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Tuberculosis in BangladeshTuberculosis (TB) is an airborne disease; common symptoms include cough with sputum and blood in some cases, chest pains, weakness, weight loss, fever and night sweats. TB can lead to the death of an infected person when left untreated. According to the World Health Organization (WHO), TB has caused about 2 million deaths worldwide, and 95% of deaths were recorded in developing countries. Bangladesh ranked sixth among high TB burden countries. The National Tuberculosis Control Programme (NTP) has attained more than 90% treatment success and more than a 70% case detection rate. Despite these successes, tuberculosis in Bangladesh remains a serious public health problem.

Reasons for Higher Infection of Tuberculosis in Bangladesh

  1.  Delays in the Initiation of Treatment: Patients in Bangladesh often receive late treatment. Delays in treatment increase chances of negative treatment results, death and community transmission of TB. A study on 1,000 patients reported that, on average, there were 61 days of delay in the treatment of women and 53 days of delay in the treatment of men.
  2.  Role of Informal Health Practitioners: Most of the impoverished people in Bangladesh prefer to go to their local practitioners due to the ease of accessibility and low cost. A recent survey showed that approximately 60% of the Bangladesh population prefers to go to these uncertified doctors. However, such doctors typically lack formal training. This may lead difficulties in accurately diagnosing and treating TB.
  3. Lack of Awareness: Directly observed treatment short-course (DOTS) has been recognized as one of the most efficient and cost-effective approaches for treating TB. In 1998, the DOTS program became an integrated part of the Health and Population Sector Programme. The inclusion of the DOTS strategy in the Programme helped TB services transition from TB clinics to primary level health facilities. These health facilities typically incorporate GO-NGO (government-organized non-governmental organization) partnerships, and the NGOs have advocated for work on literacy, social awareness along and health care development. As part of the Health and Population Sector Programme, DOTS is freely available to the public. Unfortunately, many remain unaware of the treatment option.  As a result, detection of new TB cases has stagnated at around 150,000 cases per year since 2006.
  4. Poverty: A large portion of the country is still suffering from poverty. Poverty can often lead to overcrowding and poorly ventilated living and working conditions. People with less income also cannot afford food, leading to higher incidences of malnutrition. The culmination of these factors typically make the impoverished population more vulnerable to contracting TB.

The Effort to Combat TB

Tuberculosis is a major public health problem in Bangladesh. However, continuous efforts by the NTP and various NGO organizations have played an important role in decreasing the spread of the disease. DOTS, for instance, demonstrated a 78% cure rate in 1993. Due to its success, a phase-based treatment plan was implemented in 67 million rural populations in 1996.  Since implementation, the NTP has attained a 90% treatment success rate. Further efforts to combat the disease include development of the FAST program (Find cases Actively, Separate safely and Treat effectively). The program intends to detect active TB cases and decrease spread of the disease in healthcare facilities. However, despite efforts by the NTP and a number of NGOs, significant delays in care-seeking and treatment initiation still exist as major hindrances to the program’s goals. 

Challenges to TB Programs

Tuberculosis in Bangladesh kills more than 75,000 people every year. Despite free services like DOTS and other NTP programs, limited access to quality service, lackluster funding and insufficient screening prevent adequate detection and treatment of the disease. The lowest quartile of the population is still five times more likely to contract TB, potentially due to a lack of awareness of TB-treatment programs among the general public. Adding to the problems for TB programs, private health professionals are typically inactive in national programs. While NTP programs have made progress in addressing the disease, these challenges persist, and tuberculosis remains a major health problem in Bangladesh.

Solutions

To stop the growth of tuberculosis in Bangladesh, community organizations such as the Bangladesh Rural Advancement Committee (BRAC) have shown impressive results in lowering the percentage of those afflicted by TB. Effective treatment of TB includes investment in medicine, local health services and diagnostics. To ensure full recovery, social protection of patients is also required. Multidrug-resistant TB (MDR-TB), for instance, requires two months of drug treatment and a four month continuation period. If treatment programs can satisfy requirements investment and social protection requirements, the chance of curing TB patients reaches 92%. The application of a more successful method will help in curing the most complex TB cases, such as drug-sensitive TB, with improved results. With the implementation of proper and effective treatment strategies, we can eliminate tuberculosis in Bangladesh and the benefit even the poorest members of society.

– Anuja Kumari

Photo: Pixabay

Facts About BRAC
The Bangladesh Rural Advancement Committee (BRAC) is a non-governmental organization founded in Bangladesh in 1972. It is surprisingly obscure despite its impacts. These are 10 facts about BRAC that are necessary to understand more about the organization.

10 Facts About BRAC

  1. BRAC is the largest non-governmental organization (NGO) in the world. The Economist described it as “the largest, fastest-growing non-governmental organization in the world–and one of the most businesslike.”
  2. BRAC’s mission is to alleviate poverty and encourage economic participation by empowering people through social and economic programs.
  3. Founder Fazle Hasan Abed created BRAC after becoming disillusioned with poverty in Bangladesh. Now, BRAC has a positive impact in the poorest Asian and African countries in the world, reaching an estimated 138 million people.
  4. BRAC is funded by the Omidyar Network, which invests in impactful NGOs to bring about social change. This allows BRAC’s programs to be very effective and far-reaching.
  5. In 2016, BRAC successfully put 400,000 young children in primary school, gave 90 percent of households in obscure locations healthcare and lifted 86,975 households in Bangladesh out of extreme poverty.
  6. BRAC uses its money wisely. It was awarded an AAA rating by the Credit Rating Agency of Bangladesh Ltd (CRAB). This is the highest rating that it could have received from CRAB.
  7. BRAC approaches poverty differently than other NGOs. Using a businesslike approach, BRAC understands that there are factors beyond economics that account for why people are impoverished. BRAC tackles social issues and inequality as well as using its funds to ensure its impacts are more sustainable.
  8. BRAC has four main projects, including social development, social enterprises, investments and a university.
  9. BRAC University is in Dhaka, Bangladesh and is modeled after the NGO. It fosters goodwill by encouraging students to work in careers involved with national development and progress post-graduation.
  10. BRAC enterprises allow individuals to break out of the chains of poverty by equipping them with the necessary tools needed to have a more profound participation in the economy. As a result, it has established many enterprises, one of which is BRAC Dairy, which has become Bangladesh’s top dairy producer and ensures fair prices and treatment for dairy workers. Another example of a BRAC enterprise is BRAC Sanitary Napkin and Delivery Kit, which produces feminine hygiene products to encourage women to stay in school, and home birth delivery kits to ensure that births are sanitary and safe.

These 10 facts about BRAC truly show how influential BRAC is as an NGO. Despite making such large strides already, BRAC does not foresee slowing down anytime soon. In 2021, it aims to empower 20 million individuals to get the services they need and help 110 million people in Bangladesh that are living in poverty.

– Mary McCarthy

Photo: Flickr

women_in_povertyBangladesh Rural Advancement Committee (BRAC) leader Sir Fazle Hasan Abed won the World Food Prize in 2015 for his achievements in promoting global food security. The primary objective of BRAC is to alleviate global poverty through methods that reduce maternal mortality and invest in maternal health, family planning, services to women, empowerment to women, agriculture and other livelihoods. Bangladesh achieved the Millennium Development Goal of halving hunger by 2015, according to recognition by the United Nations.

Outreach has reached 11 other nations making BRAC the leading anti-poverty advocate and activist in the world. BRAC has given 150 million people an opportunity to improve. Abed has lead BRAC for 43 years, starting in 1972 when the committee focused on helping Bangladesh recover from war with Pakistan. It now has a large staff of about 110 thousand people in the countries of Bangladesh, Afghanistan, Pakistan, Philippines, Sir Lanka, Liberia, Sierra Leone, South Sudan, Tanzania, Uganda and Haiti.

Many success stories stem from BRAC, such as the increase in the rate of immunized Bangladeshi children from 2 percent in 1986, to 70 percent in 1990. BRAC gives those in poverty microfinance, health, education, agriculture and livestock services.

The committee gave $1.5 billion small loans to those in need with $100 to $150 per person. The organization nurtures the eight percent of Bangladesh’s poorest in two-year programs created to lift them out of poverty and receive loans. BRAC uses grants, monthly salaries and health services benefiting families, as they are educated about budgeting in and out of the country. Their methods such as this have assisted 180 thousand people out of poverty.

According to statistics last year, Bangladesh is a leader amongst least developed countries (LDC) fighting for gender equality. The amount of women in parliament has increased, rising from only 10 percent in 1991, to 20 percent in 2011.

The key to success in Bangladesh has been women’s labor in agricultural and exporting positions. There were two million women working in ready-made garment (RMG) factories, which is the top export sector, reeling in a profit of $2 billion a year.

The life expectancy of women increased from 54.3 years in the 1980s, to 69.3 years in 2010. Secondary school enrollment for girls has increased, rising from 1.1 million in 1991, to 3.9 million in 2005. Today, girls are less likely to be married at a young age and fertility rates have fallen. An increase in nutritional intake and higher incomes are another result of benefiting women.

Bangladesh is ranked 100 out of 128 when it comes to gender equality. There is still some work to be done, and Abed knows this. He received the Trust Women 2014 Hero award for promoting women’s rights, becoming the first man to receive this award.

Abed was selected among 160 nominations from 45 countries. The award is given to an innovator whose activity has aided women to learn and sustain their rights. After receiving the World Food Prize in 2015, Abed upholds his goal in helping women when he stated in an article by Environmental News Service, “the real heroes in our story are the poor themselves and, in particular, women struggling with poverty.”

A work in progress within BRAC is teaching mothers in Bangladesh how to make oral rehydration fluid in order to fight diarrohoeal deaths. BRAC is particularly proud of halving the number of child mortality since the 1980s. The organization has been working on training midwives in order to reduce mortality rates of both mother and child.

BRAC’s microfinance has been especially empowering women. Microfinance is essential in rural and social development. Of the borrowers in Bangladesh, 92 percent are women and 90 percent live in a rural area.

Bangladesh has increased gender equality in two particular educational levels. Youth literacy and secondary schooling has improved greatly with higher girl to boy ratios. The country has reduced the gender gap faster than the global average and hopes are high to reserve one third of Bangladesh’s parliament for women by 2020.

However, women will continue have challenges to come. The employment rate of women in 2010 was 58 percent, which is ranked 30 percent lower than men. Women are also still unable to own land, and lack necessary tools to perform productively on the agricultural scale. They also face early and forced marriage, maternal deaths, abandonment, and hold a small amount of job opportunities.

Even so, BRAC has successfully impacted the country and Africa. Its microfinance and two-year nurturing programs have generated success. The fertility rate and child survival has improved in Bangladesh and it’s still reaching to further help women. Results for women’s equality in Bangladesh are expanding beyond borders as people leave poverty with the support of BRAC.

– Katie Groe

Sources: The Daily Star, IRIN, Harvard University SAI, The Guardian, Environment News Service
Photo: IPS News

big_push
In 1981, more than 50 percent of the world was in poverty. In 1990, only 43 percent lived on $1.25 a day. Today, only 21 percent are under the poverty line.

There’s no doubt that poverty is declining around the globe. But almost all of the gains have come from pulling up those just under the poverty line, rather than from those considered “ultra-poor.”

The ultra-poor and the poor, although both suffer from poverty, cannot be compared. The ultra-poor cannot send their children to school because they simply cannot afford it. They can’t take out loans or use banks because they lack the skills to do so. If they receive money or animals for free, they immediately spend the money and savor the food. The ultra-poor are in a trap so deep it’s almost possible to escape.

The ultra-poor have been in need of a new approach, a comprehensive solution that will train, prepare, challenge and ultimately bring them hope of a future with traction and sustainable success.

One such approach offers a viable solution. In 2002, the Bangladesh Rural Advancement Committee, an antipoverty group, started a program in Rangpur to help the severely impoverished “graduate” from poverty. The Ultra-Poor Graduation Initiative included the following key ingredients: money-making assets such as goods to start a store or land to plant seeds; training on how to use these assets as well as financial opportunities; a small regular grant of food or cash to provide time off from labor or begging to learn new skills; access to basic health services and frequent check-ins.

The program was complex and expensive. It required working with the families intensively for over two years. The results, however, were astonishing and worth the hard work.

Almost all the participating families changed their lives. A year after the program ended 97 percent were considered graduated; they had satisfied most of the basic indicators such as having cash savings, steady food sources, diversified income, a tin roof and latrine, among other things. Three years later the number was 98 percent.

Since then, 1.4 million households have participated in this program.

The Consultative Group to Assist the Poor at the World Bank along with local NGOs in India, Pakistan, Ethiopia, Ghana, Honduras and Peru have carried out similar, successful programs, focusing on people living on less than $1.25 a day.

Aid groups around the world have been refining the “big push” approach, a burst of intensely focused help for a limited period of time, for over 25 years. This concept isn’t ground-breaking, but the results of this study definitely are, showing that the positive effects of a well-designed “big push” approach can continue even after the program stops.

The most important effect from this study has been the improved mental state of those who participated. Many of the researchers have attributed the continual success of the families to the fact that they have found hope of liberation from the cyclical nature of poverty.

Alison Decker

Sources: Christian Science Monitor, The New York Times , China Daily, Yahoo News, Futurity, National Public Radio
Photo: Flickr