1. Empowerment of women through Football and Cricket : Dr Mark Newcombe-
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Country: Bangladesh
Challenge: The health system of Bangladesh must continue to develop
innovative health interventions that empower women and girls promoting
gender equity and health outcomes.
Solution: Sporting programs focused on young women and girls at primary
and secondary school that are directed by a community healthcare approach.
A health system consists of all organisations, people and actions whose
primary intent is to promote, restore or maintain health. (WHO).
Challenge:
The reduction of gender inequality has been the corner stone of development
in health outcomes for women and children in Bangladesh. (1) Its health
system has been described as innovative, pluralistic and paradoxically
successful. (2) The empowerment of women and girls continues despite
cultural and religious opposition as well as widespread poverty and slow
economic development. (3)
The real challenge for this fledging health system is to sustain past
successes and to grow and foster new and existing partnerships in order for
its post Millennium Goal development to progress towards universal health
coverage. Gender equity is a key to this progression. Bangladesh must
continue to empower its female population and utilise them as a health and
economic resource. (2) By nurturing its previously successful community
healthcare approach and investing in future inventive programs as part of its ‘
culture of ambitious experimentation ‘ Bangladesh can continue to change the
worlds view of health system development in LMIC and maintain its current
momentum. (4)
BRAC (Bangladesh Rural Advancement Committee) is one of the largest and
most successful NGO’s in the world playing a dominant role in health
development across South Asia. (2) They work closely with government and
donors whilst employing hundreds of thousands of CHW (Community
healthcare workers) across all 64 districts. They share a common goal, a pro-
poor approach that educates the poor so they can inturn help themselves. (5)
Their CHW have become a unique tool that are adaptable and will suit the
challenge at hand. (5)
Female CHW have been involved in programs that have seen infant and child
mortality rates reduced dramatically and immunization coverage improved
significantly. Thirteen million mothers were taught over 10 years to prepare
and administer ORT (Oral Rehydration therapy) useful as both a prevention
and treatment of diarrhea disease. (5) Sixty-six million people gained access to
water and sanitation and over 33 million women have been empowered
through micro finance and family planning. Women are actively employed in
government departments and private enterprise. The approach has been bold
and multi sectorial. (5)

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The World Bank’s IDA (International Development Agency) and UNICEF in
combination with government and BRAC have been running a female school
student assistance program. (9) Through the provision of a tuition stipend for
female students, improvements in teacher training and better school facilities,
remarkable results have been achieved. In 2013 Bangladesh’s development
indicator for girls enrolled in primary school was measured at 92.3% the
highest for any country in South Asia. (6)
Gender parity data shows more girls attending primary and lower secondary
school than boys. (6) World Bank data released in 2013 showed maternal
mortality has fallen from 550 per 100,000 in 1990 to 170 in 2013. (5) The
literature suggests this is due to innovative programmes aimed at empowering
women and sustainability is essential for continued success in health
outcomes. (1-5)
Financial incentives have demonstrated that cultural and religious attitudes
can be changed .The enrolment of girls over 17 increased by 67%, pass rates
improved by 23% and over 33,000 teachers were trained. (9)
Paradoxically in Bangladesh 33% of women aged 15-49 were married before
the age of fifteen. (9) Women and girls are still subject to gender violence in
various forms. (7) Cultural and religious beliefs restrict their behaviour and their
movements as many are expected to undertake ‘Purdah” a religious practice
which requires women to cover their bodies in public and avoid being seen by
males who are not directly related to them. (8)
Implementation of new programs that promote cultural change and religious
compromise are essential.
The solution can come from reflecting on past success in education
interventions. Empowerment programs aimed at girls and young women while
they attend primary and secondary school.
Sport as a tool for increasing gender equity is a relatively new concept that
promises to produce tangible development benefits not only for the girls and
their families but also for future generations. (10) Sporting programs aimed at
prepubescent girls in primary schools and post pubescent girls in secondary
school have the potential to not only improve their health and wellbeing
through exercise, but to improve their self-esteem, social inclusion,
integration, leadership as well as encouraging peer friendships by teaching
them team work. (10) Sport has been shown to improve the physical and
mental health of women and girls by assisting in NCD prevention and issues
associated with gender violence and self-confidence. Sporting programs can
act as a platform on which important health and social messages can be
communicated to both boys and girls especially those associated with
reproductive and sexual health. (18)
Sport as an empowerment intervention has been tried in a number of
programs globally and continues to produce encouraging results. (10) It has
been shown to change gender norms and improve access to public space for
both women and girls. (10)

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A number of successful programs will need to be carefully scrutinized in order
to develop the right solution.
CARE-Bangladesh ran a sport project from 2008-2011 called ITSPLEY
(Innovation through sport promoting leaders empowering youth) a US Aid
funded program built upon a previous youth program ARSHI (the adolescent
reproduction and sexual health initiative). Both projects were based on
CARE’s gender empowerment framework. (11)
UNICEF partnered another with BRAC from 2001-2010 establishing the ADP
(Adolescent Development Program). This was aimed at 550,000 girls and
50,000 boys (“Kishori Abhijan”) aged between 14-19 years they operated out
of community centres and schools. (12) The goal of the program was to
produce a safe place for adolescent girls to develop socially within their own
communities. Initial consultation with community and religious leaders as well
as parents and families went for two years before BRAC was able to change
opinion and begin the program. The program included three ultra conservative
districts Cox’s Bazar, Chandpur and Sylhet .The program was sold on its
health benefits and the possibility of economic independence for the girls. The
entire community was involved in the process. The ADP successfully
developed 40 cricket and 37 football teams across forty districts. The sporting
goal was to pick 18 elite players from around 1500 hopefuls who attended
trials in each district. (12) The health system goal was to empower all the girls.
In Cox’s Bazar the response from a once strongly opposed community was
very encouraging when evaluated post program. (12) Girls were seen as
healthier and stronger and more able to protect them selves against gender
violence. Fathers were more involved in their daughter’s lives, actively helping
them with their chosen sport. Girls were less isolated having developed more
friendships with peer groups. (13)
Girls would wear their traditional ‘Borkha’ to and from practice and games with
their sporting cloths underneath. They removed it to play. This was a
significant change in cultural behaviour.
Playing sport was shown to make girls more careful and curious about their
bodies and inturn receptive to information about reproductive health
messages that were built into program goals. (14)
The BRAC program utilised national level coaches with the girls competing for
elite positions only. (11) New solution programs need to concentrate on the
non-elite athletes. These girls need to be placed teams at a school level within
a regional competition. Alternatively team could be formed within villages or
groups of villages and then played off against each other fostering a healthy
rivalry between villages or schools.
Cricket and Football are immensely popular sports throughout South Asia and
Bangladesh is no exception. Both are an integral part of the countries culture.
Both games can be played as an indoor and outdoor form. Indoor sport
presents the interesting prospect of girls playing sport but not in public.

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The ADP is currently training female coaches for their elite teams using
coaches from the national level. WW (Women’s Win) supports this attitude in
their successful AKWOS program. (20) They believe only female staff will
produce protective, safe areas and suitable role models. Women’s Win is also
involved with NUK (Nari-Uddug-Kendra) a research based organisation that is
helping the government improve gender training for leadership positions as
well as generating appropriate gender friendly sports policy for schools. (21)
A new solution program requires a change of direction. Successful
community sports programs require the support and involvement of the whole
community. (13) The production of a large numbers of school or community
teams will involve many more children than previous programs. Utilisation of
community resources in the form of teachers, mothers, fathers and older
sisters is needed to produce the team coaches, managers and referees and
umpires. (19) Boys should not be excluded from the program for their
involvement along with their fathers is critical for a community health care
approach. Sport should be a family affair and programs must be community
based. (19) Elite athletes can still be passed onto national teams but the
concentration needs to be maintained on the others. Safety can be self-
generated through family and community monitoring.
It may be possible to call on BRAC’s army of CHW (Shasthyo Sebikas) to
become involved for an additional stipend. They are well established and
respected at a local level and they are already present in all 64 districts
especially in the poorest communities. (5) When working for new solution
programs the CHW would change hats to become CSFLW (Community Sport
for Life Workers). (11)
For a sports solution to succeed the most important factor may well be the
support of the well-respected national male and female cricket and soccer
teams. The male population love their sporting hero’s, the words of the
famous may well be enough to sway stayed community attitudes and gain
support from even the most difficult opponents. Well-known western
sportsman could also be approached for support. (16) Sports stars are national
heroes yet they are just mothers and fathers, sons and daughters and their
support for a new solution program may be readily obtainable.
The “Kishori Abhijan” project run by UNICEF and BRAC funded buy the
European union is another project aimed at girls in Bangladesh. It has already
established 2860 adolescent centres in 28 districts. The main focus is girls but
boys are also involved in building self-esteem, confidence and life skills. They
have established training facilities for peer educators and adolescent leaders.
A small sporting component has been developed into this project involving
about 2000 adolescents. (15) This project has potential as a partner to “piggy
back” the new solution.
Global sporting women has partnered with ESPN and WW and is another
organisation bringing sport to girls in Bangladesh, they influential as the first
international organisation with the sole focus of providing support for

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innovative sport and physical activity programs for empowerment and creating
social movements around sport for the advancement of women’s rights. (17)
Evaluation
Goals must be set in program or project design and then assessed upon
completion.
A systematic and analytical approach to evaluation requires the collection of
appropriate qualitative and quantitative data within internal or external
assessment. The impact on everyone involved will need to be assessed by
identifying accelerators, inhibitors and success factors. (11) The experience of
previous programs could be utilised to design evaluation methods.
External:
CARE–b chose to use external auditors Miske Witt and Associates Inc.
(MWAI) to evaluate the ITSPLEY project.. (11) MWAI used five independent
consultants who compared data from schools and community sites that were
or were not involved in the program. They assessed the attitudes of girls and
boys based on a number of issues including exercise, leadership, ambition
and safety. The results showed that the girls were very concerned with
community attitudes and were very pleased by changes in these attitudes. (11)
Girls showed an increase in confidence and improved peer support. Boys
were quoted as having the opinion “let them play” The program model and
data collection were considered very strong but underutilised. They
demonstrated that the small involvement of boys in sporting activities with
girls should be increased as the boys were reported as desiring active
involved and the girls agreed. (11)
Internal evaluation protocols can be built into the solution program’s
framework. Base line measurements could be taken before the program
begins, perhaps during the initial consultation phase. Results could then be
measure periodically during the term of the program. If the program is
sustainable then the results should be tabulated annually.
Qualitative assessment through observation, questionnaires and interviews
and focus groups are all legitimate methods for data collection and should be
used appropriately. Quantitative data on participation, drop out budgeting
require collection. Assessment of sustainability is essential.
Continuous evaluation could utilise local Shasthyo Sebikas observing
conducting interviews with women and girls and their families as well
assessing community attitudes while the program is running.
Evaluation of the impact of important social messages incorporated into the
program can be assessed appropriately with any of these methods.

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Acronyms:
AKWOS- Association of Kigali women in sport
ADP –Adolescence Development Program
ARSHI- the adolescent reproduction and sexual health initiative
BRAC – Bangladesh Rural Advancement Committee
CARE- Cooperative for Assistance and Relief Everywhere
CHW- Community Healthcare Workers
CSFLW- Community Sport For Life Workers
CMES-Centre for mass education
ESPN- Entertainment and Sports Programming Network
ITSPLEY- Innovation through sport promoting leaders empowering youth
IDA –International development scheme (World Bank)
LMIC- Low-middle income country
MWAI- Miske, Witt and Associates
NCD- Non communicable Disease
NGO – Non-Government Organisation.
NSC- National Sports Council
NUK- Nari Uddug Kendra
NWSF- National Women’s Sports Federation
ORT- Oral Rehydration Therapy
UNICEF- United Nations International Children’s
WHO- World Health Organisation
WW-Women Win
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football
“Sport is a natural partner when it comes to realising the agenda that will
guide global development goals over the next fifteen years”
Thomas Bach (IOC president)