Community Based TB Control Program in Bangladesh
"An Experience of BRAC"

Dr. Sadia A Chowdhury, Jalaluddin Ahmed, Md. Akramul Islam
Bangladesh Rural Advancement Committee (BRAC)

Summary --

Tuberculosis is one of the major public health problems in Bangladesh accounting for nearly 80,000 deaths and 150,000 additional cases each year. To make TB diagnosis and treatment services available and accessible at the village level through the involvement of the community, BRAC initiated a community based TB control program in 1984 in one thana (sub-district). Currently this model has been extended to 35 thanas under a Memorandum of Understanding (MOU) signed with the Bangladesh Government with the major objectives of increasing the case detection rate to 70% of new cases and the cure rate to 85% of the diagnosed cases. Community based female health volunteers known as Shastho Shebikas who average between 25 to 35 years of age are trained on TB control and other essential health activities. They are responsible for 150-300 of the households in their assigned district and are responsible for symptomatic identification and referral for sputum examination, provision of treatment to the patients at their homes according to the national directly observed treatment (DOT) guidelines, and follow-up to ensure treatment compliance and referral for complications and emergencies. As a strategy to ensure DOTS compliance, patients are asked to deposit Taka 200 (US$5) and sign a bond as guarantee of treatment completion. After completion of the treatment, Taka 75 is refunded to the patient and Taka 125 is given to the Shastho Shebika for her services in ensuring treatment compliance. The program currently has 6039 Shastho Shebikas operating in 34 sub-districts of Bangladesh. From 1995-996 a total of 4275 patients have been diagnosed as sputum positive and treated under this strategy, with the cure rate of 86%.