BRAC:

A New Approach to Poverty Alleviation and Health Improvement

Henry Perry

Johns Hopkins Bloomberg School of Public Health

Presented at Christian Connections for

International Health

27 June 2015

BRAC at a Glance • At work since 1972 – originally Bangladesh Rural

Advancement Committee • Reaching beyond Bangladesh across the world • Annual budget >$1 billion, 77% self-generated • Reaching 120 million people in all 64 districts in Bangladesh • More than 200,000 staff globally • Largest NGO in world in terms of beneficiaries and staff • Core programs: economic development (including micro-

finance), education, health, social development and human rights

• BRAC University and James B. Grant School of Public Health

www.brac.net

Other Programs

• Migration • Community empowerment • Gender, justice and diversity • Human rights and legal aid services

Learning from Early Mistakes

• “Capture” of programs by local elites • Failure of doctors and paramedics to function

effectively in the villages • Doctor-run clinics were expensive and had

little outreach • Refashioning of programs so they serve the

neediest people • Influence of Paulo Freire

Micro-finance

Shasthya Shebikas

Village Organizations: Pathways to BRAC’s Community Work

Essential health care

Village Organizations

Micro-finance Backbone for VOs

VOs Needed to support Shasthya Shebikas

Shasthya Shebikas Provide essential health care

VO-Supported Commmunity Health Volunteers: Shasthya Shebikas

• BRAC VO member, married and aged above 25 years

• Delivers preventive and basic curative health, door-to-door

• Average coverage: 250 households

• Fills in the critical health human resource gap

Shasthya Shebika

BRAC Village Organization

El Arifeen, “Community-based approaches …” Lancet 2013

BRAC Health Programs in Bangladesh

• Community-based services provided by Shasthya Shebikas (CHWs)

• Health promotion, prevention and treatment • MCH, nutrition, immunizations, family

planning, TB, WASH • Close coordination in Ministry of Health

(especially for immunization, family planning, and TB)

Bangladesh

BRAC Manoshi Project: Mother and Newborn at

Delivery Center with Urban Birth Attendant

Other Elements for Scale-up and Sustainability

• Vision • Leadership • Learning from mistakes/fostering “learning

organization: mentality • Strong M&E system (5% of budget goes to

research activities designed to improve programs)

• Interdependence with, not dependence on donors (and willingness to detach from donors)

F. H. Abed, President and Founder of BRAC

BRAC

• World’s best example of implementation of the ideals of Alma Ata and Health for All at scale (see http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf)

• Winner of Gates Award for Global Health in 2004

BRAC (cont.)

• Multi-sectoral approach to development, health improvement, and empowerment. Programs self-sustaining with local income through economies of scale, vertical integration, and formation of profit-making related businesses

• See their website: http://www.brac.net

BRAC Worldwide

BRAC Worldwide Operations

Country

Number of beneficiaries (in millions)

Year program established

Bangladesh 120.0 1982 Afghanistan 4.7 2002 Uganda 4.2 2006 Sri Lanka 0.7 2004 Pakistan 2.5 2007 Tanzania 1.3 2006 South Sudan 1.3 2006 Sierra Leone 1.1 2008 Liberia 0.6 2008 Philippines 0.04 2012 Myanmar -- 2013 Haiti -- 2010

Total number of employees

~ 70,000 full-time ~130,000 part-time

Total: ~200,000