1. BRACs Tuberculosis Program
Pioneering DOTS Treatment for TB in Rural Bangladesh
By- POWER WALL

2. FRAMEWORK
Situation
Analysis
Conflict Strategy
Managem Formulati
ent on
BRAC
Strategic Strategic
Control Implemen
tation

3. 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

4. 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)

5. 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

6. EXTERNAL ANALYSIS
SOCIAL ECONOMIC
53%- literacy rate (Bangladesh) GDP per capita in PPP(07)- 1178
50% - 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 agencies
Myth about government and private facilities Inflation
200 million TB patients registered every year
globally- 3,40,000 in B’desh
Reduced access to healthcare-women
 Dual Infection of TB-HIV
POLITICO-LEGAL TECHNOLOGICAL
 Stability of government- National TB programme Information & Communication
International relations- World Bank, WHO support Technology-E-health, mhealth,
Tax laws Telemedicine advances for diagnostic and
Labor laws Treatment
Electronic Health Records

7. INTERNAL ANALYSIS
MARKETING OPERATIONS
Tie up with private practitioner and Smear positive- approach
medical colleges Research and evaluation division
Tie ups with garment districts- export
processing zones
Individual factory owners
Prisons
HUMAN RESOURCE FINANCE
 Involving traditional doctors and mid Government Funding
wives with social legitimacy Global Fund
Shasthya sebika program 10 % profit margin for volunteers
Performance based incentives
Training programs

8. SWOT ANALYSIS
STRENGTHS WEAKNESSES
Community based delivery system Drop outs
Village health volunteers-shasthya Loss to follow up
sebikas Case detection rate
Unique incentives Understanding of DOTS administration
Owned Laboratory facilities by shebikas
Referral Linkages Lack of human resource
Bond System Low success rate in women
Standardisation
BRAC-NTP partnership
Financially stable
OPPORTUNITIES THREATS
Support of Govt. policies Socio-cultural barriers
More service delivery points Geographic inaccessibility
Catchment area- 30 million people Resistance from district level officials
MDR-TB diagnostic lab Duplication of programme
Quality assurance centers
Capacity Building
Awareness programs

9. TOWS MATRIX
Internal strengths Internal Weakness
+ +
External Opportunities External Opportunities
16 13
External Threats External Threat
+ +
Internal Strengths Internal Weakness
13 10

10. STRATEGIES
1) Related Diversification
 Laboratories
 Doctors Group
 Chest Clinics
 Home based Care
 Ambulatory Care
2) Market Penetration
 Awareness campaigns
 Art workshops

11. Space profile for BRAC’s Tuberculosis in Rural Bangladesh
5
financial strength
0, 4.3
4
Aggressive Profile
3
2
industry strength
competitive
1
advantage
0
-3 -2 -1 0 1 2 3 4
3.44, 0
-2.25, 0 -1
-2
0, -2.2
-3
Environmental stability
An organization whose financial strength is a dominating factor in the industry
segment

12. Strategic Alternatives for Aggressive
profiles
Related diversification
Vertical Integration
Product development
Market Development

13. VISION
BRAC’s Vision is to make sustainable
improvement in the quality of life for the
poor by working with the community and
focusing on increasing autonomy.

14. MISSION
BRACs mission is to work towards Prevention
and Treatment of Tuberculosis by providing
standard and sustainable services which are
accessible and affordable

15. GOAL
The Goal of BRACs is to Combat High
Prevalence of Tuberculosis.

16. 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

17. • 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.

18. Strategic Control
Framework
Involve Think Tank
Establish standards
Measure and compare performance
Determine reasons for deviation
Corrective action

19. Conflict Management
Interpersonal conflict-
 Due to miscommunication, Intense work
, overlapping tasks , compensation.
Solution-
By clearly defining job responsibilities with
least overlapping of tasks.
 Proper mode of communication

21. Who moved my cheese?
• Abreast with Technology- ICT
• Slow continuous process
• Simulation Exercises