THE BRAC SHASTHYA SHEBIKA COMMUNITY HEALTH WORKER IN BANGLADESH Summary Background Bangladesh has a history of using CHWs to support health services. BRAC has been a driving force and has been refining its strategies. The Shasthya Shebika (SS) Program is rooted in a gendered perspective, focusing on the need for female health workers in Bangladesh to address socio-cultural barriers to access to health care services. BRAC first adopted the Barefoot Doctor approach used in China a half-century ago and trained male paramedics, but then shifted the approach in the early 1980s to focus on women with lesser training who were often illiterate.
Implementation In 1990, there were 1,080 SSs, and by 2008 the number had grown to 70,000. At present, there are approximately 100,000 SSs.
Training SSs receive 4 weeks of basic training by the local BRAC office. They are trained to treat common medical conditions, to promote a wide variety of health behaviors, and to refer patients to preventive and curative services as appropriate.
Roles/Responsibilities During monthly household visits, SSs provide health promotion sessions and educate families on nutrition, safe delivery, family planning (FP), immunizations, hygiene, and water and sanitation. They also use this time to sell health products, such as basic medicine, sanitary napkins, and soap. BRAC introduced the sales component to provide a small profit as an additional incentive for and motivation to the community health volunteers (CHVs) to continue working. When someone has an illness that the SS cannot manage, the person is referred to government health centers or a BRAC clinic.
Incentives CHVs are given small loans to establish revolving funds, which they use to make some money by selling health products at a small markup.
Supervision Direct supervision is conducted by higher-level CHWs called shasthya kormis (SKs) Other program staff at BRAC also provide supervisory support. Appendix B–2
Draft December 2013