Project and Programs of BRAC in Bangladesh:
Economic Development
BRAC’s Economic Development programmed includes micro credit, and at present it is prominent among the biggest NGOs in terms of micro credit activities. It provides collateral-free credit using a solidarity lending methodology, as well as obligatory savings schemes through its Village Organizations. Reaching nearly 4 million borrowers, Village Organizations provide different levels of loans to different poverty groups. Through a recent initiative, BRAC has reached out also to those who, due to extreme poverty cannot access microfinance. BRAC defines such people suffering from extreme poverty as the ‘ultra poor’, and has designed a programmed customized for this group that combines subsidy with enterprise development training, healthcare, social development and asset transfer, eventually pulling the ultra poor into its mainstream microfinance programmer.
Jaminder-Ginni dolls made by village artisans. Handicrafts like these are sold by Aarong, BRAC’s handicrafts store.
In addition to Microfinance, BRAC provides sector-specific enterprise training and support to its member borrowers in poultry and livestock, fisheries, social forestry, agriculture and sericulture. It also provides supply of inputs essential for certain enterprises through its ‘Program Support Enterprises’ that include Poultry farm and disease diagnostic laboratory, Bull Station, Feed Mill, Broiler Production and Marketing, Seed Production, Processing, Marketing and Soil Testing, BRAC Nursery, and Fish and Prawn Hatchery. BRAC’s Vegetable Export program started in 1998 is a venture that is aimed at bridging the gap between local producers and international markets. BRAC also has a number of commercial programs that contribute to the sustainability of BRAC’s development programs since returns from the commercial programs are channeled back into BRAC’s development activities. These programs include Aarong, a retail handicraft chain, BRAC Dairy and Food Project, and BRAC Salt.
Education
BRAC’s Non-Formal Primary Education program provides five-year primary education course in four years to poor, rural, disadvantaged children and drop-outs that cannot access formal schooling. These one-room schools are for children between eight and fourteen years of age. Each school typically consists of 33 students and one teacher. Core subjects include Mathematics, Social Studies and English. The schools also offer extracurricular activities. As of June 2008, 37,500 Primary Schools and 24,750 Pre-Primary schools have been established by BRAC enrolling nearly 3 million children, 65% of whom are girls. The schools have a drop-out rate of less than 5%.
BRAC has set up centers for adolescents called Kishori Kendra that provide reading material and serve as a gathering place for adolescents where they are educated about issues sensitive to the Bangladeshi society like reproductive health, early marriage, women’s legal rights etc. BRAC has also set up community libraries 185 out of 964 of which are equipped with computers.
Public health
BRAC started providing public healthcare in 1972 with an initial focus on curative care through paramedics and a self-financing health insurance scheme. The program went on to offer integrated health care services, its key achievements including the reduction of child mortality rates through campaign for oral dehydration in the 80s and taking immunization from 2% to 70% in Bangladesh. BRAC currently provides a range of services that reach an estimated 31 million rural poor and include services for mothers in reproductive health care and infants. As of December 2007, 70,000 community health volunteers and 18,000 health workers have been trained and mobilized by BRAC to deliver door-to-door health care services to the rural poor. It has established 37 static health centers and a Limb and Brace Fitting Centre that provides low cost devices and services for the physically disabled. {BRAC at a Glance, June 2006}
In partnership with the government of Bangladesh, BRAC is implementing a Directly Observed Treatment Short-course (DOTS) strategy to treat Tuberculosis in Bangladesh. Its other major partnership programs with the government and/or other organizations include programs in malaria prevention and control and arsenic mitigation. BRAC’s Water, Sanitation and Hygiene (WASH) program, among BRAC’s new initiatives, plans to achieve the target set forth by the government of Bangladesh to achieve the Millennium Development Goal of improved hygienic practices and supply of safe water by the year 2014. Also one of BRAC’s new initiatives is its HIV/AIDS program addresses awareness raising activities among the generation population including education of couples, adolescent boys and girls, high-risk groups and promotes use of condoms. BRAC also provides treatment for STI/RTI and consumption loans to brothel-based sex workers to empower them for compliance to condom use.
Social Development
In 1996, BRAC started a program in collaboration with the Ain O Shalish Kendra (ASK) and Bangladesh National Women Leader’s Association (BNWLA) to empower women to protect themselves from social discrimination and exploitation of which dowry, rape, acid throwing, polygamy, domestic violence and oral divorce are common in rural Bangladeshi communities and to encourage and assist them to take action when their rights are infringed. The program has two components: the Social Development component and the Human Rights and Legal Services component.
The Social Development component focuses on building human and socio-political assets of the poor – especially women – through institution building, awareness raising, training and collective social mobilization. As part of this initiative, BRAC has initiated ward-level people’s organizations called the Polli Shomaj (Rural Society) and Union Shomaj (Union Society) which poor rural women members can use as a platform to raise their voices.
The Human Rights and Legal Services component seeks to empower the poor by increasing their awareness of their rights (legal, human and social) and entitlements through participation in activities like the Popular Theatre and through Human Rights and Legal Education (HRLE) classes arranged by BRAC for its Village Organization members. BRAC also offers external services such as access to lawyers or the police either through legal aid clinics, by helping women report cases at the local police station or when seeking medical care in the case of acid victims. At the end of June 2006, 124,748 HRLE classes were held and 1,332 acid victim cases and 1,735 rape victim cases were reported. {BRAC At a Glance, June 2006}
Disaster Relief
BRAC conducted one of the largest NGO responses to Cyclone Sidor which hit vast areas of the south-western coast in Bangladesh in mid-November 2007. BRAC distributed emergency relief materials, including food and clothing, to over 900,000 survivors, provided medical care to over 60,000 victims and secured safe supplies of drinking water. BRAC is now focusing on long-term rehabilitation, which will include agriculture support, infrastructure reconstruction and livelihood regeneration.
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 steatites, 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.
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.
BRAC Limb and Brace Centre
TheBRAC Limb and Brace Centre(BLBC) were established in 2000 to provide support to the physically disabled. The centre offers prosthetic (artificial limb) and orthodontic (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.
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.
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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.