Bangladesh group has trained 30 000 community health workers
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《英国医生杂志》
Three decades after its creation the Bangladesh Rural Advancement Committee (BRAC) has become one of the world抯 largest non-governmental development organisations. According to a review of its achievements by Dr Jon Rohde of the committee抯 own School of Public Health, its activities have touched the lives of millions of Bangladeshis. Not the least of its impact has been on their health.
The committee was set up in 1972 after the war that lead to the split of East and West Pakistan into Pakistan and Bangladesh. Like many organisations created to provide relief in the aftermath of civil and military upheaval, it could have done its bit to restore normality and then quietly faded away. It didn抰.
The committee owes much of its success to an unswerving application of the philosophy of its founder, Fazle Hasan Abed, a sometime senior executive of Shell Oil. He believed that health had to be seen in the context of poverty and that poverty is best overcome when societies revitalise and rebuild themselves from the inside.
All committee employees, from director to field workers, are in contact with the people being helped—foremost among whom are the extremely poor. "Meetings with villagers are common," says the report, adding dryly that in such settings few evening activities occur to distract from discussion. "BRAC workers align with the rhythms of the sun, the seasons, the traditions that govern rural lives." From this the programme has emerged.
Following its founder抯 view that women are the key to overcoming poverty, the committee tries to enhance the role and prospects of women and to channel much of its help through them. And from immunisation to vitamin supplementation to tuberculosis the system works. The committee has trained women in 13 million households to use oral rehydration treatment. The small loans it offers them to start local enterprises have a startlingly high repayment rate of more than 99%.
Over the years the committee has discovered that delivering efficient and equitable health care depends on getting three things right. Firstly, the people in the driving seat should be villagers—mostly women—recruited from within their own community and compensated as local resources allow. Secondly, training must focus on the most common problems and should be provided by the more experienced community workers. Thirdly, adequate back up must be given by doctors, nurses, and other health professionals.
In conditions of dire poverty health may not be people抯 main concern; being able to make a living is usually the first priority. And this is often the committee抯 point of entry: attention to health care follows when people are assured of a livelihood.
Unlike so many of the statistics emerging from developing countries the committee抯 are mostly encouraging: 30 000 community health workers covering 70 million people living in 60 000 villages throughout Bangladesh. And of its annual expenditure of more than $160m (?0m; 125m), no less then four fifths is now earned by sales of the organisation抯 own products and produce.
Although BRAC抯 principal concern has so far been with its home country, its principles are exportable. The organisation is already operating in Afghanistan, a country with problems to rival those of Bangladesh itself.(London Geoff Watts)
The committee was set up in 1972 after the war that lead to the split of East and West Pakistan into Pakistan and Bangladesh. Like many organisations created to provide relief in the aftermath of civil and military upheaval, it could have done its bit to restore normality and then quietly faded away. It didn抰.
The committee owes much of its success to an unswerving application of the philosophy of its founder, Fazle Hasan Abed, a sometime senior executive of Shell Oil. He believed that health had to be seen in the context of poverty and that poverty is best overcome when societies revitalise and rebuild themselves from the inside.
All committee employees, from director to field workers, are in contact with the people being helped—foremost among whom are the extremely poor. "Meetings with villagers are common," says the report, adding dryly that in such settings few evening activities occur to distract from discussion. "BRAC workers align with the rhythms of the sun, the seasons, the traditions that govern rural lives." From this the programme has emerged.
Following its founder抯 view that women are the key to overcoming poverty, the committee tries to enhance the role and prospects of women and to channel much of its help through them. And from immunisation to vitamin supplementation to tuberculosis the system works. The committee has trained women in 13 million households to use oral rehydration treatment. The small loans it offers them to start local enterprises have a startlingly high repayment rate of more than 99%.
Over the years the committee has discovered that delivering efficient and equitable health care depends on getting three things right. Firstly, the people in the driving seat should be villagers—mostly women—recruited from within their own community and compensated as local resources allow. Secondly, training must focus on the most common problems and should be provided by the more experienced community workers. Thirdly, adequate back up must be given by doctors, nurses, and other health professionals.
In conditions of dire poverty health may not be people抯 main concern; being able to make a living is usually the first priority. And this is often the committee抯 point of entry: attention to health care follows when people are assured of a livelihood.
Unlike so many of the statistics emerging from developing countries the committee抯 are mostly encouraging: 30 000 community health workers covering 70 million people living in 60 000 villages throughout Bangladesh. And of its annual expenditure of more than $160m (?0m; 125m), no less then four fifths is now earned by sales of the organisation抯 own products and produce.
Although BRAC抯 principal concern has so far been with its home country, its principles are exportable. The organisation is already operating in Afghanistan, a country with problems to rival those of Bangladesh itself.(London Geoff Watts)