Nous sommes une ONG qui a de nombreuses entreprises à son service

A. Mushtaque R. Chowdhury est professeur en santé populationnelle et familiale, vice-président et directeur exécutif par interim de BRAC (Bangladesh Rural Advancement Committee). Basée à Dacca, cette véritable institution – presque aussi puissante et ancienne que l’État bangladais lui-même – est un modèle original d’entreprise sociale combinant forme commerciale et statut d’ONG. Implantée dans les 64 districts du pays où elle déploie un large éventail d’activités, de la microfinance à la santé en passant par l’éducation, elle est également présente dans une dizaine de pays étrangers. Avec 120 000 salariés déclarés et 126 millions de bénéficiaires, on dit d’elle qu’elle est la plus grande ONG au monde

Nous sommes une ONG qui a de nombreuses entreprises à son service

A. Mushtaque R. Chowdhury est professeur en santé populationnelle et familiale, vice-président et directeur exécutif par interim de BRAC (Bangladesh Rural Advancement Committee). Basée à Dacca, cette véritable institution – presque aussi puissante et ancienne que l’État bangladais lui-même – est un modèle original d’entreprise sociale combinant forme commerciale et statut d’ONG. Implantée dans les 64 districts du pays où elle déploie un large éventail d’activités, de la microfinance à la santé en passant par l’éducation, elle est également présente dans une dizaine de pays étrangers. Avec 120 000 salariés déclarés et 126 millions de bénéficiaires, on dit d’elle qu’elle est la plus grande ONG au monde

Sustainability of Scientific Journals in the Developing World With Special Reference to Bangladesh

The study explores sustainability of scientific journal publication in Bangladesh. Forty-three journal editors were interviewed, and 66 current journals were physically examined for production quality, regularity of publication, and availability at concerned libraries. Findings revealed that 68% of the journals were published late, 30% had inconsistencies in typesetting, and 14% were indexed. Most journals were found either excellent or of good quality in terms of printing (85%), binding (77%), paper (92%), and graphic reproduction (76%). Most journals were not available in major libraries under study. Of the 43 editors, 28 (35%) reported a cost recovery of 1-45% from subscriptions, advertisements, and sales. About 74.4% of the editors did not consider their journals at risk. Although 86% of the editors were confident that their journals would be sustained in the long run, 37.3% could not give any convincing logic in support of their statement. Major problems include lack of skilled staff, finance, quality articles and institutional support, and lengthy peer review process. Only one journal editor was found to be a full-time editor having training in editing and publication. One-half (51%) of the editors reported have training in editing, while four had publication training. Most editors (79%) were interested in acquiring training in editing and publication. Institutional support and backup, enthusiasm and zeal of editors, unmet need for standard local journals, constant flow of funds and articles, and skilled manpower are instrumental for sustainability of science journals in Bangladesh

Marital Disruption: Determinants and Consequences on the Lives of Women in a Rural Area of Bangladesh

This study, carried out during the second half of 1995, investigated the predisposing factors leading to marital disruption and its consequences on the lives of women in Matlab, a rural area of Bangladesh. Both qualitative and quantitative methods were used. Data were generated from detailed case studies and quantitative surveys of a small number of martially-disrupted women. Additional data were used from the ongoing demographic surveillance system of ICDDR,B: Centre for Health and Population Research. The findings revealed that divorced and abandoned women and their children were extremely vulnerable, both socially and economically. Various factors that influence marital disruption were identified, the most important ones being: aspects determining the process of marriage, various family problems due to non-fulfillment of demand for dowry, mutual distrust, extramarital relationships, quality of sexual life, education of women, and other behavioural characteristics of individuals. Level of education of the wife showed an inverse relationship with the risk of divorce. Women who did not have livebirths from their first pregnancy had a higher risk of divorce. The effect of pregnancy outcome was dependent on the level of education of women. Illiterate women with unsuccessful pregnancy outcomes were at the highest risk of being divorced, with the lowest risk for women with some education and a livebirth. The findings clearly indicate the need for broad-based social development programmes for women, especially to enhance their education to reduce their vulnerability to marital instability and its consequences

A Multidimensional Approach to Measure Poverty in Rural Bangladesh

Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-consumption, which has been extensively studied in the past, health, education, shelter, and social involvement are among the most important dimensions of poverty. The present study attempts to develop a simple tool to measure poverty in its multidimensionality where it views poverty as an inadequate fulfillment of basic needs, such as food, clothing, shelter, health, education, and social involvement. The scale score ranges between 72 and 24 and is constructed in such a way that the score increases with increasing level of poverty. Using various techniques, the study evaluates the poverty-measurement tool and provides evidence for its reliability and validity by administering it in various areas of rural Bangladesh. The reliability coefficients, such as test-retest coefficient (0.85) and Cronbach's alpha (0.80) of the tool, were satisfactorily high. Based on the socioeconomic status defined by the participatory rural appraisal (PRA) exercise, the level of poverty identified by the scale was 33% in Chakaria, 26% in Matlab, and 32% in other rural areas of the country. The validity of these results was tested against some traditional methods of identifying the poor, and the association of the scores with that of the traditional indicators, such as ownership of land and occupation, asset index (r=0.72), and the wealth ranking obtained from the PRA exercise, was consistent. A statistically significant inverse relationship of the poverty scores with the socioeconomic status was observed in all cases. The scale also allowed the absolute level of poverty to be measured, and in the present study, the highest percentage of absolute poor was found in terms of health (44.2% in Chakaria, 36.4% in Matlab, and 39.1% in other rural areas), followed by social exclusion (35.7% in Chakaria, 28.5% in Matlab, and 22.3% in other rural areas), clothing (6.2% in Chakaria, 8.3% in Matlab, and 20% in other rural areas), education (14.7% in Chakaria, 8% in Matlab, and 16.8% in other rural areas), food (7.8% in Chakaria, 2.9% in Matlab and 3% in other rural areas), and shelter (0.8% in Chakaria, 1.4% in Matlab, and 3.7% in other rural areas). This instrument will also prove itself invaluable in assessing the individual effects of poverty-alleviation programmes or policies on all these different dimensions

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the expert panel

Background: The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence.Methods: An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review\u27s findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health).Results: The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the full use of community-level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence-based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached.Conclusions: Stronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence-based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detection and treatment of HIV/AIDS, tuberculosis, malaria, hypertension, and other chronic diseases. Continued strengthening of CBPHC programs based on rigorous ongoing operations research and evaluation will be required, and this evidence will be needed to guide national and international policies and programs

An Energy-Saving Development Initiative Increases Birth Rate and Childhood Malnutrition in Rural Ethiopia

BACKGROUND: Evolutionary life history theory predicts that, in the absence of contraception, any enhancement of maternal condition can increase human fertility. Energetic trade-offs are likely to be resolved in favour of maximizing reproductive success rather than health or longevity. Here we find support for the hypothesis that development initiatives designed to improve maternal and child welfare may also incur costs associated with increased family sizes if they do not include a family planning component. METHODS AND FINDINGS: Demographic and anthropometric data were collected in a rural Ethiopian community benefiting from a recent labour-saving development technology that reduces women's energetic expenditure ( n = 1,976 households). Using logistic hazards models and general linear modelling techniques, we found that whilst infant mortality has declined, the birth rate has increased, causing greater scarcity of resources within households. CONCLUSIONS: This study is, to our knowledge, the first to demonstrate a link between a technological development intervention and an increase in both birth rate and childhood malnutrition. Women's nutritional status was not improved by the energy-saving technology, because energy was diverted into higher birth rates. We argue that the contribution of biological processes to increased birth rates in areas of the developing world without access to modern contraception has been overlooked. This highlights the continued need for development programmes to be multisectoral, including access to and promotion of contraception

The wider impacts of BRAC poverty alleviation programme in Bangladesh

Over the decades of the 1980s and 90s many poverty alleviation programmes have been implemented in developing countries. Evaluations of such programmes have traditionally looked at their success in increasing the income levels of participants but less at the wider goals of human well-being. This paper looks at the poverty alleviation programme of BRAC, a large non-governmental organisation in Bangladesh, and, based on carefully designed studies, presents its impact on selected components of 'human well-being'. This study found better child survival and nutritional status in households served by the programme. Simular impacts were also found in other areas such as expenditure patterns, family planning practices and children's education. The studies also looked at the impact on the rural power structure and found a substantial change in the networking relationship of health providers. The likely influence of 'selectivity bias' on the above results is also discussed. Copyright © 2004 John Wiley & Sons, Ltd.

Producing effective knowledge agents in a pluralistic environment: What future for community health workers?

This paper is concerned with how poor populations can obtain access to trusted, competent knowledge and services in increasingly pluralistic health systems where unregulated markets for health knowledge and services dominate. The term "unregulated" here derives from the literature on the development of markets in low income countries and refers to the lack of state enforcement of formal laws and regulations. We approach this question of access through the changing roles and fortunes of community health workers over the last few decades and ask what kind of role they can be expected to play in the future. Community based health agents have been used in many settings as a way of filling gaps in service provision where more skilled personnel are not available. They have also fulfilled a more transformative role in broad based community development. We explore the reasons for the decline of programmes from the 1980s onwards. Using the specific experience of Bangladesh, the paper considers what lessons can be learned from past successes and failures and what needs to change to meet the challenges of 21st century health systems. These challenges are those of establishing credibility and legitimacy in a pluralistic environment and creating a sustainable livelihood strategy. The article concludes with a discussion of four potential models of community based health agents which are not necessarily exclusive: a generic agent that is closely linked to a reputable supervisory agency; a specialist cadre working with particular health conditions; an expert advocate; and a mobiliser or facilitator who can mediate between users and health markets.Bangladesh Health human resources Health systems Health knowledge Developing countries