The Status of Community Based Health Workers in Rural Bangladesh: Executive Summary

Introduction

Bangladesh has made tremendous strides in maternal and child health over the last thirty years. Still more than 7,300 mothers and 113,884 newborns died in Bangladesh in 2008 mainly due to inadequate care around the time of childbirth (1). The country does not have enough skilled birth attendants and 73% of deliveries occur at home without proper assistance. About half of the neonatal deaths occur in the first day of life and about three quarters in the first week, mostly from preventable causes. In addition, Bangladesh has one of the world’s highest malnutrition rates, and coverage for treatment of common diseases is low.

Studies have shown that home-based newborn care interventions can prevent 30–60% of newborn deaths in high mortality settings under controlled conditions. Therefore, WHO and UNICEF now recommend home visits in the baby’s first week of life to improve newborn survival. Community health workers (CHWs), especially those trained in essential newborn care (ENC) can save the lives of children. In a Joint Declaration entitled “Home visits for the newborn child: A strategy to improve survival”, the WHO and UNICEF focused on the need for health workers trained in essential newborn care. The Joint Statement recommends home visits by workers trained in essential newborn care in the first week of a baby’s life to improve newborn survival. ENC is comprised of very simple behaviours and practices for all newborns (e.g. thermal/hygienic care, breastfeeding, etc.), that can easily be implemented at home. ENC is included in the National Neonatal Health Strategy, and integrated into Bangladesh’s recent Health Population and Nutrition Sector Development Program 2011 – 2016.

Maternal and neonatal health statistics show that there is a need for more health workers serving their local communities across Bangladesh, but there has never been a clear picture of how many community health workers there are in Bangladesh, who deploys them and in which areas. The report which accompanies this Executive Summary, entitled “The Status of Community Based Health Workers in Rural Bangladesh” is a first step towards identifying the number of rural community health workers in Bangladesh and providing data on those trained in essential newborn care. It provides data on the number of workers and identifies them by type. The report includes breakouts for government and non-government workers and identifies those funded by large time-bound programs (i.e. large-scale, government supported mother and child health programs) in addition to routine and sustained community-level workers. Above all, the goal of this report is to identify needs in rural Bangladesh, to aid the Government of Bangladesh (GoB) and donors in future program planning to reduce maternal and newborn mortality.

The report findings are based on secondary data analysis. The Ministry of Health & Family Welfare (MOH&FW) has endorsed this data collection process which relied entirely on the cooperation of the GoB, non-governmental organizations (NGOs) and other stakeholders. The focus was on rural, community-based health workers; urban areas have not been included. Trained ENC workers in this analysis are defined as those health workers receiving a minimum 2-day ENC training, often part of more comprehensive training. The analysis did not include volunteers or untrained community mobilizers as CHWs.