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In remote regions of Bangladesh, community health workers break barriers to healthcare

In September 2012, UNICEF released the 2012 Progress Report on Committing to Child Survival: A Promise Renewed. The report shows that the number of children dying before the age of 5 has drastically declined over the past two decades.

Click here for more information on A Promise Renewed.

By Priyanka Pruthi

SUNAMGANJ, Bangladesh, 3 October 2012 – Rita Rani Boidda walks for miles every day in Sunamganj district, in one of the most remote regions of Bangladesh. She goes from door to door, navigating narrow lanes under the scorching sun, in the pouring rain, sometimes along a flooded terrain.

2 October 2012 - They go where doctors can't, where hospitals are hard to find, where trained nurses are few. Community health workers are the force behind one of the biggest success stories in Bangladesh.  Watch in RealPlayer


Ms. Boidda is counseling women on health and hygiene. She goes where doctors can't, where hospitals are hard to find, where trained nurses are few.

Frontline workers in remote areas

Deep in northeastern Bangladesh, framed by vast wetlands, Sunamganj is flood prone and poorly connected. Clean water, sanitation, infrastructure and education remain major challenges.

Easily preventable diseases are among the biggest killers of children under the age of 5. And nearly 80 percent of births in Sylhet Division, where Sunamganj district is located, take place at home, without professional assistance from skilled attendants.

In 2009, 600 women, including Ms. Boidda, stepped up to create armies of healthcare workers as part of the Maternal and Neonatal Child Survival (MNCS) project. The project stretches across eight of the hardest to reach districts in Bangladesh. Supported by UNICEF, the programme aims to create awareness about maternal, neonatal and child health in some of the most underserved communities – regions in which these workers are the only point of contact for families in need of medical assistance.

© UNICEFBANA/2012-00838/Khan
Community health facilitator Rita Rani Boidda (right) and community health promoter Moni Das (left) teach a pregnant woman and her family about neonatal care during a household visit in Jagannathpur Upazila, Sunamganj district. They are part of an army of women healthcare workers who serve this remote area through the Maternal and Neonatal Child Survival (MNCS) project.

Ms. Boidda, who was trained through the MNCS counseling package, is an undergraduate student. She serves communities in Sunamganj district, where she grew up and continues to live. “This is my neighborhood, my community. I am actually serving my mothers, aunts and sisters. These are my people, and they will benefit from my work. That’s why I chose to do this.”

Changing mindsets

MNCS workers have faced entrenched ideas about healthcare. “Initially, when we went house to house offering counseling on child and maternal health issues, the women treated us with suspicion…[and] the men were not supportive of our work,” explains Ms. Boidda. “There were many religious, conservative families that didn’t allow women to venture outside their homes during pregnancy. They weren’t allowed to go for regular medical check-ups in hospitals – the men thought women were too ‘exposed’ during the examination. They were also strongly against various temporary and permanent family planning methods,” she says.

MNCS workers have, however, broken barriers to institutionalized care. According to Ms. Boidda, it is the workers’ familiarity with their communities that has given them an advantage. “This change didn’t take place overnight. We had to work very hard for this. It was only when fathers and the elderly saw that our advice was saving lives, when their children with diseases like pneumonia returned from hospitals fully recovered, did they begin to trust us,” she says.

Empowering communities

Ms. Boidda and her staff counsel mothers, promote maternal nutrition and essential care for newborns and provide information about hygiene and diseases. They encourage immunization and ensure that every newborn in their assigned area of work is fully vaccinated before her or his first birthday.

© UNICEF/BANA2012-00861/Ahsan Khan
A mother waits for immunization vaccines at the Kolkolia Community Clinic in Sunamganj district. Ms. Boidda plays with the child. A component of the MNCS project is to encourage immunization and ensure that every newborn is fully vaccinated before her or his first birthday.

Health promoters also conduct sessions that bring young mothers, elderly women and midwives together. Trained by UNICEF’s local partners Concern Worldwide, Bangladesh, and the Voluntary Association for Rural Development, health workers have taught women safe birthing techniques, breastfeeding practices, the warning signs of illnesses and where they can receive treatment. Health workers are a critical link between the villagers and health centres.

As a result, women in the community are better equipped to take matters of their own health, as well as community health, into their own hands. With support from the project, villagers in Sunamganj district organize monthly meetings to discuss issues pertaining to healthcare. At a recent meeting in Majidpur village, the community clinic group decided to open a bank account for managing the community health centre. “We will also use the fund to support the most marginalized community members and facilitate transport of pregnant mothers to heath facilities,” says group Vice Chair Mohamed Abdul Mannan.

A door-to-door success

Over the past two decades, persistent efforts at the local level, such as the MNCS programme, have led to a sharp decline in maternal and child mortality in Bangladesh. Infant mortality declined from 97 deaths per 1,000 live births in 1990 to 37 deaths per 1,000 live births in 2011. In the same period, post-neonatal mortality fell by 50 per cent, and under-5 mortality dropped by 67 per cent.
“Implementing the MNCS project in Sunamganj was a huge challenge for UNICEF, our local partners and the government,” says UNICEF Health Specialist Shamina Shammy Sharmin. “Changing mindsets and motivating the community is an enormous task, but, even though we had limited resources, we made a difference because of commitment and conviction,” she says.



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