1

Partnership for a sustainable social enterprise in global health education in Bangladesh

2

In comparison to other developing countries the general health care situation of Bangladesh is worrisome

2

Total expenditure on health in 2007 [% of GDP]

Births attended by skilled personnel ‘00-‘08 [%]

Mortality under five years in 2008 [# per 1,000 live births]

Female mortality between 15 - 60 in 2008 [# per 1,000]

Health care status of Bangladesh and comparable countries1) (1/2)

Source: WHO 2010; Yunus Centre

1) Comparable in terms of economical growth, population, or regional focus

Malaysia 100

China 98

Brazil 97

Vietnam 88

Indonesia 73

Myanmar 57

India 47

Bangladesh 18

Global top 100

Vietnam 14

China 21

Brazil 22

Indonesia 41

Nepal 51

Bangladesh 54

India 69

Myanmar 122

Malasyia

Global top

Malasyia 97

Brazil 106

Vietnam 110

India 173

Indonesia 185

Bangladesh 230

Nepal 273

Myanmar 304

China 84

Global top 39

Vietnam

Nepal

Malasyia

China

India

Bangladesh

Indonesia

Myanmar

Brazil

Global top 19

3

Bangladesh is ranked among countries with the lowest nurse density as well as a weak nurse vs. doctor ratio

Health care status of Bangladesh and comparable countries (2/2)

Source: WHO; Yunus Centre

Density of nurses and midwives1) [# per 10k people] Ratio of nurses and midwives vs. doctors1)

The regional average number of health care workers is 4 times higher than in Bangladesh according to the WHO

Only China has a worse ratio than Bangladesh –Neighboring countries show a much higher ratio

1) 2000-2009

MalaysiaBrazil 29

BangladeshNepalVietnamIndonesiaChinaMyanmarIndia

China 0.7Bangladesh 1.0Vietnam 1.3Brazil 1.7India 2.2Nepal 2.5Myanmar 2.5Malaysia 2.6Indonesia 8.0

4

By 2020 the population will grow to over 190 million inhabitants, thereby intensifying the social need

Implications

• Nursing density will significantly decrease

• Rural areas will be negatively effected if migration to Dhaka continues

• Demand for medical advice/service will exceed the existing capacity

Population of Bangladesh 2008-2020 [# of inhabitants m]

Source: EIU; Yunus Centre

+18%

202020152014201320122011201020092008

179

5

The standard of nursing education is inadequate and a career in nursing is seen as an unattractive profession

Major reasons of the nursing shortage in Bangladesh (1/3)

Unattractiveness2| • Young people have little motivation to enter the profession as self-esteem is low

• Nursing is regarded as a very low level occupation in Bangladesh

Education standard1| • Lack of qualified teachers and schools• Existing schools have very poor conditions and

facilities

Source: Yunus Centre

6

Insufficient number of schools and teachers to assure a high standard nursing education

• Only 70 private and public nursing institutions with a seat capacity of roughly 2,000

Lack of colleges

• Existing schools have mainly very poor facilities such as hostels and lab equipment

Quality of schools

• Insufficient number of teachers

• Teacher vs. student ratio 1:27 – International standard is 1:8

Lack of teachers

• Lack of proper qualified and educated teachers

• Remote from practice and not current with their medical skills

Quality of teachers

• Doctors from private medical colleges limit the practice opportunities for nurses

• Junior doctors assume nurse tasks to practice their own skills on a live patient and to get exposure of the hospital management

Lack of on the jobtraining

• Modern teaching resources are available only in English and many terminologies cannot be translated into Bangla

• Many nurse educators and students are not fluent English speakers

Lack of language and communication skills

• Education focuses on memorization and learning by rote

• Self-directed learning, critical thinking and problem solving are not emphasized as in western countries

• Independent decision making and teamwork capabilities are not emphasized

Teaching methods

• Little opportunity to use medical and sophisticated equipments

• In an ever-changing world there are constant medical science and technology demands

Medical equipment

Main factors influencing the education standard (2/3)

Source: MOHFW; Yunus Centre

1 2 3 4

5 6 7 8

7

The nursing profession is seen as a limited and low paid career opportunity

Main factors influencing the unattractiveness (3/3)

Low salary

• Low compensation (e.g. clinics: Tk 5k ~7k per month for a Diploma nurse)

• Emigration – Better career opportunities in neighboring countries

Bad reputation

• Regarded as a very low level occupation

• Only considered by girls from less affluent society and with relatively weaker educational qualification

Career chances

• Frustration due to the lack of career development and job enrichment

• Young generation is keen to study new courses like MBA, etc.

No motivation

• Low standards of education and self-esteem

Rural jobs

• No interest to work in rural areas where vacancies are high

• High tendency to stay in Dhaka or even migrate to Dhaka

2 3 41 5

Public opinion

• Media does not play a positive role to improve the image

• Cultural sensitivities• Public negative

perception decreases the bride value

Aid nurses

• Aid nurses are doing many of the jobs which are meant for real nurses

• Their lack of competence is giving a bad name to the whole nursing profession

Lack of respect

• Doctors and patients do not show proper respect towards the nursing profession

Patient care

• Nurses are often unprofessional with patients, scolding or ignoring them, and often leaving actual patient care to untrained assistants

Lack of role model

• There are no existing education role models

7 8 96 10

Source: Yunus Centre

8

The Grameen Caledonian College of NursingA Social Business Venture in Health

Inauguration• Operating since March 2010• Capping ceremony held on

March 1, 2011Location• Grameen Headquarters, Mirpur,

Dhaka

Objectives• Establish the college as a

centre of excellence• Applying international

education standards

Education details• Provide BNC approved nursing

diploma and Bachelor degrees

Grameen education loan/salary• Granted to every student• Guaranteed employment

Repayment of the loan with 33% of monthly salary

Partnership• Nike Foundation• Glasgow Caledonian

University (UK) – Technical support

• Grameen

Management/employees• Management• 14+ employees total (teachers,

administrators, cleaners)

Key facts of the GCCN

Source: Yunus Centre

9

Grameen selection criteria are strict and more stringent than BNC criteria – Mother must be a Grameen borrower

Source: Yunus Centre

Selection criteria

1. Wealth:

2. Education:

3. Subjects:

4. Age:

5. Marital status:

6. Fitness:

Grameen – Mother of student must be a borrower of Grameen bank

Grameen – HSC-GPA must be higher than 3 (BNC – GPA must be higher than 2,5)

Grameen – Science track mandatory(BNC – Science track preferable)

Grameen – 3 years after graduation(BNC – 18 years and above)

Grameen – Unmarried

BNC – Medical certificate indicates good health and physical fitness

Overview of BNC and Grameen criteria – Student example

10

An education loan and job is granted to each student

• Approximately 33 % of monthly salary needs to be used for loan repayment

Sustainability approach for the college

Source: Yunus Centre

Grameen education loan Guaranteed employment

• Covers all tuition fees as well as accommodation and food

• Every Grameen student is entitled for it

• Placement opportunity in one of the Grameen clinics

1 2

Payback terms3

11

The Curriculum

Diploma BachelorDiploma and BachelorEducation and fee details

Source: Yunus Centre

• Length: 3 years

• Classes:– 2,688 hours for clinical practice– 1,440 hours for theoretical

college classes

• Subjects: 34

• Length: – Option A: 3 years diploma + 2

years Bachelor– Option B: 4 years Bachelor

• Classes:– Intensified lessons– According to affiliated university

guidelines

• Subjects:– English, chemistry, physics,

biology, social science– Pharmacology, nursing,

computer, leadership, management, midwifery, etc.

• Timing:– 5 days a week– 8.30am till 4.30pm– One month summer holidays– One month winter holidays

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We apply international standards for the nursing education to ensure quality

Goals

• Development of an educational role model

• Educated nurses will be able to fulfill all relevant medical assignments

• Nurse practitioners will be able to carry responsibility of independent primary healthcare providers

New teaching approaches and methods • Use of international standard literature• Students taught to independently make decisions • Focus on teamwork

Laboratory equipment • Equipped with the latest medical technology• Maintain high technology level

Emphasis is on practical work • Strong guidance by experienced nurses and training with patients• Partnerships with well established hospitals

Teacher and Professor qualification • Strict selection by the college management• International advisory by partner university

Source: Yunus Centre

13

GCCN aims to improve the reputation of the nursing profession and doctor vs. nurse ratio and empower young womenObjectives

To contribute towards mitigating extreme shortage of nurses and to help to achieve the standard 1:3 the doctor vs. nurse ratio in Bangladesh

To strengthen the nursing components of the GK Health clinics and in other health service centers in Bangladesh with nurses of quality training

To produce qualified nurses, leaders, with high level of professional standards

To offer opportunities for higher income earning to the older adolescent girls and younger women through a career in nursing, thus empowering them

To provide opportunities for potential Grameen Bank borrower’s children to be trained and employed

To empower women from rural areas and enable them to generate income for their families

To contribute towards improving the status of nursing in Bangladesh

Source: Yunus Centre