Health & Hygine

Health & Hygiene

The one of the most popular phrases of all time is “Health is wealth”; it has been significantly proving its valuable presence in the lives of every member of the community regardless he or she is coming from which socio-economic structure. But those who are living a life very close to poverty line, they are facing the fact very cruelly as health related problems are those which make their lives miserable mostly. As the people from the poor family mostly involved in jobs which requires immense physical works like farmers, rickshaw pullers, women working in the households etc. to maintain a sound health condition, less attacked by the regular diseases are the basic prayer for their lives. As they live hand to mouth, if they could not go to the work due to illness, their family need to spend the day without food. Due to this, a minimum level of health care is the crusial fact of their lives. Besides, It is a proven fact that increased access to the basic health care system is the key to ensure a sustainable development of a country. Because the proper growth of a nation can be attained by the participation of the valuable human resource in the key economic movement as an energy powerhouse. But if this valuable resource is affected by malnutrition and absence of proper health care in the very beginning of its life cycle then eventually it will result an unhealthy generation which will hold the nation in a position way backward in the competition with other countries in the same economic place, in spite of having good results in other sectors.Poor health care outcomes challenge national and household productivity ruthlessly in the existing generation and the next.

Realizing this pressing fact thoroughly, YWCA of Bangladesh has been immensely involved itself through its health care programs to improve the health condition in its intervention areas on the whole reducing the maternal and child mortality rate with desired outcome. It puts constantly an enhanced importance on the health aspect of the impoverished and destitute community people, especially of the women and girls, promoting and strengthening the essential health-care system at the field level. From its inception, YWCA of Bangladesh is involved in multi-approach based health programs which includes the services like maternal, neonatal and child survival initiatives, family planning, reproductive heath literacy, nutrition, growth monitoring, food security, water & sanitation, homestead gardening , immunization, arsenic mitigation and so on. In the period of 2010-11, around 30,000 beneficiaries were brought under the umbrella of those services. And to serve this increased amount of the beneficiaries in those respected working places, and at the same time to provide the community members the required health care services and improve the health care awareness, the local offices of YWCA has responded diverse ways. As the part of the programmatic capacity, they have provided two types of direct development support which are short term and the long term. To attain the following core objectives effectively, YWCA of Bangladesh is earnestly developing and revising its methods, modalities and implementation processes -

To change women's behavior through awareness building.
To reduce maternal, infant and child morbidity and mortality rate.
To help women to attain their rights.
To achieve sustainability through socio-economic development program.
To ensure better health.

Reproductive Health

Social development ensures a complete development of a country, because if a society transforms to a better phase then eventually the country as a whole moves to a new phase. for social, economic and human development, it’s an key priority to ensure reproductive health knowledge and awareness aiming to create a healthy family. It has been realized through the immense experience gathered by YWCA from the field level engagement over the long period of time that failure to properly deal with reproductive health problems or complicity at any stage in life sets the aspect for later health and developmental problems in larger scales. All the efforts driven from human energy and knowledge ensures a rock solid development of the community but if the core energy source is the group of unhealthy people then the aimed target can not be attained. So to transform the community people to an energy powerhouse and valuable human resource, there is no alternative for reproductive health literacy which is the most prioritize component of YWCA’s integrated health program. This development activity got priority greatly in 2010-11 period adding participatory processes with participation of multi-sectoral action and multiple orientation. The deciding factors of reproductive ill-health comes from issues like poverty, gender and other forms of injustices, social iniquity, marginalization and development failures. Considering those issues, reproductive health program of YWCA of Bangladesh was effectively continued during 20010-11 to pull together joint resources and strength for women's education in schools, youth groups, workplaces, adult literacy sessions and income generation groups etc. It contributed greatly in eradication of harmful practices affecting women's health, as well as various forms of violence at community level. As a result, to defend themselves from the vulnerabilities to sexually transmitted diseases (STD), HIV/AIDS, sexual abuse, and ill-believes, the beneficiaries had achieved significant self assurance and inner strength.

Maternal Health

In a developing country like Bangladesh, the various complications of pregnancy and issues raised in the period of childbirth are the key reasons for the death of women in the reproductive age. So this period is considered as the most vulnerable period of women life cycle, considering this as a key challenge, YWCA of Bangladesh has been providing maternal health services under its core health program at community level aimed to prevent a large number of deaths and injuries of mothers by creating a wide access to necessary knowledge and information regarding this issues. At the time of childbearing, the women who escaped from death, they also suffered from different kind of life-threatening illness related to child bearing. Thus, skill development activities similar to training, orientation, courtyard meeting, counseling and gender sessions are provided to them along with other supports targeted to reduce poverty, increase education levels of the mothers as well as improve the health of the community and the environment. At the year 2010-1`, YWCA of Bangladesh's maternal health care activity has increased services like women’s access to antenatal and post-natal care which ensured that maternal health status could be monitored effectively and timely interventions; so that if there is any difficulty raises that can be addressed effectively. The major likely problems were addressed by interventions that promoted behavior change through information, education and communication (IEC) about maternal health during pregnancy and childbirth in the home and the community. To increase the awareness about the available and easily accessible heath resources in the community various education initiatives also introduced.

YWCA of Bangladesh has implemented the activities of antenatal care which includes assessment of pregnancy status, advice on nutrition, blood pressure checkup, safe delivery, exclusive breast feeding, risk assessment, and immunization of tetanus toxoid (TT). The expectant mothers have received different services like regular checkups of weight, blood pressure etc. in the YWCA working areas. The health workers also include them in the health centers for vaccination. The critical cases are immediately referred to nearby health centers with Emergency Obstetric Care (EOC) facilities. Neo-natal health care services are also extended. The service includes health education for mother on cleanliness, umbilical cord care, breast feeding, routine eye prophylaxis and special care of pre term and low birth weight babies, prevention and treatment of Acute Respiratory Infection. In the reporting period total number of pregnant women was 435. Among them 246 mothers received antenatal care. The rate of safe delivery was 99.60%. Besides, 386 pregnant women were brought under Tetanus Toxoid vaccine course. Post natal care was extended to 243 mothers received. Within the reporting period under post natal care Vitamin A capsule was distributed to 207 newly delivered mothers.

YWCA regularly trains practicing TBAs in its working areas and provide an intensive training to promote safe delivery and ensure pre, post and ante care. The trainees are also brought under follow-up training courses. After completion of the course the TBAs are rewarded with certificate and safe delivery kits. Findings show that around 91% pregnant mothers of the YWCA working areas are using trained professionals including TBAs for their antenatal, intra- natal and postnatal care in the working areas.

Breast Cancer Awareness

If Breast Cancer syndromes can be detected in the early stage then there will be increased possibilities for effective treatment leading to a complete cure. There are certain steps like Awareness about breast cancer and someone's own health, learning breast self examination (BSE), practicing BSE monthly starting from the age 20 up to whole life, consulting doctors even for any insignificant changes or abnormality helps early detection of Breast Cancer. Just because of lack of awareness about Breast Cancer, most of the cases are detected at stage II and above. For most of the cases the late diagnosis occurred due to lack of awareness, lack of counseling, cultural & religious barriers, socioeconomic condition and inadequate diagnostic facilities. These barriers and the risk factors may result delay in diagnosis from 6 months to 5 years, on average one year. It is observed that more than 60% of the cases were at stage II and III at presentation, while only less than 5% found at stage I. About 30% cases detected at stage IV or at locally advanced stage. The important fact is prevention of Breast Cancer is possible and it is a self diagnosed disease. By changing the lifestyle the risk factors can be reduced. For example, maintaining normal weight, exercise, diet containing of plenty of fruits and vegetables, breast feeding, avoiding unnecessary radiation exposure reduced the risk factors. In order to create mass awareness on the issue of breast cancer, especially within the women, and to promote the breast self examination (BSE) for early detection of breast cancer, the YWCA of Bangladesh has taken number of initiatives throughout the year. In those events around 7800 members participated.

Family Planning

In a hugely populated country like Bangladesh, family planning played a vita role both in the development of the country as well as the welfare of the individual families. Here most of the poor families suffers a lot to provide the basic needs for its members and if the number of the children of the family is huge then it is obvious that most of them will be deprived from the basic needs fullfillment. To address poverty at its core, family planning may play significant role. There is no doubt that family planning is a way to reach a life full of prosperity and happiness. To build a potential society and nation, it has no other alternative. Providing windows of opportunity for the reconstruction of a pragmatic society in true sense, YWCA of Bangladesh is very much intended to execute family planning activity at community level in a vast scale.

YWCA of Bangladesh is implementing integrated and comprehensive campaigns of family planning at field level with the help of activities, like – social awareness and mobilization, advocacy, counseling, interpersonal communication through door to door visit, courtyard meeting and so on. Being recognized by the organizational core policies and strategies, the prime concern of this initiative is to reduce the incidence of high risk birth i.e. Maternal and child mortality. In the reporting period of 2010-11, it provided increased services as regards reproductive health and family planning encompassing motivation for use of birth control, prevention of STD/HIV/AIDS and reduction of discontinuation of short acting FP methods. In the discussion sessions on Family Planning organized by different offices of YWCA where around 4500 couples participated. The sessions focused on the discussions about the benefits of small family, birth spacing and informing the eligible couples about various contraceptives and their impact on health. Along with creating awareness the couples were also linked to the available support services especially who are willing to take a permanent method. In the reporting period 4421 (64%) out of 6959 eligible couples were found using FP devices.

Adolescent Care

After the complexity of child birth related problems, proper nutrition for a child, fighting with malnutrition related difficulties, the next challenge for a family is to ensure proper adolescent care. Adolescence, is a very critical time for the families as its the transition period of the teens to embrace adulthood. It is extremely important that teens and adults may navigate these transitions successfully. Underprivileged adolescents are confined by ill-believes, practice of risky behavior, dogmatic social attitudes, lack of access to proper health care, knowledge and livelihood oriented education. They should be made understand and think positively what is happening to them physically, cognitively and socially in the period of adolescence. YWCA of Bangladesh is conducting adolescent care activities in its intervention areas spotlighting –

how the transitions throughout adolescence affect teens both metally and physically
what adults can do to help them
and what support resources may be available instantly for a better outcome

YWCA of Bangladesh is working in the field of adolescent care integrated with health oriented activities thinking over their –

sound physical development
cognitive development
Psycho-social development.

During the teen years, adolescents experience changes in their physical development at a rate of speed unparalleled including rapid gains in height and weight and development of secondary sex characteristic. YWCA of Bangladesh is developing knowledge, attitude and practice (KAP) of the disadvantaged girls through training, workshop, orientation, courtyard meeting, gender session, counseling and so on at community level. In the last year 2010-11, its services for adolescents were mostly related to:

encouraging healthy and proper nutrition based eating habits
making aware as to adolescences & puberty, safe sexual behavior, means to avoid health risk including STD/HIV/AIDS, prevention of early marriage, marriage registration, having special education during puberty, special care during their menstruation period, antenatal care, post natal care, hygiene etc.
developing adolescents’ advanced reasoning skills including the ability to think about multiple options and possibilities
developing abstract thinking skills i.e. capacity in thinking about things like faith, trust, beliefs and spirituality that cannot be seen, heard, or touched
getting adolescents involved in discussing their behavioral rules and consequences that they take a more active role in determining how they should behave
providing opportunities for teens to get involved in community service; because, they want to become active in things that have deeper meaning
talking to teens about their views and making them aware of their potentials
establishing intimacy with the adolescents through leading approach to motivate them for giving up risky behaviors
encouraging adolescent girls’ involvement in multiple groups or activities both within school and after-school as well as at the same time, encouraging them to stick with an innovative project or activity long enough to establish some skills
helping teens explore career goals and options for developing their livelihood
helping to gain expertise for handling their own problems with their creativity and capacity.

YWCA of Bangladesh has organized integrated and diversified school education program in the reporting year 2009-10. With this effort, it identified various schools in the community and took sessions on basic rights, leadership development, participation in social & development activities, reproductive health, gender equity, women empowerment, protecting environment and so forth. Those events included a total of 3,000 adolescents. Thus, the adolescent girls one of the YWCA’s prime target groups in the working areas are being on the right way to have such keynote life skills as bargaining, negotiation, critical thinking, ability of working together, self-awareness, diversity of innovation, decision making and other diversified activities.

Nutrition

Child nutrition plays a vital role in the lives of the children throughout the lifecycle; as if the child has suffered from malnutrition in the early stage of his life, there is a huge possibility that his immune system and other core physical function will be affected. And as a result, it will affect the physical condition in the every stage of his life. YWCA of Bangladesh engages in a wide variety of awareness activities aimed at increasing knowledge and improving practice of the target groups in the aspect of nutrition comprising food safety. Building awareness of nutrition has been an intrinsic function of its integrated health program all along.

YWCA of Bangladesh believes that lack of nutrition awareness associated with food insecurity is enough for making a nation unproductive and uncreative. Reflecting on enhancing community health awareness the effective means and ways for developing human resources, its nutrition oriented activity has been helping the target groups to take appropriate actions—to improve the nutrition levels of their diets, the safety of their food, and the structures in their community to combat hunger. It is very true that nutrition for all is one of the main pre-conditions for sustainable development. To reduce malnutrition especially among women, girls and children. YWCA of Bangladesh is trying to build up communities’ capacity that they are able to asses and analyze the causes of their malnutrition problems as well as to make better use of family, community and external resources to shake up their nutritional status. To improve nutritional status of the children is one of the most prioritize task of YWCA. Aiming to it YWCA organized various activities that includes, education on giving colostrums, exclusive breast feeding upto six months, provide weaning food, regular weighing of the children from 0-3 years old, identifying underweight children and bring them under supplementary feeding support and care, administration of vitamin A capsule & de-worming tablets etc. This year a total of 2021 children of 0-3 years old will be brought under surveillance. Among them 149 children were identified malnourished. Those children were provided with supplementary feeding support and treatment in necessary cases. Of them 91 (65%) gained normal weight by the reporting time.. To encourage the mothers for cooking low cost nutritious food the YWCA organizes community feeding program. The community people participate in this program actively. They bring vegetables, eggs, fish, rice etc. from their houses and cooks together. This also becomes an event of celebration for them. YWCA also organizes National nutrition Week where the mothers are educated on the importance of exclusive breast feeding and weaning food. Community based feeding is also one of the important part of this campaign. All these included around 22,000 mother and children.

To promote Exclusive Breast Feeding (EBF) practices up to the age of 6 months including colostrums and to continue to breast feed their children up to the age of 2 years is one of the priority topic of discussion in the health sessions organized with the reference members. Therefore to educate the mothers on the importance of breast feeding and weaning food (preparation and feeding) working sessions were organized for 4000 mothers. In the reporting year among 2049 children from 0-3 years old, 746 (36.50%) were brought under exclusive breast feeding and 703 (34.50%) were given weaning food in proper time.

Environment, Sanitation and Safe Drinking Water

Safe drinking water, sanitation and environment awareness are primary requirements to ensure health, survival, growth and development in any community despite of its socioeconomic structure. But it is a great misfortune for many Bangladeshi familiesliving under the poverty line that these basic necessities are still far beyond there reaching abilities. YWCA of Bangladesh is conducting multidimensional health program being associated with the activity related to Environment, Sanitation and Safe Drinking Water in its intervention areas catering to the target groups. So, they are being aware of using drinking water fromimproved sources and able to protect themselves from the vulnerabilities to ill health and environment pollution. If the majority of the people unless people do not have the access to safe drinking water and basic sanitation, it is obvious fact that efforts to ease susceptibilities to diarrehoea and arsenicosis or to reduce the burden of waterborne diseases are doomed to failure. Lack of basic sanitation is indirectly inhibiting the learning abilities of thousands of school-aged children who are infested with intestinal worms transmitted through inadequate sanitation facilities and poor hygiene. Having this pivotal thinking in mind, YWCA of Bangladesh mounted awareness campaign in different educational institutions under health education program througharranging orientation, open dissuasion, workshop, training, colloquium and so on over the reporting period 2009-10. In the name of environment friendly watsan activity, it distributed 424 slab latrines in its working areas. As part of increasing use of clean and safe water for household work and drinking in order to prevent/ control waterborne diseases, 58 tube-wells were sunk and 106 old tube-wells were repaired as well. The goal of ensuring sound health and protecting environment for sustainable development has set YWCA on a common course to push back poverty, inequality, hunger and illness. But achieving this target is being hampered posing two major challenges:

community people’s strong belief in superstitions and traditional dogmas and practicing risky behavior immensely
lacking of consciousness of developing their life style.

In 2010-11, YWCA of Bangladesh called on respective stakeholders in its intervention areas to set realistic targets, continue achievable action plans and develop human resources needed to strengthen capacity of community people for positive change through necessary awareness of safe drinking water, environmental sanitation and tree plantation. Thus, more intensive and concerted effort by these stakeholders was assembled and mobilized through need-based advocacy and other interpersonal communication oriented activities in a very effective manner to promote the overall activities. YWCA of Bangladesh executed different types of BCC/IEC activities giving emphasis on developing positive hygiene praxis of the disadvantaged and poor community people in this year. It supported and capacitated them with technical knowledge, updated information and tailored messages on water, sanitation, hygiene and environment to extend their close and effective participation in improving watsan and environment situation of their communities as a whole. Side by side, it has been initiating tree plantation under social forestry program. It is creating and honing the awareness among the community people that environment degradation would not be multiplied by them. In the reporting year, saplings of various timber and medicinal plants were distributed among the members as part of awareness building on environment conservation. Special events were carries out on world environment day which included, rally, environment fair, discussion sessions, distribution of saplings etc. In those events around 8500 community people participated. Environment sensitive behavior is also visible among the beneficiaries. An interval survey shows about 73% of the people who were brought under environment education have a fix place in their homestead for dumping garbage. Around 35% members were found having kitchen gardens.

Medical Service & Referral

YWCA provides preventive care services to its beneficiaries in the YWCA working areas. It also offers curative care in a small scale in cases of eyes/ ears infections, cold-cough, skin diseases i.e. scabies, worm infestation etc. To help the people who are suffering from severe health problems and also have the financial ability for treatment, YWCA provides referral services as well. In this year Clinical support was extended to a total of 8545 members, off them7345 were under fives and 332 patients were extended referral support. And this referral supports turns out to a very successful one, as in Bangladesh most of the beneficiaries of YWCA do not have the enough resources to find the appropriate doctor for the particular heaths problem faced by them; for this the service is playing a very significant role.

Health Education for School Children

During the reporting period 2010-11, YWCA organized special customized sessions for 3500 school children in the community to create awareness of various health issues so that the kids can implement those leanings in their everyday lives and as well as can convey the messages to their families. The topics discussed in the sessions were; Reproductive health care for adolescent boys and girls, Behavioral change during puberty age, Self control diseases (i.e. diarrhoea), Personal hygiene, Education on nutrition/food habit, Smoking/drug abuse, Children's right/human rights, Child trafficking/acid burning, Environment (safe drinking water and sanitation), Eve teasing etc.

Behavior Change Communication (BCC)

YWCA of Bangladesh has several activities to communicate the messages which will contribute in the Behavioral change of the community people starting from the ordinary community members to the community leaders. As a developing country like Bangladesh, behavioral change plays a crucial role to ensure for bringing up the change for sustainable development. As part of overall health program of YWCA, Behavior Change Communication (BCC) is to i. identify issues to be addressed on the basis of priority at community level like general health care, family planning, nutrition, reproductive health literacy, water & sanitation, environment preservation, HIV/AIDS awareness, disease prevention & immunization and so on

ii. prepare/develop and disseminate appropriate messages and materials and utilize them through timely approaches and methods

iii. explore innovative ideas and thoughts to use different media and channels

iv. organize necessary events and actions like door to door visit, courtyard meeting, community convention, colloquium, orientation, training, workshop, seminar, symposium, counseling and so on being associated with different kinds of promotional activities

v. motivate the community people to adopt and sustain healthy behaviors and lifestyles

vi. provide necessary supportive environment to improve their knowledge, attitude and practice (KAP)

vii. make community people have enough access to prevention, care & support

viii. reduce vulnerability to stigma, discrimination and gender violence

ix. create demand for information and quality health services

x. ultimately promote positive health outcomes.

Through different programmatic interventions, YWCA of Bangladesh is continuing to understand how behavioral change communication can best impact the community where change is desired and/or needed. Behavior Change Communication is an incredibly effective tool due to the fact it can be so easily orally transmitted. Over the period of 2009-10, this activity of YWCA of Bangladesh used a range of communication channels for bringing about pragmatic changes in target groups’ behaviors through promoting & sustaining individual, community & societal behavior change. In this aspect social mobilization played an important role to make BCC more effective getting the community people involved in the course of improving their health status. As an integral component of comprehensive health program, BCC activities of YWCA of Bangladesh facilitated the tasks of –

stimulating community resource mobilization
advocating for sound health for all
improving skills and self-efficacy to tackle the common difficulties as to maintaining sound health.

Taking core program forward through the BCC based approach; YWCA of Bangladesh addressed the following topics during the year 2009-10:

Education on gender
Awareness against early marriage
Awareness on delaying of first pregnancy for the early married couples
Marriage registration
Birth registration
Pre & post marriage education
Awareness against non-commercial sex related violence against children
Mental health/mental support for women, adolescent boys & girls, elderly people and women on the menopausal stage
Drug addiction
Empowerment of women (gender and development) through economic solvency.

Health Education

Health education is the effective tool for the human being to know, learn, beware and practice effective health related measures through maintenance and restoration of health to attain a proper health condition not only for the individual but also for the community. YWCA of

Bangladesh has been implementing a wide range of health education activities to educate community people about health with the key factors of environmental, physical, social, emotional, intellectuals and spiritual health. It is creating health awareness and preventing disease, disability and premature death by educating individuals and communities to voluntarily change their behaviors to improve their health and well-being. The different elements of YWCA’s health education are disseminating knowledge of –

various nutrients present in various food materials
making balanced diet from foods available
the causes of various common diseases
how various diseases spread
the prevention measures for various diseases
vaccines available for immunizing children
the causes of environmental pollution
methods to protect environment from pollution and so forth.

YWCA of Bangladesh is significantly contributing in the advancement of target groups’ understanding and skills about health care through health awareness and striving in its working areas through the association with different promotional activities.

These initiatives positively influence their health behavior as well as the living and working conditions that influence their health.

In 2010-11, YWCA’s health education oriented activity was mostly concerned with communicating on those areas that were related to safe water, sanitation, community health, mental health, disease control, personal hygiene, disaster management cycle, reducing the risk of communicable disease and its transmission, proper nutrition etc. It mounted awareness campaign at community level as to –

developing a positive attitude towards good health
making quality health decisions and taking ownership of their health problems
developing personal values and satisfactory relationship with peers
increasing self-awareness and a positive self concept
achieving desirable attitudes and practices related to critical health issues
improving understanding of appropriate factual information and concepts
improving the knowledge and attitudes about detection, treatment and control of disease
promoting the family and community educational material vital for positive lifestyle habits
increasing knowledge, attitude and skills of all health workers of respective programs regarding sign, symptoms and management strategies for health hazards
developing resources and materials to be used in health program.

YWCA of Bangladesh’s health education program has coordinated and organized interpersonal communication activities through trainings, orientations, counseling and intensive sessions for the beneficiaries to improve their capacity of identifying the benefits of and barriers to practicing healthy behaviors and ultimately, by implementiong the learnings of this program to achieve a better standard of life.

Achievements: (need final figures)

A total of 86,599 members were brought under different health education and awareness programs.
99.66% pregnant mothers took assistance of trained professionals including TBAs for their antenatal, intra- natal and postnatal care in the working areas resulting of maternal mortality rate (MMR) 0.87% (8.7/1000 live births).
75.53% children completed BCG vaccine, 73.34% completed DPT, OPV, Hepatitis B and 59% completed vaccine for measles.
84.7% children from 0-5 years old in the working community were administered with vitamin A capsule.
36.5% mothers gave exclusive breastfeeding up to the age of six moths and 34.32% provided weaning food in proper time.
98.63% children were weighed and 64.5% gained normal weight within six months.
Use of FP devices is 75.46 % among the eligible couples and out of them 22.22% is male.
80% members have access to safe drinking water and 75% are using slab latrines.

Challenges faced

In comparison to the need of the people for healthcare education, the scope for providing health (treatment & technical) services is limited.
Keeping the staff members update with new emerging health issues.
Close and intensive monitoring and supervision of health and nutrition programs.