BRACs Tuberculosis ProgramPioneering DOTS Treatment for TB in Rural Bangladesh

By- POWER WALL

FRAMEWORK

BRAC

SituationAnalysis

StrategyFormulation

StrategicImplementati

on

Strategic Control

ConflictManagement

OVERVIEW• Bangladesh is bordered by India on all sides, Burma

(Myanmar) on the southeast and the Bay of Bengal to its south.

• 7 administrative divisions• Divisions are subdivided into districts (zila). There are

64 districts in Bangladesh, each further subdivided into upazila (subdistricts) or thana.

• Highest Population Density in 2001• 240,000 km roadway- 90% unpaved

HEALTH PROFILE

• Tuberculosis Prevalence – 391 Per 100,000 People

(2006)

• Maternal Mortality Ratio – 570 per 100,000

Population (2005)

• Infant Mortality Rate – 43 Per 1000 Population(2008)

• HIV prevalence – 100 Per 100,000 population (2005)

• Malaria Cases – 19 Per 1,000 People (2006)

HEALTH DELIVERY SYSTEM• Four Tier System

- Village ( Quacks, Other informal Health care Provider )- Union ( 1362 Sub centres )- UpZilla ( Sub district ) – 460 Upzilla Health Complexes- Zilla ( District ) – 59 Districts Hospitals

• There are 7 specialized Hospitals• Physician density-3 per 10,000• Nursing density- 3 per 10,000• Hospital beds- 4 per 10,000

EXTERNAL ANALYSISSOCIAL

53%- literacy rate (Bangladesh)50% - Poverty rate,BPL Population-5 millionFemale population restriction from working outsideSocial Myth & wrong belief about TBMyth about government and private facilities200 million TB patients registered every year globally- 3,40,000 in B’deshReduced access to healthcare-women Dual Infection of TB-HIV

ECONOMIC

GDP per capita in PPP(07)- 1178Government expenditure on health-7.2% (07)International donor agenciesInflation

POLITICO-LEGAL

Stability of government- National TB programmeInternational relations- World Bank, WHO supportTax lawsLabor laws

TECHNOLOGICAL

Information & Communication Technology-E-health, mhealth, Telemedicine advances for diagnostic and TreatmentElectronic Health Records

INTERNAL ANALYSISMARKETING

Tie up with private practitioner and medical collegesTie ups with garment districts- export processing zonesIndividual factory ownersPrisons

OPERATIONS

Smear positive- approachResearch and evaluation division

HUMAN RESOURCE

Involving traditional doctors and mid wives with social legitimacyShasthya sebika programPerformance based incentivesTraining programs

FINANCE

Government Funding Global Fund 10 % profit margin for volunteers

SWOT ANALYSIS STRENGTHS

Community based delivery systemVillage health volunteers-shasthya sebikasUnique incentivesOwned Laboratory facilitiesReferral LinkagesBond SystemStandardisationBRAC-NTP partnershipFinancially stable

WEAKNESSES

Drop outsLoss to follow upCase detection rateUnderstanding of DOTS administration by shebikasLack of human resourceLow success rate in women

OPPORTUNITIESSupport of Govt. policiesMore service delivery pointsCatchment area- 30 million peopleMDR-TB diagnostic labQuality assurance centersCapacity BuildingAwareness programs

THREATSSocio-cultural barriersGeographic inaccessibilityResistance from district level officialsDuplication of programme

TOWS MATRIX

Internal strengths + External Opportunities 16

Internal Weakness + External Opportunities 13

External Threats + Internal Strengths 13

External Threat + Internal Weakness 10

STRATEGIES

1) Related Diversification Laboratories Doctors Group Chest Clinics Home based Care Ambulatory Care

2) Market Penetration Awareness campaigns Art workshops

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Space profile for BRAC’s Tuberculosis in Rural Bangladesh

Environmental stability

competitive ad-vantage

Aggressive Profile

industry strength

financial strength

An organization whose financial strength is a dominating factor in the industry segment

Strategic Alternatives for Aggressive profiles

Related diversificationVertical IntegrationProduct developmentMarket Development

VISION

BRAC’s Vision is to make sustainable improvement in the quality of life for the poor by working with the community and focusing on increasing autonomy.

MISSION

BRACs mission is to work towards Prevention and Treatment of Tuberculosis by providing standard and sustainable services which are accessible and affordable

GOAL

The Goal of BRACs is to Combat High Prevalence of Tuberculosis.

OBJECTIVES• To this model 50% self sustainable by the year

2000• To Make 14 million women learn How to make ORS

by the year 1990.• To Train village Health volunteer to Provide basic

diagnostic and curative services• To reduce the prevalence of Tuberculosis in

Bangladesh to 300 per 100,000 population by 2005• To increase the number of Shasthya Sebika to

70000 by the year 2007

• To work in conjunction with Government for Tuberculosis programme .

• To increase the case detection rate to 90 % by the year 2007.

• To increase the treatment success rate to 95% by the year 2007.

Strategic Control

FrameworkInvolve Think TankEstablish standardsMeasure and compare performanceDetermine reasons for deviationCorrective action

Conflict Management

Interpersonal conflict- Due to miscommunication, Intense work ,

overlapping tasks , compensation.Solution-By clearly defining job responsibilities with

least overlapping of tasks. Proper mode of communication

Who moved my cheese?

• Abreast with Technology- ICT• Slow continuous process• Simulation Exercises