Program Comparison

Health system with multiple actors and large private sector

Low government health expenditure per capita

Significant health system reform to ensure universal access to healthcare, with focus on equity

High burden of non-communicable diseases

Highly centralized, mostly public PHC system

Highly constrained human resources for health

Post-Ebola epidemic, with a range of NGOs working in community health

Large rural population living in remote areas

Diverse ecosystem of government and NGO CHWs, with different training and service packages

Mix of paid, full-time CHWs and part-time volunteer cadres with income-generation activities

Developing since the 1970s, to respond to evolving health priorities (e.g. family planning in the 1970s, child health in the 1980s, etc.)

BRAC is the largest NGO program in Bangladesh, with ~50 percent of all CHWs in country

Full-time CHWs integrated into PHC teams in context of national PHC reform

Home visits and community activities to support demand for and utilization of PHC services, as well as uptake of other welfare services

Focus on maternal, newborn, and child health (MNCH) (e.g. ANC, immunization), chronic diseases (e.g. ensuring proper follow-up), identification of other family needs

Full-time, female CHWs extending geographical reach of PHC services

12-month training (5-10x longer than other programs), with range of curative and prevention/promotion services

Services delivered both at community/homes and health posts

Manage Health Development Army Volunteers, ~three million women providing role model to peers on prevention/promotion practices

Part-time CHWs providing curative and prevention/promotion services in hard-to- reach areas

Dedicated nurse supervises CHWs and provides link to facility-based PHC

Services provided at community and home level

Program managed by government, in partnership with NGOs

Government Cadres:

• Family Welfare Assistant (FWA)
• Health Assistant (HA)
• Community Health Care Provider (CHCP)

BRAC Cadres:

• Shasthya Shebika (SS) (~20h/week)
• Shasthya Kormi (SK)

• ACS: Community Health Agent (full-time)

• HEW: Health Extension Worker (full-time)
• HDAV: Health Development Army Volunteer  (~three hours/day)

• CHA: Community Health Assistant (20h/week)

Provide childhood illness education to mothers, nutrition, and water, sanitation and hygiene (WASH) education

Check immunization cards and recommend appropriate immunization, design, organize, and deliver group education meetings and counseling for individuals with chronic disease, pregnant women and women with newborns, provide information on services available at PHC center and refer as needed

Provide childhood illness education to mothers, nutrition and WASH education

Provide childhood illness education to mothers, nutrition education

Prevent neonatal sepsis, administer immunizations, identify and manage malnutrition, identify pregnant mothers, provide antenatal and postnatal care (ANC/PNC) - only CHCP/SK, preventive education on neglected tropical diseases (NTDS), non-communicable diseases (NCDs), HIV, tuberculosis (TB), and provide family planning (FP) distribution

Identify risk factors in the home, measure blood pressure/glycemia, provide 1:1 counseling on cancer and other NCDs, HIV, TB healthy behaviors and FP, schedule ANC/PNC and general PHC appointments, follow up to ensure attendance and support and adherence to medication (e.g. for diabetes)

Prevention of neonatal sepsis,  administer immunizations, identify and manage malnutrition, identify pregnant mothers, provide ANC/PNC (only HEW), deliver preventive education on NTDS, NCDs, HIV, TB, and provide FP distribution

Identify danger signs and provide referrals for pregnant women and children, identify pregnant mothers and provide them with referrals for ANC/PNC and facility-based deliveries, identify and manage malnutrition, vaccination dropout tracing, preventive education on NTDS, NCDs, HIV, TB, provide FP distribution, and basic first aid response

National vitamin A, immunization and campaigns, family planning satellite mobile clinics

Determine health needs, conduct advocacy, promote and mobilize on identified health needs

Determine health needs, conduct advocacy, promote and mobilize on identified health needs

Determine health needs, events-based surveillance for infectious diseases, immunization and campaigns, mobilize on identified health needs

• Data collection, vital record registration
• Household visits
• Attend supervision meetings; SS supervises SK
• Referrals to PHC facilities
• BRAC SS sell various health commodities and medicines for income generation

• Data collection, vital record registration
• Household visits
• Engage closely and regularly with PHC team
• Referrals to PHC facilities
• Navigation to social services

• Data collection, vital record registration
• Household visits
• Attend supervision meetings with PHCU team, HEW supervises HDAV
• Referrals to PHC facilities
• Train model families

• Data collection, vital record registration
• Household visits
• Attend supervision meetings with CHSS
• Referrals to PHC facilities