By: Taufique Joardar, Dena Javadi, Jessica Gergen, and Henry B. Perry
Background
BRAC, or Building Resources Across Communities, was founded in 1972 and is one of the largest non-
governmental organizations in the world. It has been a global leader in developing and scaling up community health worker (CHW) programs to serve Bangladesh’s large rural population. More than three decades ago, BRAC trained paramedics modeled on the barefoot doctor approach from China but then shifted the approach in the early 1980s to train local, often illiterate women. The Shasthya Shebika (SS) and Shasthya Kormi (SK) programs are rooted in a gendered perspective, focusing on the need for female health workers in Bangladesh to address sociocultural barriers to access health care services.
Implementation
In 1990, there were 1,080 SSs. At present, there are approximately 43,000. The SK cadre was introduced in
2002 to supervise the SSs and provide additional antenatal and postnatal care services, in addition to other
services. At present there are approximately 4,300 SKs.
Training
SSs receive three weeks of basic training at the local BRAC office. They are trained on family planning;
pregnancy identification, treatment of 10 minor ailments; identifying tuberculosis patients; sputum collection
and providing directly observed tuberculosis (TB) therapy; basic sanitation, hygiene, and nutrition; eye care;
and recordkeeping. SKs receive two weeks of classroom training followed by two weeks of field orientation under close supervision. They are trained on health education, antenatal and postnatal check-up, pre-
pregnancy care, adolescent reproductive health and nutrition, and reproductive health and nutrition.
Roles/responsibilities
During monthly household visits, SSs educate families on nutrition, safe delivery, family planning,
immunizations, hygiene, and water and sanitation. They also use this time to sell health products such as basic
medicines, sanitary napkins, and soap. SKs supervise SSs. SKs also provide services such as pregnancy confirmation, antenatal and postnatal care, detection of danger signs in mothers and children and referral, education about breast and cervical cancer, breast self-screening, and facilitation of referrals for women with gynecological problems.
Incentives
SSs are given small loans to establish revolving funds, which they use to make some money by selling health
products at a small mark-up. SKs work full-time and receive a monthly salary of US$190.
Supervision
Direct supervision of SSs is conducted by the SKs. SKs are supervised by BRAC Area Managers.
Impact
The program is self-sustaining and is widely perceived to have made an important contribution to
Bangladesh’s remarkable progress in reducing under-5 mortality and in contributing to the widely acclaimed
success of its national TB control program. BRAC’s CHWs have also been instrumental in the success of
Bangladesh’s national programs for immunizations and treatment of childhood diarrhea.
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