Community Empowerment and Participation: BRACs Experience in Maternal and Child Health

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Community Empowerment and Participation BRACs
Experience in Maternal and Child Health

• Kaosar Afsana
• Mushtaque Chowdhury
• Faruque Ahmed
• October 2007

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Presentation overview

• BRACs approach to health and development
• Structure of BRAC Health Programme
• MNCH intervention as an exemplar of community
  empowerment and participation
• Strategies of MNCH
• Practical implications Achievements and
  challenges
• Women deliver

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BRACs (W)holistic Approaches
Human Resource Division
Research and Evaluation Division
Economic Development Programme
Alleviation of poverty Empowerment of people
Health Programme
Education Programme
Advocacy Unit
Social Development Programme
Training Division
BRAC University
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BRAC Health Programme

• Improve maternal, neonatal child
• health
• Reduce vulnerability to infectious and
• common diseases

Reaching over 80 m in Bangladesh
MNCH
TB
Facility based care
Malaria
WASH
HIV/AIDS
ARI
Essential Health Care
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Maternal, Neonatal and Child Health Project
Human rights and legal services
Research and evaluation Division
Ultra-poor Program
Social Development
BRAC Training
Monitoring Department
MNCH
Advocacy Unit
Adolescent Development Programme
Gender Unit
BRAC Development Platform
BRAC JPGSPH
Essential Health Care
Micro-finance
Education Programme
Management Structure
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Goal of MNCH Projects

• To reduce maternal,
• neonatal and child
• deaths and diseases

• Rural MNCH
• 1.5 m pop in one district
• to 15 m in 10 districts

• ManoshiUrban MNCH
• 1 m pop in first year to 8 m
• in 3rd year in urban slums

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4. Linkage with public/private health facilities
Hospital
Hospital
5. Timely Referral of emergency cases
Staff
2. Community empowerment
1. Capacity development of HHR
SS
3. Services rendered at community and household
level
SK
BA
Packages of Activities from Home to Community and
Health Facilities
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Community Participation Health Human Resources

• Selected from BRAC VO
• and by community
• Willing to work
• High social
• acceptability
• Age 25-45 years
• Serve 150-250 HHs

• Selected by BRAC staff
• At least SSC degree
• Willing to work
• Age 25-35 years
• Nominal honorarium
• Serve 750-3,000 HHs
• Supervises 5-12 SSs

Shasthya Shebika
Shasthya Kormi

• 2,200 in rural MNCH
• 1,000 in urban MNCH

• 225 SK in rural MNCH
• 100 in urban MNCH

• Experienced
• Selected from and
• by community
• Willing to work
• Age 30-45 years
• Serve 150-250 HHs
• in rural areas
• 2-3 in each birthing hut

RBA/UBA

• 2,200 in rural MNCH
• 200 in urban MNCH

• BRAC Health Program
• 70,000 SSs
• Over 6,000 SKs

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Community Empowerment and Participation
Voice

• Women
• Family members
• Polli Shamaj
• MNCH committee
• Women support group

Process

• Interpersonal communication
• Education Forum
• BCC materials
• Meeting
• Advocacy
• Popular music and theatre

Rights to MNCH services and accountability
Access to quality MNCH services and increased
service utilization
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Roads to Improve MNCH
Outside home
Inside home

• National and sub-national
• Advocacy
• Workshop
• Mass media campaign

Improved Maternal, Neonatal and Child Health
Use of IT for referral
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Reaching the Community MNCH interventions

• Identified pregnancy 90.0
• Antenatal coverage 82.0
• TT coverage 92.0
• Delivery by trained personnel 70.0
• CPR 60.0

• Delivery at birthing hut 38.0
• Delivery at home 40.0
• Delivery at hospital 22.0

• Colostrum feeding 93.0
• Birth weight taken 80.0
• PNC visit in 24 hours 80.0
• Cord care 85.0

• EPI coverage 87.0
• Vitamin A coverage

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Women Deliver
All community health workers are women
Community participates for MNCH services

• Women receive services for
• maternal health
• Women empowered for neonatal
• and child health services

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Challenges and Opportunities
Participation continues to be at once alluring
and challenging, promising and vexing and
necessary and elusive.
Does community empowerment enhance womens
participation and inclusiveness?
Does community empowerment and participation
challenge the power of biomedical professionals?

• How do voice mechanisms enhance accountability of
  health professionals?

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BRAC believes in community empowerment and
community participation and strengthens human
resources to be resourceful to think, act and
participate in implementing interventions and
utilizing services for the betterment of the
community
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BRACs (w)holistic approach to community
empowerment and community participation
Health and development