the treatment, the deposit money is refunded to the patients and Taka 150 is given from BRAC to the Shastho Sebika (health volunteers) for her service.

BRAC signed an agreement with the Global Fund to fight AIDS, TB and Malaria (GFATM) as the principal recipients on July 7, 2004 to control TB in Bangladesh in collaboration with the Ministry of Health and Family Welfare. Subsequently, BRAC signed agreements with the ten partners- ICCDDRB, National Anti-Tuberculosis Association of Bangladesh, Damien Foundation, Urban Primary Health care Project, RDRS, Lepra Bangladesh, Danish Bangladesh Leprosy Mission, HEED Bangladesh, Lamb Hospital, Salvation Army to expand financial support for strengthening DOTS services. This program has been supported by DFID, CIDA, EU, Fidelis, WHO, Research Institute of TB- Japan, Leeds University and BRAC.

NEW INITIATIVES

HIV/AIDS Program

BRAC's HIV/AIDS program promotes mass awareness in the community about the disease, provides condoms to high-risk groups, and performs syndrome management of STIs and RTIs in high risk groups to reduce the risk of HIV infection. Program Organizers, Health Educators, Shastho Shebikas, and Extension Workers (EW) are trained to offer information about HIV/AIDS to the community people and especially the internal migrants on STI / RTI, HIV/AIDS to raise awareness. Popular theatre is also used to raise awareness of the disease within a community. Adolescent boys and girls are targeted in BRAC's awareness campaign, both during secondary school and through the medium of BRAC Education Program's community and adolescent libraries. BRAC offers information and distributes condoms to brothel-based sex workers, as well as transport workers, industrial laborers and internal migrants. Micro finance loans are also available to commercial sex workers to ensure financial stability and security, and empower them to demand condom usage. This program is being implemented with SIDA and UNICEF funds.

Malaria Prevention and Control Program

Malaria is one of the major killing diseases in Bangladesh and the whole population is at risk in high malaria endemic districts. BRAC is providing education on malaria prevention and treatment through its health programs. A special initiative was taken in the hilly areas including awareness-raising activities on malaria control as an EHC component in 1998. In 2002, Activities on Early Diagnosis and Prompt Treatment (EDPT) and distribution of Insecticide Treated Mosquito Nets (ITMN) were initiated in close collaboration with the Mal-VBDC (malaria-vector borne disease control) of Directorate General of Health Services, Government of Bangladesh, MRG (Malaria Research Group) and ICDDR,B. Identified patients receive care at their doorstep through outreach centers and home based care by the Shastho Shebikas (health Volunteers) and Shastho Kormis (front line workers).

Micro-Health Insurance

Micro-health insurance was initiated in July 2001 as a BRAC funded project. Since October 2001, it has been funded by ILO. The goal of this project is to facilitate the poor to affordable and quality health services and to empower women as the entry point for their family's access to health care. This project offers voluntary enrollment to VO, non-VO members and the ultra poor. Premium cost varies with VO membership and family size. Three packages such as a general package, a prepaid pregnancy related care package and an equity package for free enrollment of the ultra poor through this project.

Community-Based Arsenic Mitigation Project

BRAC's arsenic mitigation project seeks to raise community awareness, test tube well water for arsenic contamination, and implement safe drinking water strategies. BRAC has developed five options to ensure safe drinking water. These includes: new and renovated dug wells, rain water harvesters, pond sand filters, deep hand tube wells, and rural pipe water supply systems. This is a UNICEF and Rotary International supported program.

Early Childhood Development

The Early Childhood Development program employs advocacy, research, family empowerment and networking to increase the skills and awareness of the caregiver for holistic development of child from conception to five years of age. The project is organized by Bangladesh Shishu Academy and financed by UNICEF.

Saving Newborn Lives

This program works to improve neonatal health and survival in three rural sub-districts by promoting the use of home based hygienic delivery practices, increasing referrals to health facilities for complicated pregnancies, increasing the number of newborns with complications who receive care at a health facility, and increasing the number of women receiving ante-natal care services. BRAC is using Behavioral Change Communication in some upazilla, while direct service delivery is being used in others to determine which approach performs better. This program started in 2002 in collaboration with Save the Children (USA).

Public Private Partnership Facilitation Program

The Public-Private Partnership (PPP) program, an experimental intervention of the Ministry of Health and Family welfare supported by DFID, had been designed to improve poor women and children's access to good quality essential health services. The PPP Vision encompasses "Empowering people to take care of their own health making better use of existing resources." The PPP has also drawn on the experiences of GOB-NGO-Community partnerships where BRAC has made significant contributions in creating the provision of Essential Service Delivery making optimum utilization of available public-private community resources.

BRAC acted as a catalyst to establish six Community Health Schemes (CHSs) based at Government Community Clinics at Brahmanpara upazila of Comilla district in line with the PPP Vision. During the reporting period, BRAC concentrated its facilitation efforts to mobilize the community resources in view of transforming the CHS into a self-managed autonomous community healthcare trust. Following these efforts, six Trustee Boards were registered between July and September 2004. The Trustee Boards collected substantial money from the community. The generated money has been deposited and the CHSs receive the monthly interest as fixed income, which is being used as a subsidy for monthly operational expenses. Income is also generated by the CHSs as program revenue (user fees, profit from drug sale and pathology services).The program is supported by Northern Ireland Centre for Health Care Co-operation and Development (Nicare), GoB and DFID.

Realizing Rights – Improving Sexual and Reproductive Health in Poor and Vulnerable Populations

BRAC is a partner of Realizing Rights which is a Research Program Consortium supported by DFID. Poor sexual reproductive health is a source of enormous suffering for millions of the world's poorest people. High levels of mortality and ill-health as a result of sexual and reproductive health problems compromise efforts to reduce poverty. Realizing Rights aims to respond to these challenges using research to raise the profile of sexual and reproductive health and rights in developing countries and working in partnership to find innovative solutions. Other partners include African Population and Health Research Center (Kenya), BRAC University, EngenderHealth (USA), INDEPTH Network (Ghana), Institute of Development Studies (UK) and London School of Hygiene and Tropical Medicine (UK). For more information on the program, please visit the Realizing Rights website.