Social Innovations in Bangladesh Healthcare Sector

By Zulker Nine and Hongyi Chen

By Zulker Nine and Hongyi Chen

Social Innovations in Bangladesh Healthcare Sector

Image Attribute: Healthcare Worker Bangladesh / Source: Bangladesh MNCH, 2014

Bangladesh is one of the world’s most densely populated countries with a large population living in poverty. However, after the country was born, it developed rapidly in its healthcare sector despite several limitations. The success rate in both child and maternal health care, comparing to other South Asian countries is promising. By the end of the year 2013, Bangladesh people had “the longest life expectancy, the lowest fertility rate, and the lowest infant and under-5 mortality rates” in South Asia, even though it's overall spending on health care was less than several neighboring countries [1].

The success and growth of the health service of Bangladesh is a direct outcome of a social innovation―the community-based health program. This program has enabled the country to reach out to each and every village and union and helped the policymaker to initiate root level health programs. The journey was difficult as the health workforce is substantially smaller in Bangladesh with a rate of 0.58 per 1000 population. But with the help of government and non-government organizations (NGOs), trained community health workers grew dramatically and are mobilized to visit door to door in order to counsel and raise awareness among mothers. Data show that there are more community health workers in Bangladesh than neighboring countries such as India or Pakistan [2]. In years 2011 to 2012, there were 219,000 community health workers in Bangladesh, among which 56,000 were government workers and 163,000 were from the NGOs. Before we discuss details on how this social innovation succeeded in Bangladesh, we first give a brief overview of the healthcare programs and the NGOs in Bangladesh.

Overview of the Healthcare Sector and NGOs in Bangladesh

The healthcare service structure in Bangladesh has been developed as a mix between governmental and private contributions. Due to administrative purpose, the country of Bangladesh is divided into six divisions, which are further divided into 64 districts, and then 460 sub-districts that are called upazillas, and then 4451 unions at the bottom level [3]. Accordingly, the healthcare sector administered by the Ministry of Health and Family Welfare includes three levels, where there were 35 teaching and specialized hospitals, 59 district hospitals, and 425 upazilla health complexes, as of the year 2013 [4] [5]. At the base level of the health care structure, initiated and operated mainly by NGOs such as BRAC, 18,000 community clinics employing 56,000 health workforces mainly serve the poor and rural community people. Nowadays, these community clinics keep expanding and aiding the healthcare facility while acting as a major building block in the healthcare sector of Bangladesh. They are also acting as a community change agent that develops and re-innovates the social life.

Due to Bangladesh government’s “unusual friendly” relationship with NGOs [6], there are currently 800 NGOs serving the Bangladesh people. Among them, BRAC, OXFAM, and Action Aid Bangladesh are the pioneer ones, and BRAC and GB are regarded as the flagship NGOs [7]. Together, all these organizations account for 163,000 community workers in the country with a ratio of 13.7 per 10,000 people [4]. BRAC, an NGO that started as a small social relief project distributing emergency aid for victims from the independence war, is recognized as the largest NGO in the world judging by the number of employees since 2012 [6]. Based in Bangladesh, BRAC now operates in all 64 districts of the county as well as 13 other countries in Asia, Africa, and America. With the “simple yet radical” idea to bring poor people in poor countries together to share resources and train them to start their own business [8], BRAC does practically everything ranging from health care to primary education, food processing, financing, legal, and so on [6]. In the healthcare field alone, BRAC had 11 ground-breaking programs running since 2006, covering almost 90% of the population in Bangladesh [9].

Social Innovation Examples in the Healthcare Sector

Community-based healthcare service was approached due to the overcrowded population and lack of established hospitals and medical facility in remote rural areas of Bangladesh. Before the establishment of the community health services, most of the public and private healthcare development concentrated mainly in urban areas, leaving nearly 75% of the population which is in rural areas uncovered [18]. Due to reasons such as difficulty to retain doctors, the unfriendly behavior of the healthcare providers, and unofficial fees being charged in Upazila health complexes, local people mostly avoid them but seek help from private healthcare providers with no formal medical qualifications [21]. To solve the problem, BRAC first trained a few male paramedics to deliver minor treatment for common illness in the 1970s [4]. Nowadays, both male and female community health workers are hired and trained for wide ranged treatments. These community health workers act as foot soldiers and visit door to door to raise awareness regarding the child mortality, birth control, usages of contraceptive pills, sanitary napkins, iodized salt, hygienic soap, pneumonia, diarrhea and infectious diseases. They are also trained as paramedics to support primary treatments.

“Reading glasses for improved livelihood”, a simple yet powerful project as part of the BRAC’s “eye care interventions” program, was designed to support rural women who are suffering from “Presbyopia”, an eye related problem that occurs naturally due to aging [9]. In rural areas, women play a major role in managing the family and control all the household related issues. Presbyopia in women causes trouble and ceases all the household efforts. To solve the problem, the community workers in this program distribute reading glasses in exchange for a nominal fee. These glasses are normally used for reading and to do near sighted works like sewing, weaving, handicraft making, etc. With the glasses, those women can be more productive and self-empowered. The community clinics and workers are not only spreading the healthcare facility to rural people but also try to ensure sustainable health in the communities. For example, while distributing the glasses, the community workers also check for other eye-related problems and if necessary advise the patient to consult with doctors. Because of the program, 48% of the suspected patients were treated in 2006 [9]. Through the mobilization of the community health workers, the community health service has also changed and empowered the rural communities.

Another life-changing project undertaken by BRAC is the Micro Health Insurance (MHI) program, it is jointly funded by the International Labor Organization (ILO) for the deprived rural people. Due to poverty, the fear of cost and the lack of government financial support, many people in rural areas, especially women, do not have access to healthcare service. The MHI program provides primary medical and pathological facilities to the selected members in two pilot projects in Bangladesh. With a yearly fee of only BDT 100 (USD 1.25), rural women can afford the use of primary health checkup facilities nearby.

Besides BRAC, two other NGOs, Grameen Kalyan (GK) and Society for Social Services (SSS) also developed similar MHI programs in the late 1990s and early 2000s [7]. As mentioned earlier, GB is a major NGO that gained great reputation by developing the microfinance program in Bangladesh to provide collateral-free loans in small amounts to enable poor people, especially women, to develop household-based micro-enterprises [10]. Despite the popularity and proven benefits of the microfinance program, a group of poor people who experience reduced work capacity due to sickness and not being able to afford healthcare is excluded as beneficiaries. To help these vulnerable people who are the poorest poor and let them benefit from the microfinance program, the founder of GB added an MHI program by founding a non-profit company GK in 1996 [11] to prevent GB clients from economic downfall due to health issues. Through this program, GB provided affordable insurance not only to its members but also the non-members at a slightly higher price [10].

The social innovations in Bangladesh have been changing the rural life in Bangladesh since a series of programs were launched. Comparisons of development indicators and health outcome data between Bangladesh and its neighboring countries show the longest life expectancy (68.3), the lowest infant and under-5 mortality rates (0.042 and 0.051) and the lowest maternal mortality rate (0.00194) in Bangladesh despite its highest poverty rate (32%) [12]. The projects discussed above lead to the improved health condition of rural women, which motivated them to be more productive and change their course of lives. Data show that in 1983, only 8% of the women population participated in economic activities in rural areas; whereas in 2011 it became 57% [12]. Such dramatic improvement reveals the direct impact from social innovations such as the community-based health service and MHI programs.

This is an excerpt taken from an original work by Zulker Nine and Hongyi Chen. Views and opinions expressed in the adaptation are the sole responsibility of the author or authors of the adaptation and are not endorsed by Zulker Nine and Hongyi Chen.

About the Authors:

Zulker Nine, Maritz Consulting Group, Minnetonka, MN, USA.

Hongyi Chen, Department of Mechanical and Industrial Engineering, University of Minnesota Duluth, Duluth, MN, USA.

Cite this Article:

Nine, Z. and Chen, H. (2016) Cultivating Social Innovations: Lessons from the Bangladesh Case. Open Journal of Social Sciences, 4, 56-63. doi: 10.4236/jss.2016.45009.


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[4] (2014) The situation of Newborn and Child Health in South-East Asia. W. H. Organization.

[5]  (2014) Annual Report 2012-2013 PDF. Bangladesh Ministry of Health and Family Planning.

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[7]  Ahmed, M.U., Islam, S.K., Quashem, M.A. and Ahmed, N. (2005) Health Microinsurance: A Comparative Study of Three Examples in Bangladesh. CGAP Working Group on Microinsurance—Good and Bad Practices Case Study No. 13.

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[9]  (2008) BRAC Health Programme: Breaking New Grounds in Public Health. BRAC, Dhaka.

[10] Hamid, S.A., Roberts, J. and Mosley, P. (2011) Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from Bangladesh. World Development, 39, 99-411.

[11]  Grameen Kalyan Official Website, 16 April 2016.

[12]  Chowdhury, A.M.R., Bhuiya, A., Chowdhury, M.E., Rasheed, S., Hussain, Z. and Chen, L.C. 2013) The Bangladesh Paradox: Exceptional Health Achievement despite Economic Poverty. The Lancet, 382, 1734-1745.

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IndraStra Global: Social Innovations in Bangladesh Healthcare Sector
Social Innovations in Bangladesh Healthcare Sector
By Zulker Nine and Hongyi Chen
IndraStra Global
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