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BRACs Tuberculosis ProgramPioneering DOTS Treatment for TB in Rural Bangladesh By- POWER WALL
FRAMEWORK Situation AnalysisConflict StrategyManagem Formulati ent on BRAC Strategic Strategic Control Implemen tation
OVERVIEW• Bangladesh is bordered by India on all sides, Burma (Myanmar) on the southeast and the Bay of Bengal to its south.• 7 administrative divisions• Divisions are subdivided into districts (zila). There are 64 districts in Bangladesh, each further subdivided into upazila (subdistricts) or thana.• Highest Population Density in 2001• 240,000 km roadway- 90% unpaved
HEALTH PROFILE• Tuberculosis Prevalence – 391 Per 100,000 People (2006)• Maternal Mortality Ratio – 570 per 100,000 Population (2005)• Infant Mortality Rate – 43 Per 1000 Population(2008)• HIV prevalence – 100 Per 100,000 population (2005)• Malaria Cases – 19 Per 1,000 People (2006)
HEALTH DELIVERY SYSTEM• Four Tier System - Village ( Quacks, Other informal Health care Provider ) - Union ( 1362 Sub centres ) - UpZilla ( Sub district ) – 460 Upzilla Health Complexes - Zilla ( District ) – 59 Districts Hospitals• There are 7 specialized Hospitals• Physician density-3 per 10,000• Nursing density- 3 per 10,000• Hospital beds- 4 per 10,000
EXTERNAL ANALYSISSOCIAL ECONOMIC53%- literacy rate (Bangladesh) GDP per capita in PPP(07)- 117850% - Poverty rate,BPL Population-5 million Government expenditure on health-Female population restriction from working outside 7.2% (07)Social Myth & wrong belief about TB International donor agenciesMyth about government and private facilities Inflation200 million TB patients registered every yearglobally- 3,40,000 in B’deshReduced access to healthcare-women Dual Infection of TB-HIVPOLITICO-LEGAL TECHNOLOGICAL Stability of government- National TB programme Information & CommunicationInternational relations- World Bank, WHO support Technology-E-health, mhealth,Tax laws Telemedicine advances for diagnostic andLabor laws Treatment Electronic Health Records
INTERNAL ANALYSISMARKETING OPERATIONSTie up with private practitioner and Smear positive- approachmedical colleges Research and evaluation divisionTie ups with garment districts- exportprocessing zonesIndividual factory ownersPrisonsHUMAN RESOURCE FINANCE Involving traditional doctors and mid Government Fundingwives with social legitimacy Global FundShasthya sebika program 10 % profit margin for volunteersPerformance based incentivesTraining programs
SWOT ANALYSIS STRENGTHS WEAKNESSESCommunity based delivery system Drop outsVillage health volunteers-shasthya Loss to follow upsebikas Case detection rateUnique incentives Understanding of DOTS administrationOwned Laboratory facilities by shebikasReferral Linkages Lack of human resourceBond System Low success rate in womenStandardisationBRAC-NTP partnershipFinancially stableOPPORTUNITIES THREATSSupport of Govt. policies Socio-cultural barriersMore service delivery points Geographic inaccessibilityCatchment area- 30 million people Resistance from district level officialsMDR-TB diagnostic lab Duplication of programmeQuality assurance centersCapacity BuildingAwareness programs
STRATEGIES1) Related Diversification Laboratories Doctors Group Chest Clinics Home based Care Ambulatory Care2) Market Penetration Awareness campaigns Art workshops
Space profile for BRAC’s Tuberculosis in Rural Bangladesh 5 financial strength 0, 4.3 4 Aggressive Profile 3 2 industry strengthcompetitive 1 advantage 0 -3 -2 -1 0 1 2 3 4 3.44, 0 -2.25, 0 -1 -2 0, -2.2 -3 Environmental stabilityAn organization whose financial strength is a dominating factor in the industrysegment
Strategic Alternatives for Aggressive profiles Related diversification Vertical Integration Product development Market Development
VISIONBRAC’s Vision is to make sustainableimprovement in the quality of life for thepoor by working with the community andfocusing on increasing autonomy.
MISSIONBRACs mission is to work towards Preventionand Treatment of Tuberculosis by providingstandard and sustainable services which areaccessible and affordable
GOALThe Goal of BRACs is to Combat HighPrevalence of Tuberculosis.
OBJECTIVES• To this model 50% self sustainable by the year 2000• To Make 14 million women learn How to make ORS by the year 1990.• To Train village Health volunteer to Provide basic diagnostic and curative services• To reduce the prevalence of Tuberculosis in Bangladesh to 300 per 100,000 population by 2005• To increase the number of Shasthya Sebika to 70000 by the year 2007
• To work in conjunction with Government for Tuberculosis programme .• To increase the case detection rate to 90 % by the year 2007.• To increase the treatment success rate to 95% by the year 2007.
Strategic ControlFrameworkInvolve Think TankEstablish standardsMeasure and compare performanceDetermine reasons for deviationCorrective action
Conflict ManagementInterpersonal conflict- Due to miscommunication, Intense work , overlapping tasks , compensation.Solution-By clearly defining job responsibilities with least overlapping of tasks. Proper mode of communication
Who moved my cheese?• Abreast with Technology- ICT• Slow continuous process• Simulation Exercises