Community Health Workers in Bangladesh
Remarkable collaboration increases demand and access to medical care for rural residents
For more than 40 years, both government and NGOs have worked - sometimes in collaboration and sometimes in parallel - to establish, expand, and improve robust pluralistic CHW programming. The programs are noteworthy for their large impact and scale; data-driven, innovative programming; focus on women’s health and empowerment; and integration into the larger health system.
The Bangladesh government and its NGO partners have developed complementary, supplementary, and overlapping community health worker programs that have helped the country reduce under-five mortality rate by 75 percent and maternal mortality ratio by 71 percent. They have helped increase the percentage of rural children who receive the critical DTP vaccine from near zero in the 1980s, to more than 90 percent. Today, about 130,000 CHWs, most of them women, deliver health education, preventive, promotive, and limited curative care across Bangladesh’s rural areas. About 50,000 of these CHWs work for the government, and the rest work for NGOs and the private sector.
Data-driven, problem-focused programming
Bangladesh has harnessed a wealth of data to design programming that both addresses the most pressing health challenges and adapts to changes.
Commitment to experimentation, innovation, and adaptation
The first CHW program started shortly after Bangladesh’s independence, as the cash-strapped government’s innovative attempt to provide family planning information and services to rural women.
Supporters of CHW programming proved expert in cultivating and sustaining -over nearly 50 years - the political commitment necessary to support robust programming.
Leveraging NGO resources
Through contracts and deep partnerships built over decades, Bangladesh proved exceptionally adept at harnessing NGO expertise and resources to further its goal of improving access to health care.
A robust NGO sector developed its own channel of supplementary and complementary CHW programming, matching in scale the government’s CHW cohort. Bangladesh has consistently harnessed such NGO expertise, staffing, and other resources in three ways:
- The government has repeatedly and continually asked for NGOs’ assistance developing, testing, improving, and expanding its own programming
- The government has encouraged NGOs to develop NGO-led CHW programming that complements government programming
- The government has contracted to hire NGO CHWs
These diverse and intertwined CHW systems have increased knowledge of and demand for health care and made a spectrum of essential health services widely available.