NGO-Collaboration: lessons learned and way forward Faruque Ahmed Director, Health and Nutrition Program BRAC

 Population: 132 million  Density: 894 people/sq- km  GNP per capita: US$ 345  Life expectancy: 61 years  Adult literacy rate: 41%  IMR: 66/1000 live births  TFR: 3.3 Bangladesh At a Glance Bangladesh

BRAC Programs  Diverse in its operations with economic, health and education programs  Innovation and scaling up are two distinguished features  Over 30,000 regular staff, 34,000 part time teachers and 37,000 health volunteers  Micro-credit reached to 4.07 million poor people  Basic health care services to over 31 million people  Non-formal primary education to 3.7 million children (70% are girls)

Partnership in TB between Government and NGOs  Over 70,000 deaths and 300,000 new TB cases occur every year in Bangladesh  DOTS strategy started in 1993 in collaboration with the NGOs, WHO and international agencies DOTS coverage (by 1998) BRAC 60 and other NGOs 126 sub-districts BRAC 60 and other NGOs 126 sub-districts Government health complex 274 sub-districts Government health complex 274 sub-districts  NTP provides policy guidelines, ensure supplies and NGOs implement activities  NTP report 2002 showed increased detection and cure rates in NGO collaboration areas

BRAC Community Based TB Program Since 1984  Health Volunteers (Shebikas) selected from micro-credit group members  Shebika provides health services to 300 households  Shebika give education on TB and identify suspects  Mobilizing community leaders and health providers  Decentralized smearing centers Financial deed Taka 200 ($3.5) for ensuring treatment Shebika provides DOTS

Enhancing Partnership Between Government and NGOs  Participatory planning meeting of all partners and professional association in March 2003  key problems and priority activities identified and submitted a national proposal to GFATM  Scale up of NGO collaboration by 2003 BRAC: 283 sub-districts & part of 5 cities BRAC: 283 sub-districts & part of 5 cities Other NGOs: 177 sub-districts and part of 4 cities Other NGOs: 177 sub-districts and part of 4 cities  Government and BRAC are PRs in GFATM approved proposal ($42.4 million) for 5 years

Achievements and Challenges BRAC: case detection rate 66% and treatment success rate 90% in 60 sub-districts where program running for 5 years BRAC: case detection rate 66% and treatment success rate 90% in 60 sub-districts where program running for 5 years National case detection rate 38% and treatment success rate 84% National case detection rate 38% and treatment success rate 84% Increase national case detection rate to 70% and maintain high treatment success rate Increase national case detection rate to 70% and maintain high treatment success rate Intensify DOTS services in areas where NGOs recently expanded Intensify DOTS services in areas where NGOs recently expanded Expansion of DOTS services to urban areas, hospitals, workplaces, and hard to reach areas Expansion of DOTS services to urban areas, hospitals, workplaces, and hard to reach areas

Lessons Learned and Conclusions  Government and NGO commitment through joint planning, strategy development and performance review  International support, joint operations research and sharing of findings  Build and maintain mutual trust and support among government, NGOs and donors  Human, technical and financial resources need to be mobilized  Bangladesh will reach the target if not by 2005 then soon thereafter  BRAC as one of the major NGO partners of NTP, commits to give full support in this endeavor