Table 2 Evolution of BRAC’s CHW programme over 60 years (1970–2019)
Characteristic | Evolution over time | ||||
|---|---|---|---|---|---|
Time period | 1970–1979 | 1980–1999 | 2000–2009 | 2010–2019 | 2020–2029 |
Socioeconomic environment | Extremely poor, with a low literacy level and poor communications infrastructure | Poor but literacy and communication improving | Poor with acceptable literacy and communication networks | Low-income country but developing and urbanizing, with increased access to digital networks | Developing country that has achieved status as a lower middle-income country in process to become an upper middle-income country, population better educated, older, more urbanized, and well connected to digital communications |
Stage of development of CHW programme | Experimental, pilot | Embryonic | Expanding | Maturing | Entrepreneurial |
Type of CHW envisioned | Empowered woman | Educator and mobilizer | Healthcare service provider | Healthcare service provider who is sustained through cost recovery | Business women who is a service provider who earns the money herself needed to sustain herself |
Objective of CHW programme | Empowerment of women (CHWs with access to knowledge, social recognition, and financial inclusion) | Improved child health | Improved access to health services and health information | Improved resilience of community in meeting its health needs | Improved access to quality healthcare through a digitally enabled community-based healthcare system |
Nomenclature for CHW cadres | Paramedic, lady family planning officer | Oral therapy extension worker, shebok shebika | Shasthya shebika, shasthya kormi, nutrition promoter | Shasthya shebika, shasthya kormi, programme assistant, mid-level ophthalmic paramedic, midwife, skilled birth attendant | Shasthya shebika, shasthya kormi, programme assistant, mid-level ophthalmic paramedic, midwife, para-psychosocial counsellor |
Tasks | Provision of over-the-counter drugs and family planning commodities at the home | Education and mobilization for diarrhoea prevention and treatment, immunization, vitamin A, demand creation for public health services, maternal and adolescent health, and communicable diseases | Promotion of positive health behavior, creation of demand for public and BRAC services, provision of services free of cost at households and outreach points, paper-based data collection | Promotion and demand creation, service provision with service fees, health centre-based service provision, introduction of digital data collection | Promotion, demand creation, service provision, psychosocial counselling, digital real-time recording of demographic and management data |
Scope of services | Provision of family planning commodities, treatment of common ailments | Child health (prevention and treatment of diarrhoea, child survival interventions); WASH interventions; ANC, safe delivery, and PNC; adolescent family life education, nutrition supplementation | RMNCH; communicable diseases (TB, malaria); child feeding, dietary diversification, and micronutrient supplementation), eye care | RMNCH, NCDs, nutrition, eye care | RMNCH, NCDs, nutrition, eye care, mental health, early childhood development, food safety, climate change mitigation |
Training duration | 2 months for basic training with monthly refresher training | 1 month of basic training with monthly refresher training | 18 days of basic training with monthly refresher training, provision of new knowledge periodically | Basic training over a 2-year period (initial 3 weeks of basic training followed by 3 days of basic training every 3 months for 2 years, and then monthly problem-based refresher training) | Same as in 2010–2019 |
Training content | Family planning, common ailments | Child health (prevention and treatment of diarrhoea, child survival interventions); WASH interventions; ANC, safe delivery, and PNC; adolescent family life education, nutrition supplementation | RMNCH, communicable diseases (TB, malaria), nutrition and IYCF (promotion of appropriate infant and young child feeding), dietary diversification, and micronutrients; eye care | RMNCH, NCDs, nutrition, eye care | RMNCH, NCDs, nutrition, eye care, mental health, early childhood development, food safety, climate change mitigation |
Training methodology | Pedagogy (face-to-face lecture-type learning) | Pedagogy (face-to-face, lecture-type learning) using printed materials, flip charts, and posters | Combination of pedagogy with participatory adult learning using audiovisual aids, simulation games, field placements, and clinical training in health facilities | Subject-based training with lengthy courses of up to 1 year in not duration; specialized training institutes are contracted to give courses | After in-person basic training, digital training is provided depending on skill needs; self-learning provided through a digital platform |
Impact | Public health orientation started in the country | Reduced numbers of diarrhoea deaths, reduced night blindness, improved child vaccination coverage, improved ANC coverage | Improved CPR, reduced number of child and maternal deaths, increased case identification and treatment completion of TB, reduced severe malnutrition among children | Use of clinical contraception improved, reduced number of child and maternal deaths, stunting reduced, improved access to treatment for communicable diseases and NCDs, improved access to eye glasses to correct refractive errors and to cataract surgery | Access to quality services improved |