Reaching millions through scaling-up community health actions

Bangladesh has made rapid progress in improving health status of its population in past three decades considering to her neighboring countries. Total fertility rate (TFR) has reduced from 6.3 (1975) to 2.7 (2007), immunization coverage increased from 2% (1980) to 82% (2007), under-five mortality declined from 221 (1975) to 65 (2007) and MMR declined from 570 (1990) to around 280 (2007). The country is on track to achieving health MDGs 4 & 5.  These successes may be rightly attributed to successful Govt.-NGO partnership in health services delivery at the community. 
 Among the NGOs, BRAC has pioneered training of large scale community health volunteers or Shasthya Shebika since early 197’s. Currently there are over 74,000 female community health volunteers working with BRAC. They deliver services through door-to-door visits and each one covers an average of 250 households. This program is low–cost and that is linked with BRAC’s poverty alleviation program (micro-finance).  This provided an intersectoral collaboration and largely enabled BRAC in vertical expansion of programs and horizontal integration of services.  
 In the 1980's, BRAC implemented the famous Oral Therapy Extension Programme (OTEP) and successfully reached 13 million households.  Since then, BRAC has applied similar mass approaches to improving immunization levels, strengthened availability of family planning services and increasing access to tuberculosis diagnostics and treatment. Through successful scale-up of Shasthya Shebika programme, BRAC has already reaching over 92 million (3/4^th of Bangladesh’s population) with a essential package of health care including 86 million people with access to Tuberculosis treatment.   Other major interventions such as the Maternal, Neonatal and Child Health (MNCH) projects target the poorest of the poor in both rural areas and urban slums (11 million rural and 8 million urban slum population). By using the health volunteers model, BRAC has shown that integration of vertical (disease specific) and horizontal primary health care is possible as envisioned in the Alma Ata.