Bangladesh Health sector at a Glance – Key challenges and constraints

Over 43 years after independence in 1971 the health system of Bangladesh has gone through a
number of reforms and established an extensive health infrastructure in the public and private
sectors. Bangladesh has achieved impressive improvements in population health status by
achieving MDG 4 by reducing child death before the 2015 target, and rapidly improving on other
key indicators including maternal death, immunization coverage, and survival from some
infectious diseases including malaria, tuberculosis, and diarrhea. However, some challenges for
the health system remain critical, such as:

1. Critical shortage of trained health providers with appropriate skill-mix in the public sector
and widespread increase in unregulated informal providers.
2. Inequitable access to health services between urban and rural areas including variable
health financing mechanisms.
3. Low annual allocation to health in the government budget and high out-of-pocket
payments by households.
4. Lack of coordination across two different ministries for implementing primary health-care
service delivery in rural and urban areas

Brief background of BRAC HNPP

Since the inception in 1972, BRAC has made enormous strides in healthcare which has resulted
in a decline in maternal and child mortality, increased awareness about nutrition and an
increase in the number of people seeking out institutional health care services. As the nation
continues to prosper and make strides to becoming a middle income country, there has been a
decline in the funding envelope/aid for Development initiatives in Bangladesh. This decline has
limited BRAC’s capacity to support its development programme. Hence BRAC has slowly
transformed itself from a “free” to a “fee based” organization by introducing health services and
packages for marginal communities. For 2018 – 2022, the healthcare strategy for BRAC is to
provide quality, accessible & relevant primary health services to urban and rural communities at
affordable price. BRAC intends to make quality health services available to clients in order to
ensure timely detection of critical health issues while removing funding as a major barrier from
accessing such services. To ensure this BRAC HNPP intends to upgrade its Community health
worker (CHW) platform and introduce targeted health services through a center based
approach.
Description of Health Social Enterprise Models
BRAC HNPP intends to develop and implement the following Social Enterprise models in a pilot
scale in 2018. The following is a brief description of the different center and field based units:
SE Model Description Services

 Doctors Consultation via Telemedicine

BRAC operated outlets,
A. Health  Basic Diagnostic tests
selling medicines, products
Center  Medicine sales
and targeted health services
 Health commodities

 Family planning services

B. Nari Shishu Up gradation of maternity
 Basic Diagnostic tests
Shastho centers to provide targeted
 Telemedicine services
Kendra (NSK) health services
 Linkage to care

A. Health Center – first point of primary healthcare

Background: In Bangladesh it is common practice for people in both rural and urban areas
to consult with Pharmacists on various health related issues. While the underlying logic for
this is to go to one fixed location where both health consultation and medicines are
available, clients suffer from receiving incorrect treatment from untrained/unlicensed
pharmacists, purchase excessive medicines or are deprived from institutional care.

BRAC HNPP intends to intervene in this sector and address this issue by introducing
“Health Centers” that will provide Doctor’s consultations through Telemedicine solution,
primary diagnostic tests, medicines & health commodities. These pharmacy styled centers
will intercept clients and act as their first point of primary care at Upazilla & Union level.
BRAC’s goal is to provide targeted health services through these health Centers, provide
affordable services, link clients to care, develop a sustainable business model that evolves
with changing market requirements.

Objective: To meet unmet demand of quality primary healthcare service in rural areas.

Location: Upazilla & Union

Proposed Service: Doctors’ consultation via Telemedicine, Primary Diagnostics, Medicine

Population Coverage: 200,000 (approx.) in rural areas (Village, Union etc.)

Competitor: Village Doctors, Local pharmacies, Local diagnostics etc.

Operational model and staffing requirement for Health Centers

Each Health Center will be manned by a Pharmacist and a Paramedic who will oversee the
day to day operations, oversee supply chain/book keeping, sell medicines/health
commodities and provide targeted health services to clients. The center will be supported by
5 Community health workers who will operate at door level of the community proving health
education & diagnostic services through portable devices.

Targets for Health Centers

 Operate 400 stores by 2022

 Reach 16 Million people by 2022
 Achieve break even by 2023, achieving 1 – 2% profits in year 5

B. Nari Shishu Shasthya Kendra (NSK) – one stop healthcare center for
maternal & child care

Background: There is a market demand as well as opportunity for “a better primary care
center for Woman & Children with more healthcare service options” targeting the lower
middle class & middle class. In order to meet these new standards, larger spaces were
attained, and higher skilled and more specialized health professionals were placed and
trained to recognize and manage various maternal and neonatal complications.

Hence BRAC intends to upgrade these BMCs into Nari Shishu Shasthya Kendras (NSKs)
which will provide extensive maternal care services such as Ultrasonograms, basic
diagnostic screening services and Doctor Consultation services through Telemedicine.
BRAC intends to operate these NSKs as a “one stop center for maternal care” where clients
will receive necessary primary care services during pregnancy and be referred to relevant
facilities during complications. BRAC also envisions to include consultations and counselling
services for children and adolescents in these centers.

Objective: To provide primary healthcare targeting Woman & Child in urban areas.

Location: Urban Areas (City Corporation)

Proposed Service: Doctors’ consultation, Primary Diagnostics, Medicine

Population Coverage: approx. 100,000 (Lower middle class & Middle class)

Competitor: Local pharmacies, Local diagnostics, NGO etc.

Operational model and staffing requirement for NSK

Each NSK will be manned by 1 center manager, who will oversee operations for the NSK. In
addition to this there will be 3 – 4 Midwives providing targeted health services on a rotation
basis. Each NSK will also have 2 Urban Birth attendants providing logistics and support
services for the NSK. Each NSK will also support 5 community health advisors who are
providing health education, targeted health services and referring clients to NSKs.
Targets for NSKs

 Operate 120 NSKs by 2022

 Reach 12 Million people by 2022
 Achieve break even by 2020
Case analysis: Developing the marketing plan for BRAC HNPP Social Enterprise
As marketing Manager of the Social Enterprise unit, you have been assigned to develop the
overall marketing plan for communicating the overall value proposition at the community level.
For this marketing plan you are required to focus on the following areas and present to HNPP
Senior Management:

 Marketing strategy for “Brac Health Center” & “Nari o Shishu Shatho Center”
 Value proposition
 Target market analysis, market segmentation and identification of needs
 Promotional campaign plan
 Budget requirement
 Marketing campaign KPIs and plans for measuring campaign impact

Additional instructions: Kindly articulate the marketing plan within 5-10 slides, clearly describing
the approach for developing the marketing plan.