g irene khan chair brac international UN Special Rapporteur for freedom of expression and opinion, bio
recalls sir fazle abed- what if every country in asia (or indeed everywhere) had enjoyed through the last half century an inspiring connector of women's productivity lifts up half the sky
"BRAC's approach has been to put power in the hands of the poor, especially poor women and girls," said Sir Fazle Hasan Abed.
We were sitting in his office on the 19th floor of the BRAC Headquarters in Dhaka. Abed Bhai was describing BRAC's pioneering work with women and girls. Although I had heard him recount these anecdotes many times and had also seen some of the programmes on the ground, it was always inspiring to listen to him.
As dusk fell over the slums and rooftops of Dhaka that evening, Abed Bhai turned from talking about what BRAC had achieved for women and girls in Bangladesh to what still remains to be done elsewhere, about where and how it must scale up, innovate, break barriers and set new records. His plans were as audacious as ever, his energy seemingly abundant. But we both knew time was running out for him and the baton must pass on to others. When we next met a few months later, it was to say goodbye as he lay in bed, his eyes closed. Weeks later, on December 20, 2019, Sir Fazle Hasan Abed passed away.
Of all the remarkable contributions for which Abed Bhai is remembered today, I believe none has been more ambitious in scale, nor more impactful in consequence, than his work to empower women and girls. His ground-breaking approaches to development turned perceived wisdom on its head and transformed the lives of millions of women and girls in Bangladesh and beyond.
Watching women toil in the villages and small towns of Bangladesh, he saw in their thrift, ingenuity and resilience the promising talent of would-be entrepreneurs. Women became the key resource as well as the subject of BRAC's poverty eradication strategies.
With astute business sense, Abed Bhai invested heavily in women and girls through education, health, legal services and microfinance programmes, income generation opportunities, community development and social mobilisation. BRAC's approach of working directly with communities to develop solutions and of testing, monitoring and modifying programmes constantly to make them more responsive gave new meaning to women's empowerment.
3.1 Women's agency was explicit in what is one of BRAC's—and Bangladesh's—great success stories: the Oral Rehydration Therapy (ORT) programme. Over a decade, starting from 1979, BRAC visited around 11.8 million homes, covering 98 percent of the total rural households, to teach at least one woman in each household to make oral rehydration therapy with a three-finger pinch of salt, a handful of gur (molasses) and half a litre of boiled water. With no particular skills needed, ingredients available in every home and a simple technique for measuring, mothers produced oral rehydration solutions to treat diarrhea and reduce infant mortality. Today, Bangladesh has one of the lowest death rates from diarrhea and one of the highest user rates for ORT in Asia.
In the early 1980s, BRAC created income generation opportunities for women in poultry rearing and trained women to vaccinate chickens for a fee. The government provided free vaccines but there was no cold chain to carry the vaccines from the office of the sub-district livestock officer to the villages. So, BRAC devised a simple system by which the vaccines were packed inside ripe bananas to preserve the temperature and provide protection against damage during transport.
These are just a few examples of Abed Bhai's down-to-earth approach to development and his relentless drive for scaling up. He was thrifty, creative and persevering, just like the poor women he admired so much. Today, frugal innovation on scale is a badge that BRAC wears with great pride.
With his characteristic audacity, Abed Bhai carried BRAC's development models to other geographies. From adolescent girls in BRAC's schools in Helmand, Afghanistan to the BRAC community health micro-entrepreneurs in small towns in Uganda, thousands of woman and girls broke barriers to take control of their own destiny.
1.3 One of BRAC's most transformative programmes is the Ultra Poor Graduation initiative, which focuses on the poorest and most marginalised families, usually women-headed households, who are unable to afford even one full meal a day, live on the fringes of society and are caught in the inter-generational trap of extreme poverty. For two years, the women are given an income generating "asset" (such as a cow or chickens), a stipend, healthcare, and education for their children, alongside training and counselling to build their financial capabilities, a sense of self-worth and become integrated into the community. Results show that over 95 percent of the almost 1.5 million women and their families benefitting from this programme have "graduated" out of ultra-poverty, and even more remarkably, have continued to improve their lives. Many have become successful microfinance savers and borrowers.
As always, Abed Bhai was keen to scale up and readily shared BRAC's experiences with others. Today, the Ultra Poor Graduation Initiative is being replicated in 45 countries with impressive results.
Abed Bhai knew that development cannot be sustained if it does not change the social and cultural norms that hold back the progress of women and girls, but to be successful, the change itself must take into account the cultural context of the community. So, to make girls' education culturally acceptable to tradition-bound families and communities in Afghanistan, BRAC trained thousands of female teachers and engaged hundreds of older women to chaperone the girls from home to school and back. In Bangladesh, where the social context is different, popular theatre and public campaigns are used to transmit messages on gender equality, women's groups are mobilised at the village level to advocate for social change and thousands of paralegals are trained to resolve family disputes in ways that respect women's human rights.
Whether in Afghanistan, Bangladesh or many other countries, the major barrier to women's empowerment and gender equality remains patriarchal values. "Patriarchy is an enemy to both men and women," Abed Bhai declared on International Women's Day in 2018, acknowledging that gender equality was his "unfinished agenda".
Ultimately, the poor woman's struggle is not only a struggle to increase material assets but a struggle for equality, justice and dignity. Much remains to be done to make the world a safer, more equal place for women and girls. The pandemic has made that task harder, and also more urgent and vital. But when I think back to that evening in Abed Bhai's office and how he not only made the impossible possible but also sustainable and scalable, I feel optimistic. The arc of development is long but it bends towards gender equality.
Irene Khan is an international thought leader and advocate on human rights, gender and social justice issues. She is a member of BRAC International governing body.
A Simple Solution
ReplyDeleteBy Jon E. Rohde
Dhaka, Bangladesh
Spring 2005
When I stepped off the plane to the steamy hot monsoon air of Bangladesh some 37 years ago, I had little idea that I would remain so long! As a newly graduated doctor from Harvard I expected to serve a few years and return to Boston, but the challenges and opportunities proved so exciting, and the prospect of solving some of the most pressing human problems so rewarding that I have stayed working in poor countries to this day. No regrets!
Participating in the research that led to Oral Rehydration Therapy (ORT) brought Harvard science into the far-flung villages of the Ganges delta. This solution of several salts and glucose proved to save lives from the massive loss of fluids that characterize this most feared epidemic illness. While it worked in the hospitals, it took the huge refugee crisis of the 1972 Bangladesh liberation war, when cholera swept the crowded camps housing 10 million refugees, to show how robust this new technology is. Far from any hospital, we mixed large quantities of the correct ingredients and taught family members to administer a large glass of ORT each time the patient passed liquid stools — each movement out followed by an equal amount in! Some patients required 20 to 30 liters (quarts) per day, but the disease is self-limiting and in a few days they recovered. Mortality fell from over 30% of cases to under 3 %, even in such a primitive setting! Small wonder the Lancet editors described ORT as "potentially the most important medical advance of the 20th century".
While the refugees huddled in the mud and rain of the camps, the war raged inside Bangladesh, accompanied there too by cholera. Along with Bengali colleagues, I trained young volunteers to make ORT from packaged raw ingredients, using teaspoon measures and a standard sized glass, preparing them to return behind the lines and save lives as their positive contribution to the liberation war. This Volunteer Service Corps spread ORT to the farthest villages, saving lives and gaining confidence for the new nation.
While "modern hospitals" continued to treat diarrhea with costly intravenous fluids, ORT spread in rural clinics and soon into pharmacies in convenient foil packets that had all the correct ingredients in the proportions to make one liter. The World Health Organization (WHO) established a program to train doctors and nurses all over the world in the use of ORT and the United Nations Children's Fund (UNICEF) provided millions of ORT packets. By the late 1970s, oral treatment was the international norm. In fact, when I visited my alma mater in Boston, it was the only place I found still hospitalizing kids and rehydrating them with intravenous catheters — they too soon changed to ORT!
One day, seeing patients on the porch of a headman's house in a far rural village, a man was carried to me comatose, collapsed from severe cholera. No ORT packets were available — he was on the brink of death. I asked for water, salt and sugar. They brought me a clay pot and some dark molasses and crude sea salt — all they had. Guessing at the correct proportions I hastily mixed up a solution in the pot and started spooning it into the man's slack cheeks. He sputtered and swallowed, most of the fluid flowing out of his mouth and across his chest. Patiently persisting, I managed to get a liter or so into his stomach, and he started to come around, drinking with some new vigor. In an hour he was sitting up and departed in my jeep for the hospital some 25 kilometers away. When I arrived there in the evening, he was walking stiffly around the ward, continuing to drink ORT to replace ongoing losses. I was a convert to "simple solutions"
PAET 2- .
ReplyDeleteSubsequently, BRAC, the largest community NGO in Bangladesh, embarked on an ambitious program going house to house across the countryside teaching each and every mother how to make and use "home ORT" from molasses, salt and water.
It took them over 10 years with some 2500 women trainers to reach every one of 13 million households and patiently teach each woman to make and administer the "simple solution". Dramatically, infant mortality fell by half over this time, and diarrhea, previously the number one cause of death became far less fatal. Today Bangladesh has the highest use rate of ORT in the world — it is part of the local culture.
Earlier this year I was in some of the villages I used to visit 30 years ago. They are still poor, and more crowded than ever, but the women are transformed from those I knew a generation ago. They look you in the face, tell with confidence how they feed and nurture their children. They vie with each other to show how to mix home ORT, as well as describe the benefits of breast milk, their preference for iodized salt, and can explain why they weigh their babies each month, right in the village to be sure they have adequate weight gain. Two thirds boast that they are using modern family planning methods, and insist that their kids, especially daughters stay in school. They enthusiastically show vegetable gardens, chickens and fish ponds that provide their family with quality food. It is a transformed population of empowered women, no longer passive and submissive, who have learned how to better control their own destiny and that of their family.
That seems a long way from Oral Rehydration Therapy, but it all started with the "simple solution" that saves lives.
About the author:
Dr. Rohde, a Harvard trained public health specialist and pediatrician, is an international public health consultant. For the past thirty-five years he has lived and worked in developing countries conducting research on diarrheal disease and nutrition in Bangladesh, representing the Rockefeller Foundation in Indonesia, and directing the Rural Health Delivery System for Haiti. The first Director of the EQUITY Project, he came to South Africa from twelve years in India where he was the Representative of UNICEF (1993-97) and the Global Advisor for health and nutrition to Mr James Grant during his 15-year tenure as Executive Director of UNICEF.