Bangladesh’s community health workers are lifesavers. Commonly referred to as doctor apas (‘doctor sisters’) out of affection and respect, their impact on children’s lives is remarkable.
But winning the confidence of local communities hasn’t been straightforward. As the story of Sheuli Rani Das – a community health worker in Bangladesh’s southern district of Barisal – shows.
Just 8 years ago, Sheuli was overwhelmed by the challenges she faced in her work. “The community did not understand the importance of immunisation and refused to vaccinate their children,” she recalls. “I felt anxious and helpless as there was nobody to guide me.”
Now all that has changed. With support from Save the Children, Sheuli has received training on delivering healthcare to local communities. And she has engaged and informed the community and pushed local government to expand immunisation coverage and to raise awareness of it in local communities.
Sheuli is providing immunisation services three days a week at her community clinic. On other days, she visits neighbouring villages, vaccinating children and raising local awareness about the importance of immunisation for children.
The change in local communities has been remarkable. Now Sheuli says mums and dads ask her, “Doctor apa, when will you come to our neighborhood? I want to vaccinate my child.”
The immunisation rate in Sheuli’s catchment area used to be very low and has now risen to 100%. General health awareness of community members has also improved.
“It feels great to see communities becoming more aware about the health of their children,” she says.
The bigger picture
Sheuli’s story – impressive in its own right – is part of a much bigger story of progress.
Between 2007 and 2018, child mortality in Bangladesh has dropped from 65 to 45 deaths per 1,000 live births. This reduction was only possible thanks to contributions from community health workers, working tirelessly on the frontline to provide health services to vulnerable populations living in Bangladesh’s remote wetlands.
But as Sheuli’s story shows, just a few years ago Bangladesh’s doctor apas were held back by lack of support.
Even after successfully combating epidemics during floods and diarrhoeal disease, frontline health workers did not have their own policy guidelines. And the government’s Health Workforce Strategy, developed in 2015, to provide a basic framework of key interventions, lacked a definition of community health workers or detailed information on how they work and how they should be deployed.
As a result, there was uncertainty over what community health workers do, a lack of coordination and inefficiency.
Changing the story
As Sheuli’s story suggests, that situation has started to change. Over the last 3 years, through continuous advocacy efforts, Save the Children in partnership with the Government of Bangladesh and other partners have developed the National Strategy for Community Health Workers.
We contributed to this advocacy win by developing strategic partnerships, working through coalitions, influencing policymakers and providing technical assistance.
The children left behind
It’s a positive step. But huge challenges remain, particularly in reaching children left behind. In the last 20 years in Bangladesh, immunisation programmes have helped vaccinate more than 760 million people against deadly diseases, saving more than 13 million lives. But a high proportion of children under 5 still die from preventable and manageable causes.
National averages mask huge inequalities, with the poorest children at higher risk due to lack of access to vaccinations and geographical variations in immunisation coverage. As a result, among the poorest households there are 49 deaths per 1,000 live births, compared with just 28 deaths per 1,000 live births amongst richest households in 2019.
Community health workers are clearly critical to addressing these gaps and reaching those children who are left behind. They are central to helping achieve universal health coverage and attaining the Sustainable Development Goals.
That’s why we’ll continue to work with the government and other agencies to develop a costed implementation plan for the National Strategy for Community Health Workers. We will work tirelessly to mobilise donors and partners to generously support its delivery and ensure that Bangladesh’s doctor apas are fully supported to contribute to improving access to healthcare – and to helping every child in Bangladesh get the chance to survive and to help build a better future.