Health Program
Health remains an integral component of BRAC’s development intervention since its inception in 1972. By improving the health of the people, especially the poor, and promoting the capacity of a community to deal with health problems, the health programme contributes to achieving BRAC’s twin objectives of poverty alleviation and empowerment of the poor. Over the years, BRAC’s health programs have evolved in step with the national and global health priorities and changing knowledge base. Starting from small scale curative care to a large scale Oral Therapy Extension Program (OTEP) to fight massive diarrhoeal deaths in the 1980s, we have gone through successive programmes in the nineties including Women’s Health and Development Program (WHDP), Reproductive Health and Diseases Control (RHDC) Programme and National Nutrition Program (NNP). Over time BRAC has forged successful partnerships with the government in implementing different health programmes such as family planning, immunisation, tuberculosis control and malaria control. In addition to this, BRAC is now actively collaborating with the present ‘Health,Nutrition and Population Sector Program’ (HNPSP) of the Government of Bangladesh.

Since 2002, all BRAC’s health interventions have been incorporated under the BRAC Health Program (BHP).Today; we reach more than 92 mil people with 18,000 staff members and 68,095 all-female community health volunteers working in all 64 districts of Bangladesh. The health interventions are delivered through four components: BRAC’s own programs, partnership programs with the government, facility based services, and pilot initiatives. Our maternal, neonatal, and child health programmes currently target 8 million urban slum dwellers and 11 million rural people. The tuberculosis control programme has already reached 86 million people in 42 districts.

Essential Health Care (EHC) Program
The Essential Health Care (EHC) Programme is an integrated grassroots approach  with the goal of ensuring nationwide access to essential health care services for the poor and disadvantaged, particularly women and children. Our model of an essential health care package currently includes nine components. These are: health and nutrition education, water and sanitation, family planning, pregnancy related care, promotion of safe delivery practices, basic curative care for ten common diseases, acute respiratory infection (ARI) control, immunisation, and tuberculosis control. Through this programme, we also collaborate with the Government’s national health programmes such as the expanded programme for immunisation (EPI), family planning, vitamin-A campaign and sanitation program.
 
Until 2006, the essence of EHC was to provide health support to the members of our village organisations (VO). In 2007, there was a strategic shift in our operations towards a more community-centered approach, meaning that everyone in the community will be offered our EHC services. As a result, the programme has significantly expanded both in terms of reach and coverage. In 2007, we reached more than 92 million people through our health volunteer home visits, which was three times higher than the previous year.
 
Since 2002, all BRAC’s health interventions have been incorporated under the BRAC Health Program (BHP). Today, we reach more than 92 million people with 18,000 staff members and 70,000 all-female community health volunteers working in all 64 districts of Bangladesh.
 
Essential Health Care for Ultra Poor Members
In 2002, BRAC initiated a special health program designed to address the challenges of improving health outcomes for members of BRAC’s Ultra Poor Programme The ultra-poor have very limited access to health services and health information provided through the mainstream health system.The provision of health care services for the ultra poor involves two distinct strategies in addition to general BRAC services. First,we provide health awareness and basic health care services to all ultra poor members, irrespective of their health status. Secondly, those who are diagnosed with mild and severe morbidity are provided with financial assistance for their clinical care. We currently provide health care for more than 180,000 ultra poor families from the poorest areas in Bangladesh. In 2007, the ultra poor programme performed better than the previous year in terms of service coverage. Antenatal care (ANC) coverage increased to 95% in 2007 from 72% in the previous year, postnatal care (PNC) service coverage reached 93% from 69% and TetanusToxoid immunisation coverage reached 99% from 84% in 2006.

During the reporting period, BRAC procured the services of 290 medical doctors to provide treatment to 179,251 sick patients and 5,162 severely ill patients free of cost including medicines. Partial financial assistance has been extended to 428 patients for tertiary care. To increase access to sanitation services and safe drinking water, ultra poor members were provided with 29,166 slab latrines and 4,612 tube-wells.

WATER, SANITATION AND HYGIENE (WASH)
Building on our long experience in promoting access to safe water and sanitation services, an integrated water, sanitation and hygiene (WASH) programme was started in 2006. The WASH initiative, in partnership with the Government, aims to ensure access to sanitation services for 17.5 million people, hygiene education for 37.5 million people and safe water services for 8.5 million people living in 150 sub-districts of Bangladesh. These are communities who are not significantly served by other national or international NGOs water and sanitation programmes.

We are working to improve water supplies and sanitation facilities in schools and communities, and promote safe hygiene practices to help achieve the Millennium Development Goal for water and sanitation by:
1.    Providing sustainable and integrated WASH services in rural areas of 150 sub-districts (Upazilas)
2.    Promoting safe hygienic behaviour in order to break the contamination cycle of unsanitary latrines, contaminated water, and water borne communicable diseases.
3.    Ensuring the sustainability and scaling-up of WASH services

By the end of 2007, the WASH programme completed its third phase and had successfully expanded to cover all 150 targeted sub-districts. The areas covered under earlier phases have already completed the first stage of intervention (hygiene education) and progressed on to subsequent stages.

In 2007, the programme reached 12 million people in the community and 4 million school children with integrated water, sanitation and hygiene education.To reinforce these messages, an additional 2,485 theatre shows and 720 sub-district level advocacy workshops were organised.

792 Rural Sanitation Centres (RSC) have been set-up by providing interest free loans to rural microentrepreneurs. At the household level, 247,229 latrines have been installed and 11,358 latrines re-installed. At the school level, 32 separate latrines for boys and girls with waste disposal facilities have been constructed in schools.

The WASH program also responded immediately in the areas worst affected by Cyclone Sidr in November 2007. By December 2007, 203 Pond Sand Filters were repaired, 6 new pond sand filters were constructed and 1,990 ponds were cleaned in those areas.

Rural MNCH
In late 2005,we launched a pilot initiative with an intensive focus on maternal, neo-natal and child health (MNCH) in one of the poverty-stricken districts in northern Bangladesh.The programme promotes an integrated service approach and community based solutions to maternal, neonatal and child health problems.The major interventions were designed towards capacity development of community health human resources, empowerment of women and support groups, provision of maternal, neonatal and child health services and development of referral linkages with health facilities nearby.

In just over two years,we have seen the contraceptive prevalence rate (CPR) increase from 56% in 2005 to 62% in 2007, ante natal care service nearly double from 43% to 85%, delivery in the presence of trained personnel increase from 17% to 53% and postnatal care visits (first visit) increase from 28% to 75%. Child immunisation coverage has also increased from 51% to 92% with colostrum feeding increasing from 58% to 95%.These results are highly encouraging as they are higher than the national data. As a result, BRAC has received commitments from major donors to scale-up the programme in nine more districts in 2008.

Manoshi: urban MNCH
In 2006, BRAC started a pilot project for maternal and child health for sections of the urban slum population in Dhaka. In 2007, the pilot evolved into Manoshi - a five year urban maternal, neonatal and child health programme with funding from the Bill & Melinda Gates Foundation.The program is designed to significantly improve the maternal, neonatal and child health situation and will benefit approximately eight million urban poor living in slums in the six major cities of Bangladesh.

By the end of 2007, the Manoshi program had been rapidly expanded to all urban slums in Dhaka and now reaches around 1.5 million slum dwellers.During this short period,we were able to identify 86% of all pregnancies in the selected areas of which 81% were provided with ante natal care and 80% of pregnant women received post natal care at least three times. In an attempt to increase delivery attended by specially trained personnel, several delivery centres or birthing huts were established. By 2007, approximately 44% of the pregnant women under the programme used the BRAC Delivery Centres

Tuberculosis Control (TB)
Tuberculosis is a major public health problem and one of the leading causes of preventable adult mortality in Bangladesh. The WHO ranks Bangladesh 5th among the world's high-burden TB countries. It is estimated that over 300,000 new TB cases and 70,000 TB-related deaths occur annually in Bangladesh.

BRAC's TB Control Program was initiated as a pilot community based TB control project in 1984 in Manikgonj district.The aim was to diagnose and provide treatment to TB patients in the community through our trained community health workers. In 1994, BRAC entered into a partnership with the Government's National Tuberculosis Control Programme (NTP) to help expand the programme.

Today,we are implementing a TB control programme in collaboration with the Government of Bangladesh that covers approximately 86 million people in Bangladesh. In recognition of our work in tuberculosis control in Bangladesh,we have received two awards in 2007 including the 'NATAB Award 2007' from the National Anti-Tuberculosis Association of Bangladesh and the 'STOP TB Partnership-Kochon Prize 2007' from the Kochon Foundation.

In 2007, a total of 765,251 suspected patients were examined and 88,128 persons were diagnosed with TB.Of them, 69,229 were new sputum positive, 1,941 were sputum positive relapse cases, 10,211 were smear negative and 6,747 were extrapulmonary TB cases. BRAC's case detection rate was higher than the national average by 7.5% points and treatment success rate by 2.3% points.

Malaria Prevention and Control Program
Malaria is a major public health problem in certain areas of Bangladesh. Thirteen out of the 64 districts in the country are highly malaria endemic and the majority of malaria related morbidities and mortalities are recorded in the Chittagong Hill Tracts (CHT) region.

In 1998, a special pilot initiative to raise awareness about malaria prevention and control was undertaken in this region. By 2002, this pilot initiative had grown into a comprehensive malaria control programme including early diagnosis and prompt treatment and distribution of insecticide treated mosquito nets. BRAC has developed a partnership with the Malaria and Parasitic Diseases Control (M&PDC) unit of the Government of Bangladesh,MRG (Malaria Research Group) and ICDDR, B.

In 2007, BRAC and the government successfully secured a grant from the Global Fund to Fight Against AIDS, Tuberculosis and Malaria (GFATM) to strengthen national malaria control activities in thirteen districts of Bangladesh. As the principal recipient for the NGO component, BRAC is leading a consortium of 14 NGOs to strengthen and expand malaria control activities in the country and also to directly implement the programme in the Chittagong Hill Tracts. At the end of 2007, a total of 105,919 uncomplicated falciparum malaria cases and 25,187 vivax malaria cases had been successfully treated by BRAC.

HIV/AIDS Program
In Bangladesh, prevalence of HIV/AIDS is still low compared to other countries. But presence of high risk behaviour and high prevalence in neighbouring countries has made it high-risk country for an HIV/AIDS among the injecting Drug Users (IDU). In this present situation, it is possible that the epidemic could spread exponentially to the general population as IDUs could be bridging group for the spread of HIV infection. The country also has large sex industry with a low rate of consistent condom use among the client of sex workers. At the same time, low levels of knowledge about sexually transmitted infections (STIs) and HIV/AIDS and low risk perception among the general population are also very common.

The HIV/AIDS prevention Program was commenced in September 2002  with the purpose of bringing about changes in risky sexual behaviour. Recognising BRAC’s effort, the Swedish International Development Agency (SUDA) came forward in July 2004  with collaborative support for the Community Based HIV/AIDS Education Program. The Program was implemented in four districts, namely Faridpur, Madaripur, Jamalpur and Khulna, encompassing approximately 7.5 million people. In addition, along with three other NGOs, BRAC has been implementing a project focusing on the Internal migrants under the HIV/AIDS Prevention Programme (HAPP) package in Sylhet, Chittagong and Barisal city corporations. In collaboration with the Government of Bangladesh and UNICEF, this project covers about 41,149 internal migrants.
 
Program Components
Community Awareness Raising on HIV/AIDSCommunity awareness raising is an important component of the HIV/AIDS Program. BHP Pos organize education sessions for both VO and non-VO members at community level. Various IEC materials including flip charts and pictorial cards are used for dissemination information on routes of transmission and prevention of HIV/AIDS. In addition, Shebikas interact with the program beneficiaries, especially the couples, and educate them on HIV/AIDS. Gonontaks (popular theatre) and video shows on HIV/AIDS are also organized in program areas.

Adolescent Awareness Raising on HIV/AIDSAdolescents are considered particularly vulnerable to HIV/AIDS. This programme targets boys and girls of classes VII to X in schools and madrasas. In addition, adolescent members of BRAC community libraries are also included. School and madrasa teachers. Librarians of community libraries and supervisors of BRAC’s adolescent centres are oriented to conduct HIV/AIDS education sessions. In addition, school and madrasa teachers also conduct HIV/AODS education sessions

Awareness Raising and Services for High-Risk Groups
Brothel bases Sex Workers: The Pos conduct monthly sessions with the sex workers in brothels to provide HIV/AIDS related information. Condoms are distributed at a low price to promote safer sex. Sanitary napkins are also sold at brothels to promote hygiene during menstruation. The sex workers are encouraged to save money by participating in a weekly savings scheme. In addition, consumption loans are also provided to ensure their financial security.

Transport and industrial workers: Different categories of transport and industrial workers in the programme areas are provided with information on STIs and HIV/AIDS by the POs. The POs also distribute condoms to this group at subsidized price.

Drug Users: The programme has also targeted drug abusers. Drug abusers are provided short-term detoxification therapy through drop-in-centres orgnised by NGOs The family members and local stake holders sensitized to drug abuse and HIV/AIDS issues.

People living with HIV/AIDS (PLWHA): BRAC HIV/AIDS project includes the HIV positive people as project beneficiaries to reduce the socioeconomic impact of HIV infection in the community. The district managers routinely conduct counselling sessions to sensitise th family members of PLWHA. A fixed monthly allowance of TK. 1,500 per person is also provided to ensure better nutrition.

Shushasthya (BRAC Health Centres)
BRAC health centres, or Shushasthya, were opened in 1995 to reinforce our community-based health interventions and offer curative services to underserved areas.The centres were ultimately aimed at developing a sustainable model of providing institution based services nearest to the community. In 2007, there are 30BRAC health centres in different parts of the country. They are appropriately staffed with trained health personnel and are equipped to provide out-patient and inpatient services, pathological services and essential drugs. Seven centres are currently being upgraded with emergency obstetric and neo-natal care services and minor surgical interventions. In 2007, our centres provided 103,624 medical contacts, 75% of which were female and included 4,344 deliveries, 4,562 menstrual regulation (MR) services and 1,252 caesarean sections

BRAC Limb and Brace Fitting Centre (BLBC)
BLBC was established in 2000 at Shymoli, Dhaka to provide support for people who are physically disabled.The centre offers prosthetic (artificial limb), orthotic (braces) and physiotherapy services at affordable costs. At the end of 2007, the centre had provided rehabilitation services to 1906 people with an annual increase in client flow of 16% and the highest ever cost recovery of 92%.

PILOT INITIATIVES
Scaling up of successful interventions is an important hallmark of BRAC Health Programme. Currently,we are implementing several pilot interventions in order to examine their potential for expansion.

Reading Glasses for Improved Livelihoods is providing access to affordable reading glasses for presbyopic cases.

Mainstreaming Nutrition is improving nutrition related activities for women and children. Components include promoting exclusive breastfeeding and appropriate complementary feeding, improving maternal nutrition and providing treatment for severe malnutrition.

The School Health pilot project is addressing the development and health needs of school children and undertaking health promotion activities at the schools.

The Health Micro Insurance scheme is developing a sustainable community-health financing model to increase the community's access to health treatments and safeguard household health security for the poor.