A brief historical and present analysis of Health Education and Health Promotion Activities in Bangladesh

1. HEALTH EDUCATION AND HEALTH
PROMOTION ACTIVITIES IN BANGLADESH
Col Zulfiquer Ahmed Amin
M Phil (Healthcare & Hospital Management), MPH (Hospital Management),
PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)

2. Twenty years back, a pregnant woman in rural Bangladesh would
have gestated without any sort of maternal care; a newborn baby
would have been raised without any type of immunization.
Now, in Bangladesh, the infant mortality rate has declined from
9.7% live births in 1990 to 3.7% live births in 2011. 82.6% children
of age ≥12 months are now receiving all essential vaccinations
(Ministry of Health Bulletin, 2015). Along with other significant
attributes, health education and health promotion are a
significant contributor to this development.
INTRODUCTION

3. History:
In mid-April of 1958 a grave epidemic of smallpox and cholera took place in
East Pakistan. By the time the epidemic subsided, 30 million Bengalis were
vaccinated for smallpox, which was due largely to motivational approach for
vaccination; which was a precursor to its extensive role in the 1970s helping
WHO eradicate smallpox from Bangladesh.
In 1961, a pilot public health education research project began in Dacca
(Present Dhaka), East Pakistan, with the goals of developing educational
programs and research in educational methods in family planning.
In 1963, ‘Comilla Approach’, for community development to address social,
economical and health problems were undertaken.
The ‘Dacca Family Growth Study’ was implemented in 1964 to measure the
relative effectiveness of family planning education to men only, women only
and to both groups.
In 1967-68 in an cholera epidemic in the then East Pakistan, a controlled
cholera vaccine field trial was conducted, which needed drive to educate and
motivate people.
Caritas Bangladesh began in 1967 as Caritas East Pakistan with agenda of
health and nutrition; adolescents' health care; pro-life reproductive health
education.

5. The establishment of Community Health Clinics (CCs) in the rural
areas of Bangladesh has played a significant role in making a
huge change in public health through PHC and health education
since 1998.
In order to enable the vulnerable population of rural areas to
have access to basic health services, one community clinic was
established for every 6,000 people within each region. Currently
the program has provided access to basic services for almost all
the people of rural Bangladesh, with the establishment of 13,136
(As on June 2016) community clinics.
ROLE OF COMMUNITY CLINICS (CCs) IN HEALTH PROMOTION
Present Situation:

6. The major services include providing health counseling and health
education to fight communicable diseases and to create
awareness about hygiene and sanitation. Public health promotion
in Bangladesh through the community health clinics deserves the
attention of a critical analysis due to its profound influence in
modern Bangladesh as well as its global acceptance as a pro-
people public health program model.

7. m-Health (i.e. mobile-based health systems) tools are also being
utilized for health promotion and awareness. Non-government
agencies through health workers and information workers (e.g.,
Info-Ladies) promote basic health care information targeting
prevention and linking with health care institutions in case of
need.
- The Info Ladies bike hundreds of miles,
bringing laptop computers and internet
connections to thousands in impoverished
farming villages.
- Villagers can contact loved ones via Skype,
use social media like Facebook and find out
about government services.
- Vital service in a country where only five
million of 152m have internet access.
- Info Ladies also offer advice on health
matters and are trained to give blood tests.

8. Information and Education for Health (IEH) activities in the Health
and Population Sector began in 1998 when the Bureau of Health
Education was established under the Directorate General of Health
Services (DGHS) in the Ministry of Health and Family Welfare
(MoHFW).
The Bureau of Health Education has contributed significantly to the
health education and promotion of the people in Bangladesh.
BHE (Bureau of Health Education):

9. - Providing educational support to all national health programs
including Primary Health Care (PHC).
- Providing consultative services and technical guidance in
planning educational aspects of various health programs.
- Planning, implementing and evaluating the health education
aspects of various health programs.
- Developing health education human resources.
Functions & Responsibilities:
The Bureau of Health Education, Director General of Health Services (DGHS)

10. - Incorporating health education components in the training
programs of all categories of health personnel.
- Assisting in planning and implementation of the school health
education program.
- Planning and implementing the hospital and clinic health education
program.
- Designing and developing educational messages on different health
issues.

11. - Planning and developing mass health education programs through
radio, television and newspaper.
- Procuring and supplying health education materials and
equipment.
- Liaising and coordinating with development partners and NGOs in
the promotion and implementation of health education activities.
- Monitoring and evaluating national health education programs.
- Providing professional leadership in health education.

12. - Conducting orientation in health education for program managers
and health administrators.
- Developing educational materials for training as well as for use in
community health education programs.
- Conducting field studies and research on socio-cultural beliefs
that affect health behaviors.
- Coordinating and collaborating with international organizations
promoting health education programs.

13. 1. Model Village:
BHE has selected 128 villages throughout Bangladesh to serve as
models for healthy behavior and community mobilization. In each
Model Village, health education and promotion activities are led by a
Health Assistant (HA) in collaboration with a local Model Village
Committee. Model Villages work on health, family planning and
nutritional issues.
Programs under BHE:

14. General objective of the model village:
-To develop an area to serve as model area for application of
health education approaches with various methods and tools of
health education
-To enable the people of that area to solve their health
problems by their own action and efforts and
-To use that area as demonstration area of health education.
Geographic location and numbers
The model villages established in all 64 districts of Bangladesh.
Each district contains 2 model villages.

15. Approaches Activity
Target
Audience
Method
Community
Mobilization
Select Volunteers (1 for every 20 HHs) Villagers Selection
Develop awareness among the mothers
group with a special focus on lactating
mother and pregnant women
All Mothers
and
pregnant
women
Community
meeting
Awareness raise among the mass
villagers on Water and Sanitation,
environment, emerging and reemerging
diseases etc
Villagers Advocacy
Capacity
Building
Provide orientation /training to the
village volunteers on DM, ARI, PHC,
MCH, FP, Nutrition, Sanitation and other
communicable and non communicable
diseases
Village
Volunteers
Training
The Campaign Plan (Proposed by BHE)

16. Counseling
/Group
Discussion
Among married couple (both new
and old)
Married couples IPC
Among pregnant women and
lactating mothers
Mothers IPC
Among the adolescent group on
personal hygiene, physical and
mental change etc
Adolescent boys
and girls
IPC
School
Health
Education
Health education session at primary
school
School children
Community
Clinic
Outdoor health education session
at community clinic
Patients IPC

17. 2. School Health Education:
BHE promotes healthy behavior among students from an early age.
Health Inspectors and Health Assistants organize and conduct 1-hour
health education sessions at schools and madrasas on a monthly
basis.
For successful implementation of on going school health programs
of our country, ‘a School Health committee’ was formed in each of
the schools of 128 Model Health Education Villages with
representative from school teachers , local health field staffs,
guardians, local leaders, Chairman, Members, Imam & voluntary
organizations.
School Health Education programs are carried out by the MO, SI,
HI, AHI, and HA in Upazila, Union and village level.

18. 3. Develop and disseminate IEC/BCC Materials:
BHE produces and disseminates posters, flip charts, leaflets, TV spots,
newspaper advertisements and other IEC/BCC materials on various
health issues.
4. Health Education Resource Centers:
Resource Centers are located in district headquarters or in
Hospitals/UHCs in all 64 districts.
5. Sensitization:
Senior and Junior Health Education Officers and others organize
community education sessions at district hospitals; Upazilla Health
Complexes; Union Sub-Centers; Community Clinics; markets;
courtyards; and other places on various health, family planning and
nutrition issues.

19. 6. Creating awareness on emerging health issues:
In case of urgent health situations, BHE acts quickly to empower
people with knowledge and information, so that they can protect
themselves and their families.
7. Observing Health Days:
BHE leads the observation of World Health Day and other
important health-related events at the national and grassroots
levels.

27. AV-Van Show:
Innovative Enter-educative approach in FP-MCH program
through audio-visual shows to reach the unreached in
hard-to-reach/remote areas including slums in City
Corporation and Municipalities and thus, raise awareness.
"Enter-educate" approach, is the blending of popular
entertainment with social messages, to change health
behavior. The enter-educate approach spreads its
message through songs, soap operas, variety shows, and
other types of popular entertainment mediums.

28. Health Education in HNP- Related
Projects (1998-2003) and SWAps
(2003-2021)

29. Project name Duration HE Objective Financiers
Bangladesh First
Population Project
1975–80
Increase use
of FP and
MCH services
World Bank, Australia, Canada,
Germany, Netherlands, Norway,
Sweden and United Kingdom
Bangladesh Second
Population and
Family Health
Project
1980–86
Development
of national FP
programme
World Bank, Australia, Canada,
Germany, Netherlands, Norway,
Sweden and United Kingdom
Bangladesh Third
Population and
Family Welfare
Project
1986–91
Reduction of
fertility and
IMR
World Bank, Australia, Canada,
Germany, Netherlands, Norway
and United Kingdom
Bangladesh Fourth
Population and
Health Project
1992–98
Reduction of
fertility and
IMR,
improvement
of MCH
World Bank, Australia, Canada,
Germany, Netherlands, Norway,
Sweden, United Kingdom and
European Union.
Major HNP-related projects in Bangladesh, 1975–98
(With HE Components)

30. Program
name
Duratio
n
Fund (GOB
contribution)
Co-financiers Key Agenda
Health and
Population
Sector
Program
(HPSP)
1998–
2003
US$ 2.2
billion (62%)
World Bank,
Canada,
Germany,
Netherlands,
Sweden,
United
Kingdom and
European
Union
•Comprehensive
Reproductive Health.
•BCC
•Essential service package
•Reorganization of service
delivery
•Integrated support service
•Hospital level services
•Sector-wide management
Health SWAps in Bangladesh, 1998–2014

31. Health,
Nutrition and
Population
Sector Program
(HNPSP)
2003–11
US$ 5.4
billion
(67%)
World Bank,
Canada,
Germany,
Netherlands,
Sweden,
United
Kingdom,
European
Union and
UNFPA
•Essential service delivery
•Communicable disease control
•Improved hospital services
management
•Procurement, logistics and
supplies management
•Family planning service delivery
•Pre-service and In-service
training
•Improved financial management
•Human resource management
•Policy reforms
• Health Education & Promotion
Program
name
Duration
Fund (GOB
contributi
on)
Co-
financiers
Key Agenda

32. Health,
Population
and Nutrition
Sector
Development
Program
(HPNSDP)
2011–16
US$ 7.7
billion
(76%)
World Bank,
Canada, Sweden,
Australia, United
Kingdom, Germany
and United States.
•Expanding the access and
quality of MNCH services.
•Strengthening of various
family planning interventions
to attain replacement level
fertility.
•Strengthening preventive
approaches as well as control
programs to communicable
diseases and non
communicable diseases.
•Strengthening support
systems and increasing health
workforce at all levels.
•Improving MIS with ICT and
establishing M&E system.
•Pursuing priority institutional
and policy reforms.
•Health Education &
Promotion (HEP)
Program
name
Duration
Fund (GOB
contributi
on)
Co-financiers Key Agenda

35. 174
32.9
23.3
36.4

36. Bangladesh in recent years has experienced some severe effects
of climate change. The destructive paths left by Sidr and Aila are
just to begin with. But other natural disasters like flood and
draught are also having their drastic effects throughout the years
in the lives of the people of Bangladesh. CCHPU established in
2010.
Goal of the Unit:
To build capacity and strengthen health systems to combat the
health impact of climate change and to protect human health
from current and projected risks due to climate change.
(CCHPU)

37. Objectives of the Unit:
(1) To coordinate all Health Promotional activities of Intra and Inter
Ministerial initiatives.
(2) To increase awareness of health consequences of climate
change;
(3) To strengthen the capacity of health systems to provide
protection from climate-related risks through e-Health and
Telemedicine;
(4) To ensure that health concerns are addressed in decisions to
reduce risks from climate change in other key sectors;
(5) To conduct research, evaluate and monitor program related to
health promotion and climate change;
(6) To coordinate emergency medical services and school health
promotion to reduce health hazards during disasters and
emergencies.

38. Health, Nutrition and Population Strategic Investment Plan (HNPSIP ) (2016-2021)

40. Bangladesh’s first national comprehensive social and behavior
change communication (SBCC) strategy for its Health, Nutrition
and Population (HPN) sector was officially released on August 30,
2016.
The event was organized with technical assistance from
Bangladesh Knowledge Management Initiative (BKMI). BKMI is
jointly implemented by USAID’s global Health Communication
Capacity Collaborative (HC3) – based at the Johns Hopkins
Center for Communication Programs (CCP) – and the Bangladesh
Center for Communication Programs (BCCP).
Comprehensive SBCC Strategy for Health, Nutrition and Population

41. -Deutsche Gesellschaft für Internationale Zusammenarbeit, the German
Federal Enterprise for International Cooperation
-Integrated Environmental Management (IEM)
-Sustaining Health Outcomes through the Private Sector (SHOPS)
Mattra, a new generation advertising agency of BangladeshVISION:

42. NGOs and International Organizations
involved in Health Education and
Health Promotion in Bangladesh

43. 5. Grameen Bank
6. ASA
7. PROSHIKA
8 HEED (Health, Education and Economic development)
9. CARE
10. OXFAM
11. PLAN
12. Save the Children Fund
13. WHO, USAID & Others

44. WHO current collaboration
-Development of guidelines and standards to establish National
Health Promotion foundation.
-Establishment of model health promoting schools and youth
training centres.
-Development of National Communication Strategy and Plan of
Action to reduce NCD high risk behaviours.
-Capacity building on health promotion through training, and
facilitating establishment of Health Promoting Upazila.
-Development/updating of curriculum on diet, physical activity
and tobacco.
-Raise mass awareness through supporting various campaigns,
websites and observance of important days.

45. -Chicago-Based ZF Spreads Health Education in Bangladesh:
Zakat Foundation, a Muslim nonprofit humanitarian organization,
shares education with the world. Bangladesh is one of many projects.
WorldShare:
Through Bangladesh partner's integrated program of education
health training, and income development activities, the project assists
girls in Pallabi, a slum area of 300,000 people. WorldShare is
supporting the ‘adolescent health, safety and HIV/AIDS’ part of their
program.
HEED Bangladesh is a National, non-profit making voluntary
organization, registered with the Government of Bangladesh in
October 1975. 'HEED' stands for 'Health, Education & Economic
Development'. It is committed to provide Health Education and
Health Promotion activities to remote areas in Bangladesh.

47. The Government of Bangladesh and UNICEF have identified
the need to ensure better health awareness and practices
from an early age. To support this process the Directorate of
Primary Education (DPE) and UNICEF collaborated on a 2008
survey to identify the current status and future needs of the
School Health and Nutrition program in Bangladesh’s primary
schools.
A health initiative entitled Water Sanitation and Hygiene
project (WASH) was developed by CARE-International,
Bangladesh as a relief effort after the devastating 1991
cyclone in Bangladesh. WASH focused on the repair of
damaged water sources, construction and supply of hygienic
latrines, hygiene education component that focused on
drinking safe water , the installation and use of latrines , and
hand washing.

48. WASH & Nutrition | WASHplus
Integrating Water, Sanitation, and Hygiene
into Nutrition Programming.

49. Gates educational framework: A multi-media sanitation and
hygiene intervention for children and their caregivers
• Funded by the Bill and Melinda Gates Foundation
• To promote positive behaviors related to sanitation and
hygiene among children ages 3 to 7 years and their caregivers
in low-resource communities in Bangladesh
• Provides critical messaging on using the latrine, wearing
footwear when defecating, promoting hand-washing to break
the oral-fecal route of disease transmission, safe water
collection and purification practices, and improved waste
disposal practices.
• Project includes both mass media and community and school-
engagement components

51. Use of Mass- Media:

52. The economic and demographic transition in Bangladesh is
increasingly causing adverse effects on both health and wealth
of the population. High consumption of tobacco, changes in
eating habits, increasing substance abuse, lack of physical
activity and mushrooming of unregulated food and beverage
industries are behind this increase.
Communication channels, both electronic and print, are
channeling information for public consumption. Children are
being appraised by information inclusion in the school
curriculum. In spite of all these measures health promotion is yet
to gain the desired momentum, and this is due to dearth in
resource allocation in this area. Taking precedence from other
counties, use of dedicated taxes (from alcohol and tobacco) for
health promotion could be a sustainable solution.