Health, Nutrition and Population Programme At a Glance 2013...Health, Nutrition and Population Programme BRAC’s Health, Nutrition and Population Programme (HNPP) promotes a broad

Health, Nutrition and Population Programme

BRAC’s Health, Nutrition and Population Programme (HNPP) promotes a broad concept of health among

disadvantaged communities through a combination of preventive, curative, rehabilitative and promotional health

services. Healthcare interventions have been an integral aspect of BRAC’s holistic approach to development.

Taking b irth weight of a newborn baby in a village of Gaibandha district, Bangladesh.

Discussing

basic health

issues in a health

forum in a village of

Jamalpur district,

Bangladesh

Aim is to • Improve reproductive,

maternal, neonatal, child

health and nutrition

• Reduce vulnerability to

communicable diseases

and common ailments

• Combat non-

communicable diseases

• Enhance quality of life

Its unique approach through

the frontline community

health workers, namely,

Shasthya Shebika and

Shasthya Kormi brings

health, family planning and

nutrition services closer at

doorsteps, promotes health,

creates demand and links

community with government

and private health sectors. Essential Health Care Evolved as BRAC’s core

health intervention, the

Essential Health Care

(EHC) offers basic, low-cost

essential health services

through community health

workers since 1991.

Special health care is given

to ultra-poor families using

EHC infrastructure. Maternal, Neonatal

and Child Health

Programme Started in 2005 as a pilot

initiative in Nilphamari

district, BRAC’s MNCH

services have been

expanded across 10 rural

districts and 8 city

corporations providing

access to quality MNCH services to rural and

urban slum populations Tuberculosis

Control Programme As the principal recipient

of the Global Fund to Fight

AIDS, TB, and Malaria,

At a glance (Jan2013-Dec2013)

BRAC HEALTH PROGRAMME Coverage 64 districts

Population 120 m Shasthya Shebika 97,000 Shasthya Kormi 10,008

Programme Organiser 4,224 District Manager 194 Medical Officer (Field) 53

ESSENTIAL HEALTH CARE Coverage 64 Districts Population 120 m Contraceptive acceptance (Modern method) 24,385,756 CHWs assisted

immunisation 1,344,612 Ultra poor

received treatment 188,601

www.health.brac.net

BRAC has been working along

with the government to offer

service for TB control. In

addition to providing 42 partner

NGOs with technical support

and supervision, BRAC directly

implements TB related activities in 297 sub-districts since 1998.

Malaria Control

Programme The National Malaria Control

Programme works with 20 NGOs

led by BRAC to implement control

activities in affected areas. As a

principle recipient for the NGO

component, BRAC provides

support to other NGO partners

and directly impliments

programme in high endemic

Chittagong Hill Tract districts and

in Moulvibazar. Nutrition Programme The Infant and young child

feeding practices (IYCF) are

being promoted through Alive &

Thrive project to address under-

nutrition of U2 children. Evidence

of IYCF practices has been

replicated in MNCH programmes

and gradually expanded to 50

sub-districts by adopting 1000

days approach. Micronutrient

powders are also promoted to

address childhood anemia. Eye Care Interventions Vision Bangladesh (2

nd phase)

aims to eliminate the backlog of cataract blindness from

urban slums by 2015. Vision Spring Aim is to combat presbyopia

which results difficulty in near vision and reduces

productivity of adults over

the age of 35 years.

Facility Based Services BRAC facility based initiative was

established by linking community

with good quality curative and rehabilitative services

at affordable costs to

general population. mHealth (mobile Health) Intervention mHealth was initiated in urban

slums of Dhaka to address

quality maternal, neonatal and

child health services through

mobile phone based

technological platform by

providing patient care and

emergency management

support and ensuring

monitoring and supervision. A

comprehensive digital echo- system has been created,

tested and equipped for

scale-up to ensure quality of

care in low resource setting.

BRAC Healthcare Innovations Programme (bHIP) bHIP aims to jump-start the

journey toward universal health

coverage in Bangladesh by

providing a transformative

option for the health care

consumer. It will provide access

to comprehensive, good quality

care that minimizes the risk of

economic compromise and will

integrate three major lines of innovation in healthcare related

to service provision, financing

and information management.

MATERNAL, NEONATAL AND CHILD HEALTH PROGRAMME Rural Urban Coverage 12 dist. 9 city corp. Population 21.2 m 6.9 m 4+ ANC 377,412 99,435 Hospital delivery 134,658 75,487 BRAC Delivery centre delivery - 32,216 Immunisation 390,974 107,270 TUBERCULOSIS CONTROL PROGRA MME Coverage 42 districts Population 92.9 m TB symptomatic tested 120,480 TB case detected and treated 89,983 Treatment success rate

of smear positive case 93 MDR-TB patients diagnosed 193 MALARIA CONTROL PROGRAMME Coverage 4 districts Population 2.18 m Long Lasting Insecticidal

Mosquito Nets (LLIN)

distributed and in use 120,100 Malaria patients treated 11,428 NUTRITION PROGRAMME Coverage 104 sub districts Population 26.5 m Exclusive breastfeeding 911,219 Timely & appropriate

complementary feeding 173,832 Sprinkle sachet distributed

(61 districts) 14.5 m

EYE CARE INTERVENTIONS Vision Bangladesh Suspected patient examined 451,199 Cataract surgeries done 42,082 Vision Spring Person examined for eye problem 531,278 Glasses provided 104,289

FACILITY BASED SERVICES

BRAC Health Centre 18 BRAC Clinic 13 BRAC Limb and Brace Centre 2

Although ev ery effort has been made to include and verify the accuracy of relevant inf ormation in this fact -sheet, users are urged to check independently on matters of specif ic interest.

Report any discrepancies/suggestions to [email protected]. This document was last updated on March, 2014, is revised quarterly and made available on www.brac.net/visitors.

SOCIAL MOBILIZATION ATTENDED FOR THE MONTH OF APRIL- JUNE 2012

DEMOGRAPHY

District 47

Upazila 363

Population 53 million

HUMAN RESOURCES

District Manager 99

Upazila Manager 379

Program Organizer 1,815

Shasthya Kormi 4,204

Shasthya Shebika 48,842

HEALTH AND NUTRITION EDUCATION

Group health education forum 3,089,891

WASH PROMOTION

Slab latrines installed 172,728

IMMUNIZATION

Under 1 children fully immunized 846,368

Pregnant women received TT 783,794

FAMILY PLANNING

Contraceptive acceptance (Modern)

6,360,085

PREGNANCY RELATED CARE

4 or more antenatal care 497,291

Skilled attendance at birth 619,716

BASIC CURATIVE CARE

Common ailments treated by SS 3,909,235

Patients referred by SS 195,700

TUBERCULOSIS CONTROL

Sputum microscopy for TB 1,123,642

MALARIA CONTROL

Symptomatic malaria case tested 164,785

MANAGEMENT OF PNEUMONEA

U5 pneumonia managed 257,062

MANAGEMENT OF DIARRHOEAL DISEASES

U5 diarrhea managed by ORS 321,669

NUTRITION

Early initiation of breastfeeding (within one hour)

762,556

ESSENTIAL HEALTH CARE PROGRAMME At a glance’ 2013

Initiated in 1991 Essential Health Care (EHC) has revolutionized the primary health care approach in Bangladesh reaching millions with low cost basic promotive, preventive and curative services through the frontline community health workers – Shasthya Shebikas and Shasthya Kormis. Goal Improve access to essential health services through delivering community care and organizing a bridging network with public health care system Objectives

Promote positive health, nutrition and hygiene behaviors and create demand for public and private health services

Mobilizing children and women for preventable vaccination, deworming and vitamin A supplementation

Improve domiciliary access to non-clinical contraception and referral for clinical ones

Ensure early screening for pregnancy complications, appropriate referral in emergencies and facilitation of safe home delivery

Provide home based management with referral for common symptoms, including diarrhea and pneumonia

Provide early recognition, diagnosis and supervised treatment for infectious and common non communicable diseases

Provide screening support for presbyopia and cataract and arrange for correction

Strategy Shasthya Shebikas (SS) and Shasthya Kormi (SK), the frontline community health workers are locally recruited women and trained as health providers to deliver door-step health service. They prevent and promote health activities through health education and dissemination of health and nutrition messages through health forums, household visits and meetings with the wider community. In addition, basic curative services are provided at doorsteps of target populations. In collaboration with the government, BRAC is working in areas of immunization, family planning and basic pregnancy related care. More importantly, major interventions, such as, tuberculosis, malaria and maternal, neonatal and child health and nutrition programmes are founded on the basic structure of

EHC.

SOCIAL MOBILIZATION ATTENDED FOR THE MONTH OF APRIL- JUNE 2012

PROFILE

District 42

Upazila 297

City Corporation 7

Population 92.9 million

Rural: 88.2 & Urban: 4.7 million

HUMAN RESOURCES

Shasthya Shebika involved in DOTS

63,810

Program Organizer (Lab) 508

Program Organizer (Field) 1,153

SETUPS AND PLACES COVERED

Peripheral laboratories 392

DOTS corner at hospitals 27

Prisons covered 41

Port hospital covered 2

EPZ covered 1

Work places covered 776

TRAINING PARTICIPANTS

Basic training on TB 276

Health management training 45

Capacity building on M&E 68

Training on PSM, PMDT, IC, PAL, TB/HIV

340

Training on Child TB 2,138

Training on PAL (Practical Approach to Lung Health)

324

Training of lab technicians 240

Orientation of interns & private practitioners

2,1,354

Training on MDR TB 1,179

Training of multipurpose health staff of SRs

196

SOCIAL MOBILIZATION PARTICIPANTS

Religious leaders 32,195

Village doctors 31,874

Factory workers 19,581

Scouts and girls guide 2,089

Cured TB patients 31,281

Women group members 8,120

TB/HIV NGO workers 1,213

PERFORMANCE

New smear positive cases 71,674

New smear negative cases 30,497

New extra pulmonary cases 18,309

Symptomatic tested for MDR TB

2,220

MDR TB patients diagnosed 193

INFORMATION SR (SUB RECIPIENT)

Total number of SRs 42

Population coverage 57 million

Human resources 986

Map of Bangladesh indicating districts supported by NGOs (excluding metropolitan city areas)

In Bangladesh, tuberculosis (TB) is a major public health problem and a leading cause of adult mortality. The WHO ranks Bangladesh the 6th among 22 high burden TB countries. Every year around 76,000 people die of TB in Bangladesh. BRAC is the first NGO to sign a MoU with the Government of Bangladesh in 1994 to expand the Directly Observed Treatment Short course (DOTS) services nationwide. Along with the government, BRAC is the principal recipient of Global Fund to Fight AIDs, Tuberculosis and Malaria (GFATM) to strengthen health system and expand DOTs across Bangladesh. BRAC and 42 NGOs are implementing TB interventions in partnership with the government. Goal To reduce morbidity, mortality and transmission of TB until it is no longer a public health problem. Objectives To achieve and sustain at least 70% case detection and 85% treatment success among smear-positive TB cases under DOTS. BRAC’s approach for TB diagnosis and treatment focuses on community level education and engagement. BRAC conducts orientation with different stakeholders of the community to engage them in efforts to identify patients, ensure treatment adherence, and reduce stigma. The stakeholders include: cured TB patients, local opinion and religious leaders, girls’ guides and scouts, other NGO workers, village doctors, pharmacists and private practitioners. The Shasthya Shebika (SS), the first frontline community health worker, plays a pivotal role of connecting individuals with TB control services during household visits and health forums. They disseminate TB messages, identify suspects, refer them for sputum examination to Upazila Health Complex (Government sub-district health complex) or BRAC laboratory services, ensure daily intake of medicine for identified TB patients through DOT and refer for proper management of the side effects during TB treatment.

TB CONTROL PROGRAMME At a glance’ 2013

Epidemiology

District 13

High Endemic Districts (Chittagong Hill Tracts) 3

Moderate Endemic Districts 1

Low Endemic Districts 9

Upazila 70

Risk Population 13.1 million

Number of Malaria cases in 2012 29,518

Number of Malaria deaths in 2012 11

P. Falciparum: P. Vivax 96:4

Information about BRAC

Working Areas 27 Upazilas

Population Coverage 2.18 million

Shasthya Shebika involved in Malaria 3,132

Shasthya Kormi involved in Malaria 686

Programme Organizer (Lab) 73

Programme Organizer 160

Training participants

Laboratory Technicians trained on malaria microscopy

40

Staff trained on reporting documentation and m -health

101

Staff trained on Logistic Management Information System

48

Staff trained on Public Health Management 44

Staff trained on ACSM 49

Health Workers trained on Diagnosis and Treatment

320

Staffs trained on Malaria Management 20

Performance

Blood slide examination 89,354

Rapid Diagnostic Test (RDT) 55,465

Malaria cases diagnosed 11,569

P.falciparum diagnosed 11,419

P. vivax diagnosed 150

Malaria cases treated by community service providers

11,428

Severe malaria referred 15

Social Mobilization

Popular theatre shows held 507

Folk song events organized 507

Peoples oriented on malaria through BCC 8,327

Village Doctors oriented on malaria 2,583

LLINs distributed 120,100

Information about SR NGOs (Sub-Recipient)

Number of SRs 20

Working Areas 47 Upazilas

Population Coverage 10.92 million

Health Workers 1,037

Other Human Resources 261

Malaria is a major public health problem in 13 districts of Bangladesh, of which Chittagong Hill Tracts (CHTs), Cox’s Bazar and Chittagong are highly endemic.

Sporadic incidence occurs in other parts of the country. In partnership with the National Malaria Control Programme (NMCP), BRAC successfully secured a grant

from the GFATMto strengthen and expand national malaria control activities to all endemic districts working directly and through other NGOs.

Goal To reduce overall burden of malaria (morbidity and

mortality) by 60% from baseline year 2008 in 10.9 million populations in 13 high endemic districts of Bangladesh by 2015

Objectives To expand use of LLIN, 2 nets per household, to

achieve 100% coverage in 3 high malaria endemic districts and maintain 80% coverage with ITN/LLIN in the remaining districts

To expand and improve quality diagnosis and treatment to 90% of malaria cases

To further strengthen program management

capacity, and coordination and partnership in malaria control

BRAC’s main approach for malaria control is to inform

and educate people at community level, promote use of insecticide treatedbed nets andincrease early diagnosis and prompt treatment of malaria. BRAC also enhances

referral of symptomatic cases for diagnosis by RDT or BSE, ensure treatment, and reduce stigma. The Shasthya Shebikas and Shasthya Kormis (Health

Workers) are responsible for providing diagnostic and treatment services at community level. They also refer patients to the nearest government health facility and pay

special attention to pregnant women, children under 5 kg of weight and severe malaria cases.

Malaria Control Programme At a glance’ 2013

DEMOGRAPHY (12 Districts)

District 12

Upazila 82

Union 788

Village 14,106

Population 21.2 million

House hold 5,081,566

STAFFING PATTERN (12 Districts)

District Manager 25

Program Organizer 902

Paramedic 46



Newborn Health Worker 17,157

Community Skilled Birth

Attendant (CSBA) 752

MATERNAL HEALTH (10 Districts)

Contraceptive acceptance

rate (Modern method) 64%

Antenatal care by SK 2,244,721

Total delivery 402,405

Facility delivery 134,658 (33%)

Delivery by skilled birth

attendant 168,923 (42%)

C-section 69,725 (17%)

Four or more antenatal care 377,412 (94%)

Postnatal care within 48

hours of delivery 242,660 (91%)

Three or more postnatal care 314,635 (88%)

Maternal mortality ratio 182

NEONATAL HEALTH (10 Districts)

Live birth 392,347 (98%)

Low birth weight 73,241 (21%)

Initiation of breast feeding

within one hour of birth 363,642 (96%)

Birth asphyxia diagnosed 12,712 (3%)

Birth asphyxia managed by

SS 7,553 (59%)

Neonatal sepsis referred 8,291 (87%)

Neonatal mortality rate 30

CHILD HEALTH (10 Districts)

Exclusive breast feeding 213,436 (55%)

Fully immunized children 390,974 (99%)

Pneumonia managed by SS 154,792 (88%)

Diarrhea managed by SS

with ORS 272,971 (97%)

IMPROVING MATERNAL, NEONATAL & CHILD SURVIVAL PROJECT At a glance’ 2013

Goal To reduce maternal, neonatal and child mortality and morbidity, particularly, among the poor and socially excluded populations Objectives Increase knowledge and practices related to maternal,

neonatal and child health Improve provision of quality maternal, neonatal and child

health services at household and community levels Increase availability and access to quality continuum of

maternal, neonatal and child health care and services at facilities

Increase participation, accountability and responsiveness to communities’ voice in maternal, neonatal and child health services

Community health workers (CHW), namely, Shasthya Shebika, Newborn Health Worker, Shasthya Kormi and Community Skilled Birth Attendant (CSBA) are the frontline workers catering family planning, pregnancy related care, newborn and under five child care at door steps. Behavior change towards healthy practices in terms of reproductive health, nutrition, hygiene and sanitation is the strategy to preventive and promotive care. CHWs offer basic care e.g., antenatal care, delivery care, postnatal care, newborn care and management of birth asphyxia, diarrhea, ARI and some common ailments. CSBA attends home deliveries to ensure safe maternal and neonatal outcome at birth. A well-structured referral system is in place to reduce delays in accessing health care by bridge gaps between community and facility during emergencies. UNICEF is working with the government at hospitals and health facilities to improve health care. In essence, a continuum of care is provided to mothers, neonates and under-five children.

Improving maternal, neonatal and child survival (IMNCS) project

is a comprehensive community based health intervention focusing

on preventive and curative care with a group of trained community

health workers under structured supervision and monitoring

system. This comprehensive undertaking is uniquely designed to

address the bottlenecks of demand and supply side for ensuring

continuum of care from home to hospital. About 21.6 million

populations living in rural areas of 12 districts are being reached

with maternal, neonatal and child health services.

DEMOGRAPHIC PROFILE

City corporations 09

Regions 13

Branches 72

Delivery centers 375

Population 6,857,955

House hold 1,920,657

STAFFING

Regional Manager 13

Branch Manager 72


Manoshi Midwives 157

Shasthya Kormi 981


Urban Birth Attendant 805

MATERNAL HEALTH

Contraceptive acceptance rate

65%

New pregnancy identification

193,176

Antenatal care (ANC) by SK 824,178 (93%)

Total delivery 123,080 (81%)

Facility delivery 75,487 (61%)

Delivery at “Delivery Center” 32,216 (26%)

Delivery by skilled attendance

85,197 (69%)

C-section 41,359 (34%)

Four or more antenatal care 99,435 (81%)

Postnatal care (PNC) within 48 hours of delivery

122,624(100%)

Three or more PNC 95,871 (94%)

Maternal mortality ratio 130

NEONATAL HEALTH

Live birth 120,979 (98%)

Initiation of breast feeding within one hour of birth

118,531 (98%)

Low birth weight 15,779 (13%)

Birth asphyxia diagnosed 3,614 (03%)

Neonatal sepsis diagnosed 6,346 (05%)

Neonatal mortality rate 17

CHILD HEALTH

Exclusive breastfeeding 60,110 (60%)

Fully immunized children 107,270 (99%)

In Bangladesh, about one-third of the populations live in urban areas with worse health situation in slums and squatters of Bangladesh. To improve health status of slum population particularly women and children, BRAC started Manoshi, a community based health care programme in 2007 in urban slums of six city corporations in Bangladesh through the development and delivery of an integrated, community-based package of essential health services . Goal To decrease illness and death in mothers, newborns, and children in urban slums of Bangladesh Objectives

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 improvements in health status of poor urban mothers, newborns and children by bringing healthcare services at their doorstep via our community frontline health workers (CHWs). The Shasthya Shebikas and Shasthya Kormis provide household level antenatal and postnatal care and essential newborn care (ENC) and child health care. They use behavior change communication interventions to motivate, educate and prepare expectant mothers for delivery, highlighting an array of health issues including maternal and neonatal dangers signs, maternal and neonatal nutrition, etc. BRAC Delivery Centers 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 from slum to hospital or health facilities strengthening linkages, and ensuring continuum of care. Community is connected with health facilities via an innovative mobile phone based referral system. After expanding to two additional city corporations in 2012, Manoshi is currently being implemented in 9 city corporations.

MANOSHI At a Glance’ 2013

ALIVE AND THRIVE PROFILE

District 16

Upazila 50

Union 413

Population 1,05,73,320

UNDER 2 CHILDREN PROFILE (Monthly on an

average)

0-6 months 284,124

7-12 months 318,513

13-24 months 659,740

Under 2 children / district 289,557

Under 2 children / upazila 92,658

Under 2 children / union 11,218

Under 2 children / PK 4,282

Under 2 children / SS 648

ALIVE & THRIVE INFORMATION

Shasthya Kormi 633

Shasthya Shebika (health

volunteer) 7,154

Pushti Shebika 2,517

Pushti Kormi (IYCF promoter) 1,082

Po (A&T) 100

PERFORMANCE

Live birth 152,877

Early initiation of breast feeding 140,078 (92%)

Exclusive breast feeding 911,219 (92%)

Timely initiation of CF 173,832 (97%)

Information on CF:*

Appropriate amount 453,826 (81%)

Proper frequency 495,900 (88%)

Animal food 498,004 (89%)

Orderly placed hand washing

station 406,222 (72%)

*information on CF is for 8-12 months

of children

SOCIAL MOBILIZATION

School teacher & guardians 14 (278)

Village doctors 285 (5,540) Fathers of 7-8 months children 1,445 (27,096)

Graduate doctor orientation 47 (866)

Popular theater 3,144

(1,131,980)

ALIVE AND THRIVE At a Glance (January to November’2013)

Alive & Thrive (Community Component) initiative aimed to develop scaled up models for preventing child malnutrition through improving Infant and Young Child Feeding (IYCF) practices. A&T’s intervention focuses on achieving behavior change in IYCF through counseling, coaching and demonstration at household level by trained community health workers. Core Interventions: Home visits Where SSs, and PKs provide mothers of children 0-24 months of age IYCF counseling, coaching, demonstrations, problem-solving, and referrals. Home visits provide the opportunity to:

Provide timely and targeted counseling on recommended IYCF practices

Ask about barriers to recommended practices and ways of overcoming them

Teach and demonstrate skills such as positioning and attachment of the baby to the breast and combinations of household foods to improve the quality of complementary food.

Solve feeding problems or refer for assistance Social mobilization Social mobilization sessions on IYCF raise awareness and seek commitments to action by influential members of the community. This provides an overview of the nutrition situation and the importance of providing optimal nutrition for children during the vulnerable first two years and to acquaint stakeholders with the objectives and activities of Alive & Thrive. Participants at this orientation include government and nongovernment officers, political and religious leaders, health officials, alternative health care providers, teachers, adolescents, and other respected members of the community.

PROJECT PROFILE

District 17

Upazila 104

Population 26,505,166

STAFF INFORMATION


Pushti Shebika 5,008

Shasthya Kormi (Pushti) 2,532

PO (Nutrition) 213

UNDER 2 CHILDREN PROFILE

0-24 Months 8,26,842

0-6 Months 2,08,493

7-12 Months 2,08,887

13-24 Months 4,09,462

PERFORMANCE

Live birth 1,47,760

EIBF 74%

EBF 76%

Timely initiation of CF 85%

Animal food consumption 78%

Hand washing 52%

PREGNANT WOMEN AND ADOLESCENT INFORMATION

# Of pregnant women counseled

on maternal nutrition 364,492

# Of lactating women counseled

on nutrition 9,422,709

# Of adolescent girls counseled

on nutrition

313,314

SOCIAL MOBILIZATION

Religious leader 437 (8,740)

Village doctors 430 (8,600)

Gob health & FP staff 412 (8,240)

GoB health & FP staff 102 (2,040)

Fathers 765 (15,300)

NUTRITION PROJECT At a glance’ 2013

The Nutrition Project of BRAC is based on BRAC’s experience

over many years in providing nutrition intervention addressing the

determinants of malnutrition. The program aims to reduce

malnutrition among pregnant-lactating women, adolescent girls,

and young children in order to reduce mortality and morbidity,

particularly among poor and socially excluded populations.

Focusing Area:

IYCF, Maternal and Adolescent Nutrition.

Core Interventions:

Home visits

Where SSs, and SKs provide mothers of children 0-24

months of age IYCF counseling, coaching,

demonstrations, problem-solving, and referrals

SSs and SKs provide counseling on maternal diet

diversity for pregnant and Lactating mothers

Court yard meeting with a group of adolescent girls on

nutrition, balance diet, anemia: causes and prevention,

menstruation management and UTI.

Social mobilization

Social mobilization sessions on IYCF, maternal and adolescent

nutrition raise awareness and seek commitments to action by

influential members of the community. This provides an overview

of the nutrition situation and the importance of providing optimal

nutrition for the vulnerable groups like, children under two years

of age, pregnant women as well as adolescent girls with the

objectives and activities of Nutrition Project. Participants at this

orientation include government and nongovernment officers,

political and religious leaders, health officials, alternative health

care providers, teachers, adolescents, and other respected

members of the community.

DEMOGRAPHY

District 61

Upazila 455


UNDERNUTIRTION IN BANGLADESH

Children 6-59 Months Old 15.4 million

(100%)

Underweight Children 5.5 million

(36%)

Anemic Children 9.9 million

(64%)

STAFFING




MNP DOSE AND SCHEDULE (WHO 2011)

1 Sachet daily 2 months 60 Sachets

4 months gap

1 Sachet daily 2 months 60 Sachets

4 months gap

Total 1 year 120 Sachets

SACHET DISTRIBUTION

Distribution (Jan-Dec’13) 14.5 million

Distribution since launch 41 million

To prevent and control iron deficiency anemia and other

micronutrient deficiency, Bangladesh Sprinkles Programme

was launched in 2010 by BRAC in collaboration with Global

Alliance for Improved Nutrition (GAIN) and Renata Ltd.

BRAC currently promotes and makes micronutrient powder

(MNP)/Pushtikona available through its network of

community health workers for children 6-59 months.

Mothers are given demonstration how to follow correct

procedures for home-based food fortification with

Pushtikona. MNP dosage is given according to WHO

protocols and compliance monitored by BRAC health

workers. Families buy Pushtikona sachets but BRAC

provides free sachets to the very poor families through

BRAC’s Ultra Poor Programme.

Pushtikona is integrated into BRAC’s many different health

interventions for improving anemia situation:

Rural platforms

Essential Health Care (EHC)

Maternal, Neonatal, and Child Health (MNCH)

Alive and Thrive (A&T)

Challenging the Frontiers of Poverty Reduction:

Targeting the Ultra poor (CFPR-TUP)

Urban platforms

Manoshi (MNCH-Urban)

BANGLADESH SPRINKLES PROGRAMME At a glance’ 2013

Sprinkles Available

No Sprinkles (Malarial Regions)

Bangladesh Total: 64 Districts Sprinkles Coverage: 61 Districts

PROFILE

Category Number

BRAC Health Center 18

BRAC Clinic 13

BLBC 2

Doctor 76

Nurse 121

OUTDOOR SERVICES AT BHCs / CLINIC

Category Patients

Outdoor 71,779

Indoor 10,970

PREGNANCY RELATED CARE AT BHCs / CLINIC

Services provided Attended

Antenatal care (ANC) 22,753

Postnatal care (PNC) 2,206

INDOOR SERVICESAT BHCs / Clinic

Services Patient

MR / post-abortion care 2,807

Normal deliveries 3,680

Caesarian section 3,522

Major surgery (Gynecology) 106

Major surgery (General) 129

SERVICES IN BLBC

Services Patient

Total Patient

1,843

Above Knee prosthesis 81

Below knee prosthesis 170

Brace 1,097

Physiotherapy 194

COST RECOVERY (BHCs/BLBCs/Clinic)

BHC BRAC Clinic

BLBC

Cost recovery 50.86 50.30 91.29

BRAC facility based care has 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.

Recently, BRAC has revisited the approach of facility based

services and classified it into three categories: BRAC Health

Center (BHC) (basic outpatient services and normal delivery);

BRAC Clinic (comprehensive outpatient and inpatient

services) and BRAC Hospital (all services facilities).

At present, BRAC runs a network of 31 BHCs (n=18) and

Clinics (n=13). Further to offer quality services, BRAC is in

the stage of establishing three hospitals in Rangpur, Hobigonj

and Gazipur by upgrading the existing ones into 50-bed

Hospitals. BRAC is also enhancing lab facilities turning those

into BRAC Diagnostics.

To support the physically disabled populations with

rehabilitative aids and services, BRAC is operating two BRAC

Limb and Brace Centers (BLBCs) providing low-cost

appropriate technology.

BRAC FACILITY BASED SERVICES At a glance’ 2013

DEMOGRAPHY

District 7

Upazilla 37

Union 380


PERFORMANCE

Patient screening programme

(PSP) held

886

Persons examined 451,199

Refraction error identified 22,460

Presbyopia identified 15,125

Glasses sold 5,868

Cataract identified 45,526

Cataract operated 42,082

SOCIAL MOBILIZATION

Folk songs 87

Advocacy meeting with municipality 6

Upazilla coordination meeting 44

Meeting with local Govt. bodies 36

Meeting with religious leader 156

Meeting with primary school teachers 261

VISION BANGLADESH PROJECT At a glance’ 2013

Vision Bangladesh Project (VBP) is a joint venture of Ministry of

Health & Family Welfare (MoH&FW) of Bangladesh, BRAC and

Sightsavers to eliminate the cataract backlog from Sylhet

division by 2013. Besides, National Eye Care and BRAC have

jointly initiated the 2nd phase of Vision Bangladesh Project from

July 2013-December 2015.

Goal

Elimination of avoidable blindness from Bangladesh by 2020

Specific Goal

Elimination of the backlog of cataract blindness from Sylhet

division by the year 2013 and from slums of cities by the year

2015”.

Objectives

Increased demand for eye care services particularly for

cataract in the community

Increased accessibility to quality eye care services

especially cataract particularly for the poor

Developed efficient HR of service providing eye care

facilities

Managed 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

in 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 mobilize the

community people through different forum 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.

Sylhet Division

Barisal C.C.

Khulna C.C.

Dhaka C.C.

DEMOGRAPHY

District 54

City Corporation 7

Upazila 407

Target population 16.1 million

TRAINING INFORMATION

District Manager 74

Upazila Manager 464

Program Organizer 2,223

Nurse / Paramedic 23



PERFORMANCE

SS involved in eye screening 12,172

Persons screened 531,278

Identified as presbyopia 368,159 (69%)

Identified with other eye problems

80,976 (15%)

Referred (other than presbyopia)

53,661 (66%)

Identified as no eye problem 82,143 (15%)

Total glasses sold 104,289

a) Single Vision 65,620 (63%)

b) Bi-focal 37,041 (36%)

c) Sunglasses & Eye Protector

1,628 (2%)

R A N G A M A T I

S Y L H E T

T A N G A I L

B O G R A

B A N D A R B A N

K H U L N A

C O M I L L A

P A B N A

D I N A J P U R

N A O G A O N M Y M E N S I N G H

S U N A M G A N J

C H I T T A G O N G

J E S S O R E

S A T K H I R A

H A B I G A N J R A J S H A H I

R A N G P U R

N E T R A K O N A

N A T O R E

D H A K A

S I R A J G A N J

B A G E R H A T

K U R I G R A M

B H O L A

F A R I D P U R

N O A K H A L I F E N I

K U S H T I A

J A M A L P U R

M A U L V I B A Z A R

G A Z I P U R

G A I B A N D H A

K I S H O R E G A N J

J H E N A I D A H

K H A G R A C H H A R I

C O X ' S B A Z A R

C H A N D P U R

N I L P H A M A R I

S H E R P U R N A W A B G A N J

N A R A I L

R A J B A R I

T H A K U R G A O N

G O P A L G A N J

M A G U R A

M A N I K G A N J

B A R I S A L

B R A H A M A N B A R I A N A R S I N G D I

P A N C H A G A R H

S H A R I A T P U R M A D A R I P U R

L A K S H M I P U R

C H U A D A N G A

L A L M O N I R H A T

J O Y P U R H A T

M U N S H I G A N J

P A T U A K H A L I

M E H E R P U R

P I R O J P U R B A R G U N A

N A R A Y A N G A N J

J H A L O K A T I

Plan for expansion

Present coverage

READING GLASSES FOR IMPROVED LIVELIHOODS At a glance’ 2013

In Bangladesh about 20% people suffer from presbyopia and

are deprived of contributing to household activities and in the

national economy as well, 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 organization in the USA.

The mission of VisionSpring is to reduce poverty and generate

opportunity in the developing world through the sale of

affordable eyeglasses is consistent with the mission of BRAC

which is 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

mobilizes people who suffer from eye problems. She uses

forums like village organization (VO) meeting, group health

education meeting etc. For a broader coverage of the program

camps are also held in different project areas. After testing

vision the SS offers reading glasses of proper magnification to

the presbyopic clients at affordable cost. Patients with other

eye complaints are referred to district eye hospitals. Shasthya

Kormi and Program Organizer support the SS in screening and

referral. Upazila Manager and other supervisors provide

periodic supervision and follow-up.

DEMOGRAPHY

District 40

Upazila 222

Population 850,608

HUMAN RESOURCES

Regional Manager 3

District Manager 37

Program Organizer (Branch) 326

HEALTH AND NUTRITION EDUCATION

Household visited 129,000

Eligible couple mobilized for family planning

68,283

REPRODUCTIVE AND MATERNAL HEALTH

Contraceptive acceptance (Modern) 48,531

Delivery by skilled birth attendant 2,053

Four or more antenatal care 3,504

Pregnant women protected against tetanus

1,430

CHILD HEALTH CARE

Early initiation of breastfeeding within one hour of birth

4,072

Under five children with diarrhea managed by ORS

3,166

Under five children with pneumonia managed

5,018

Children benefited through micronutrient supplements

99,028

WATER AND SANITATION

Slab latrine installed 10,901

Tube-well installed 248

MORBIDITY TREATED

Morbidity episodes treated 188,601

CAPACITY DEVELOPMENT

Regional managers - TUP 90

District mangers - STUP 89

Upazilla manager 214

Programme Organizer - TUP 786

Capacity development on IYCF for PO 315

Shasthya Kormi 926


4,895

ESSENTIAL HEALTH CARE PROGRAMME FOR CFPR-TUP At a glance’2013

In Bangladesh, 8% of populations are suffering from extreme poverty. Their health status lags far behind than general populations. Essential Health Care (EHC) services for ultra-poor under CFPR-TUP (Challenging the Frontiers of Poverty Reduction – Targeting the Ultra Poor) program is a specially designed programme to meet the needs of extremely poor households, who are unable to access or benefit from traditional development interventions. Goal To reduce the vulnerability of the poor and ultra-poor to sudden health shocks and to prevent them from sliding back into the vicious cycle of extreme poverty The program aims to increase access to health services, through demand-based strategies and by providing a package of basic health services with a special focus on meeting the needs of the ultra-poor. The strategy involves social mobilization, raising health awareness and provision of basic health care services for all, especially for the targeted ultra-poor. Financial constraints are major impediments to accessing the available health services by the ultra-poor. To address this problem of financial constraints to health care, BRAC has introduced the provision of providing financial assistance to the ultra-poor so that they can access medical care from Government or other health facilities. Community participation is ensured in the program through community forum (Gram Daridro Bimochon Committee) which forms an organized network for the improvement of health and social status of rural poor in each village. Committee members actively provide motivation and financial support to the ultra-poor for accessing different health services.

Health, Nutrition and Population Programme At a Glance 2013...Health, Nutrition and Population Programme BRAC’s Health, Nutrition and Population Programme (HNPP) promotes a broad

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