By: Taufique Joardar, Dena Javadi, Jessica Gergen, and Henry B. Perry
Bangladesh relies on a substantial CHW workforce comprised of Family Welfare Assistants (FWAs), Health Assistants (HAs), and Community Health Care Providers (CHCP) to address community health needs. Hired by NGOs, such as BRAC, and the government, CHWs are trained to screen and offer a variety of services including family planning, support for pregnant women, TB case detection and treatment support, and immunizations among others. The country’s progress in reducing maternal and under-five mortality is largely attributed to its CHWs.
Bangladesh has a long history of using community health workers (CHWs) to support health services. At
present there are approximately 185,000 CHWs in Bangladesh. Most CHWs work with non-governmental
organizations (NGOs), especially BRAC, as described in a separate case study, while the remainder are
employed by the government as Family Welfare Assistants (FWAs), Health Assistants (HAs), or Community
Health Care Providers (CHCPs).
FWAs were introduced in 1976 and numbered about 19,600 in 2017. Their work focuses on family planning
and referral of mothers for antenatal and postnatal care and for conducting delivery at reproductive health
facilities. HAs worked originally as vaccinators or malaria control workers. Beginning in 1995, their role
expanded to include vitamin A supplementation and detection and treatment of pneumonia, diarrhea, malaria,
and TB. There are about 15,200 HAs at present. The government introduced CHCPs in 2010 to staff
Community Clinics that were established at that time to provide primary health care services. There are about 12,300 CHCPs at present.
FWAs visit the same household/same couple every two months, register new couples, encourage them to
utilize a family planning method, distribute contraceptives, and refer clients for antenatal care, postnatal care,
and normal delivery at family planning facilities. HAs provide immunizations and vitamin A capsules and
distribute packets of oral rehydration salts. CHCPs work in Community Clinics (which each serve a
catchment area of about 6,000 people on average) where they provide antenatal and postnatal care; treat
pneumonia, diarrhea, and anemia; and provide injectable contraceptives.
FWAs receive 21 days of training followed by on-the-job training. HAs receive training of a similar length,
and CHCPs receive 12 weeks of training.
FWAs are supervised by male supervisors, called Family Planning Inspectors, with whom they meet at least
twice per month during field visits. HAs are supervised by Assistant Health Inspectors, each of whom is
responsible for three HAs (one in each old Ward). CHCPs are supervised by the field supervisory team of
Upazila Health and Family Planning Officers, e.g., the Health Inspector or the Assistant Health Inspector.
Incentives and remuneration
FWAs receive a government salary of US$ 132–318 per month, HAs, US$ 135–327 per month, and CHCPs,
US$ 150–362 per month.
There are no available evaluations of these programs. The strong CHW presence in Bangladesh is widely perceived to have made an important contribution to Bangladesh’s remarkable progress in reducing under-
five mortality and maternal mortality and in helping couples achieve their reproductive health preferences.
- Taufique Joardar is a USAID/Multisectoral Nutrition Programming through Implementation Science Activity, FHI 360, Dhaka, Bangladesh.
- Dena Javadi is Alliance for Health Policy and Systems Research, Geneva, Switzerland.
- Jessica Gergen is a Public Interest Data Designer, Visualst, Maputu, Mozambique.
- Henry B. Perry is a Senior Scientist at Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA