Concern Worldwide's Child Survival Program has revolutionized maternal and child health by utilizing established local leaders to spread knowledge throughout the communities about how to access hospitals and healthcare. It has laid a foundation within the community and with local actors that is saving lives on a grassroots level.
In the backstreet of a slum in the north of Bangladesh, children play the chicken game. They hop and kick a stone for as long as they can without falling over. Nothing unusual here, except if it wasn't for a groundbreaking health program from Concern Worldwide these children wouldn't be alive. In Bangladesh, one in every dozen children dies before school age. But the odds against surviving are even worse in the most deprived areas of the overcrowded cities. Here almost one in seven young children die because health care just doesn't reach the majority of those living in absolute poverty. That's what Concern Worldwide is changing. Ten years has been spent developing the Child Survival Program, and it's transforming healthcare for some of the world's poorest people.
Concern Worldwide (U.S.) INC. Child Survival: Reaching the poorest women and children
Saving the lives of children means aiming the program at pregnant women, mothers, and babies too. And in the areas where the project is working it's significantly reducing what had been a very high death rate in childbirth and the first five years of life.
DR. YEASMIN CHANDANA [Maternity Unit]
I've been working for 22 years, and fewer children are dying. The number of neo-natal deaths and the infant mortality rate has decreased from previously.
So how's it being done? Remarkably Concern isn't actually treating anyone, or providing the medicines and equipment in the way that most development projects work. New ground is being broken with a completely new approach: investing time, expertise and encouragement to persuade communities in this part of Bangladesh to improve healthcare for themselves.
When the program first started, we looked at where the poorest people were going for advice related to health services. They weren't going to the doctors; they weren't going to nurses. They were going to homeopaths, local pharmacists, and mother in laws. So the program really starts by working with them.
Concern is working with leaders in religion and politics. This is Friday Prayers, and the Imam is about to give health advice, passing on what Concern has encouraged him to learn. The project has reached into the very heart of the life of the region.
MOHAMMED ZOBAYER [Imam]
Before I got training from the program, the lives of mothers and babies were very much at risk. They often died. In those days, when they came to me for help I would simply give them Holy Water. They would drink it and we believed it would be enough. Now we're all aware of what needs to be done.
The project has taught those who've traditionally been the first port of call for the sick what medical help is available and how to send people to get it.
DR. ALI AHMED KHAN [Homeopath]
Concern in Bangladesh gave me three days training. They invited all the homeopaths when they started the program here. They covered things like vaccinations, pneumonia, and diarrhea in babies. It has really helped a lot. Now when people come to me with diarrhea or pneumonia I treat them, but if they aren't better quickly I send them to hospital with a letter. They are admitted swiftly and lives are saved.
Here's another life saved. Facilities in this hospital are limited but this boy is getting treatment for pneumonia, which has been one of the biggest killers. And he's getting help because a homeopath sent him here. The community has been mobilized with an army of health volunteers, a network of people like Jasmine who go from home to home offering advice. They've been given training by instructors who were trained by Concern, and it means mothers are being reached too.
JASMINE AKHTAR [Health Volunteer]
I've been given a lot of training. How to care for mothers and babies better, how to treat the conditions that mothers and babies suffer from, basic health messages for the mothers, such as keeping the baby safe and keeping them and their things clean. We were also given training on diarrhea, cholera, birth control and vaccinations.
RAHENA BEGUM [Mother]
Two days before my baby was due I was bleeding and in pain. I rang Jasmine on her mobile and asked her for help. It was midnight, but she came. Jasmine arranged everything, and within an hour I was in hospital. I needed blood and I had the baby at half past one. If it hadn't been for the program I would have been in serious trouble. My life was in danger. But because of the program I got the help I needed.
Before the program began a lot of mothers and babies died in pregnancies like this. Before this, people didn't go to hospital to get help. The death rate has fallen since we started work. People are more aware about children and mothers' health.
The youth have been engaged too. This play about polio encourages vaccinations against preventable diseases, promotes healthy and safe pregnancies, and gives advice on good hygiene. The local Ward Health Committee organizes them, groups of the great and the good set up throughout the cities. They are the champions of the Child Survival Program, pushing for more and better healthcare.
SHAHEEN AKHTAR [Councilor, Saidpur]
This is our commitment to the community. It's now in my manifesto that the healthcare system must be improved. I promised that if they gave me the opportunity I would be a good leader. The budget for healthcare is now more than it was before the project began, but it's still not enough. We need to spend more.
That growing commitment to providing free or affordable healthcare to the poorest people brings clinics like this, providing tests, medicines and supplements to pregnant women and helping mothers-to-be and unborn children alike. It's a direct result of Concern Worldwide's work here without actually being provided by Concern. And that's the beauty of this bold new approach -- it increases the number of people Concern's work can reach with limited resources.
Twenty years ago, Concern was basically running a clinic right here in this building, it was a clinic designed for the slum population. Our staff was nurses, doctors, and educated people who were out doing outreach work. Basically Concern closed this clinic and said, "Aren't there other ways to help the poorest people access health services? It's great we're working here in this one city but there's over three hundred cities in Bangladesh so what kind of impact are we having, how long is it going to last?" So our staff, who were very used to providing services themselves, all of a sudden were in a position where they had to encourage political leaders, teachers, pharmacists, homeopaths, health volunteers, and get them to come together and talk about health, get them to advocate to the mayor's office to allocate more resources. So that was a major change.
IZAZ RASUL [Program Manager, Concern Worldwide]
A lot of talking, a lot of explaining, and a lot of time spent on talking to these people to help them understand why they would invest their time for health, how their investment would bear fruit in the future, what they can expect from this project, what would be their role. So we had to spend a lot of time explaining all these aspects.
DEWAN KAMAL AHMED [Mayor, Nilphameri]
Back them I wasn't concerned about providing healthcare, it wasn't my headache. But when I saw what they were doing in Saidpur, the next municipality to us, where they were already running the program, the idea came to me too. Now my heart and soul are in this program.
The idea began here, in the bustling town of Saidpur in the north of Bangladesh in 1998. There were trials here and in Parbatipur for five years and was such a success that Concern wanted to see if it could be used elsewhere. So for five more years it's been tried in another seven urban areas. But before handing them over entirely to the people involved, Concern has carried out research to see how well it all worked and how to transfer the idea right across this country and into others too. The results are just what Concern dreamed it would see.
Child Survival Program Achievements: Reached one million people, antenatal care dramatically improved, increased child protection against illness, health gap between rich and poor halved, thousands of lives saved.
In five years it's reached a million people, increased the number of women getting healthcare after giving birth to one and a half times what it was, and it had the same big increase in the number of children getting vitamin supplements to protect against illness. It means the gap between rich and poor in access to healthcare has been halved, saving thousands of lives and improving countless more.
SUSAN ROSS [Independent Evaluator]
A lot has been accomplished in a pretty short period of time. We've seen a dramatic increase in knowledge. They're very willing, and now very able, to go ahead and do these things on their own.
RUNA LAILA [Councilor, Joypurhat]
We've learned a lot from Concern, so we know how to handle the program alone.
Saidpur was a test case for this program, because we achieved so much here it was introduced to another seven municipalities. Now seven more is not enough, we need to introduce this across Bangladesh. So all the municipalities are working for good healthcare for mothers and babies.
And it's spreading further than that. Child Survival Programs have now begun in the countries of Haiti, Burundi, and Rwanda.
It's exciting. Who would have believed that an organization that was running a slum clinic themselves could become a leader in defining a model that actually works to help the urban poor and could be replicated not only at a national level but also has implications for urban areas around the world. I'm really proud of what's been accomplished here in Bangladesh.
Concern Worldwide would like to thank its partners in the Rajshahi region of Bangladesh. This project was made possible thanks to generous donations from the general public, and the support of the United States Agency for International Development (USAID). Concern Worldwide (U.S.) INC, www.concernusa.org.