Today, BRAC reaches reach more than 92 million people with 18,000 staff members and 68,095 all-female community health volunteers working in all 64 districts of Bangladesh. The health interventions are delivered through four components: BRAC’s own programmes, partnership programmes with the government, facility based services, and pilot initiatives. Our maternal, neonatal, and child health programmes currently target 8 million urban slum dwellers and 11 million rural people. The tuberculosis control programme has already reached 86 million people in 42 districts.
BRAC focused on building a three-tier proprietary network of providers, which includes:
- Tier 1: Part-time community health workers (Shasthya Shebikas)
- Tier 2: Cadre of female health paramedics (Shashthya Kormis)
- Tier 3: Network of health clinics (BRAC Shushasthos)
To expand access to these services, BRAC created four health insurance benefit packages. The first package is for microfinance clients. The second is an equity package offered to the ultra-poor (free of cost). The third package is a pre-paid pregnancy package. And the fourth package is for school children. Referral to external providers in the event that the BRAC network is unable to handle a case.
Micro Health Insurance for Poor Rural Women in Bangladesh (BRAC-MHIB):
The BRAC Micro Health Insurance for Poor Rural Women in Bangladesh (BRAC-MHIB) started as a pilot project in Madhabdi in Narshingdi District in July of 2001. It formally launched in November of 2001 when a 3-year financial and technical assistance agreement was signed with the ILO’s Women’s Empowerment through Employment and Health (WEEH). At that time, it was also extended to include Fulbari in the Dinajpur District. The project falls under the administration of BRAC, but operates as an independent entity.
The scheme offers voluntary enrolment in the General Benefits Package, which provides subsidized essential services such as consultation, pathology testing and medicine for an annual premium and a co-payment. Family size and Village Organization (VO) membership determine the premium amount, while MHIB membership determines co-payment charges. Each BRAC MHIB policyholders is issued a card, which serves as evidence of insurance coverage. The BRAC microinsurance products target both poor and the ultra poor. The ultra-poor can enroll in the Equity Package free of charge and gain access to all the benefits of the General Benefits package. BRAC cross-subsidizes the cost of ultra poor enrollment with revenue generated from VO enrollment. To encourage women to take advantage of ante-natal services, BRAC MHIB also introduced a Prepaid Pregnancy-Related Care Package in January 2002. The package includes services that were previously unavailable, such as pre-delivery complications (abortions and miscarriages), post-delivery complications, and neo-natal care.
The program has referral service links with a few government and private hospitals for cases that BRAC's Health Clinics are not equipped to handle. Furthermore, MHIB has an agreement with a private clinic in Madhabdi and with 4 private clinics in Fulbari to provide x-ray and ultra-sonogram services to cardholders at a 30% discount. MHIB has also negotiated to receive a 15% discount on all medicines from the programme’s various pharmaceutical suppliers.
Shasthya Shebikas and DOTS
While TB medications have always been provided for free by the government, BRAC requires patients to hand over a small deposit prior to beginning treatment that’s returned only when the patient completes the six months of treatment (this can be paid by the community or waived when necessary). Shasthya shebikas watch the patients take their medications every day (a strategy now called directly observed therapy, short-course or DOTS) at their homes, receiving a small payment upon treatment completion. This technique has been very successful in terms of making sure patients complete their treatment for tuberculosis.