Harvard Case - BRAC: Shasthya Shebikas' Role in Delivering Health Care Service to Rural Markets
"BRAC: Shasthya Shebikas' Role in Delivering Health Care Service to Rural Markets" Harvard business case study is written by Sanal Kumar Velayudhan, Sayeda Shabukta Malik, Kaosar Afsana. It deals with the challenges in the field of International Business. The case study is 14 page(s) long and it was first published on : Dec 7, 2017
At Fern Fort University, we recommend that BRAC, in order to further enhance the effectiveness and reach of its Shasthya Shebikas program, should focus on a multi-pronged strategy combining strategic partnerships, innovation in service delivery, and sustainable financing mechanisms. This approach will enable BRAC to leverage its existing strengths, address the challenges of reaching rural populations, and scale the program for greater impact.
2. Background
BRAC, a renowned international development organization, has implemented the Shasthya Shebikas program to provide essential healthcare services to rural communities in Bangladesh. The program utilizes trained female community health workers (CHWs) to deliver primary healthcare services, including family planning, maternal and child health, and basic treatment for common ailments. The case study highlights the program's success in improving health outcomes and empowering women, but also underscores the challenges faced in terms of sustainability, scalability, and adapting to evolving needs.
The main protagonists of the case study are:
- BRAC: The organization responsible for implementing and managing the Shasthya Shebikas program.
- Shasthya Shebikas: The female community health workers who provide healthcare services to rural communities.
- Rural communities: The beneficiaries of the program, who face significant challenges in accessing quality healthcare.
3. Analysis of the Case Study
To analyze the case study, we can utilize the Porter's Five Forces framework to understand the competitive landscape and the Value Chain Analysis to assess BRAC's internal strengths and weaknesses:
Porter's Five Forces:
- Threat of New Entrants: Relatively low, due to the significant investment required in training and infrastructure.
- Bargaining Power of Buyers: Low, as rural communities have limited alternatives for healthcare services.
- Bargaining Power of Suppliers: Moderate, as BRAC relies on external partners for training and supplies.
- Threat of Substitute Products: Moderate, as alternative healthcare providers, such as government clinics and NGOs, exist.
- Rivalry Among Existing Competitors: Moderate, as various NGOs and government programs compete for resources and beneficiaries.
Value Chain Analysis:
- Primary Activities:
- Inbound Logistics: BRAC manages the procurement of supplies and equipment.
- Operations: Training and deployment of Shasthya Shebikas, service delivery, and data collection.
- Outbound Logistics: Distribution of supplies and information to rural communities.
- Marketing & Sales: Community engagement and awareness campaigns.
- Service: Providing healthcare services and follow-up care.
- Support Activities:
- Infrastructure: Establishing healthcare centers and training facilities.
- Human Resource Management: Recruitment, training, and supervision of Shasthya Shebikas.
- Technology: Utilizing mobile technology for data collection and communication.
- Procurement: Sourcing supplies and equipment.
4. Recommendations
To address the challenges and capitalize on opportunities, BRAC should implement the following recommendations:
1. Strategic Partnerships:
- Government Collaboration: Partner with the Ministry of Health to leverage government resources, infrastructure, and policy support. This can involve joint programs, funding, and integration of Shasthya Shebikas into the national healthcare system.
- Private Sector Engagement: Collaborate with pharmaceutical companies, medical device manufacturers, and telemedicine providers to access technology, expertise, and funding. This can include joint ventures, supply agreements, and technology transfer.
- NGO Partnerships: Collaborate with other NGOs working in rural areas to share resources, expertise, and reach. This can involve joint outreach programs, training initiatives, and data sharing.
2. Innovation in Service Delivery:
- Telemedicine Integration: Utilize telemedicine platforms to connect Shasthya Shebikas with specialists in urban centers, enabling remote consultations and diagnoses.
- Mobile Health (mHealth): Leverage mobile technology for data collection, patient education, and appointment scheduling. This can improve efficiency, data accuracy, and patient engagement.
- Community-Based Health Insurance: Pilot community-based health insurance schemes to reduce financial barriers to healthcare access and ensure program sustainability.
3. Sustainable Financing Mechanisms:
- Social Impact Bonds: Explore social impact bonds to attract private investment in the program, with returns tied to achieving specific health outcomes.
- Microfinance Integration: Integrate microfinance services into the program, allowing beneficiaries to access loans for healthcare expenses and improve financial resilience.
- Fundraising and Grants: Diversify fundraising strategies, including seeking grants from international donors, foundations, and corporate social responsibility initiatives.
5. Basis of Recommendations
These recommendations are based on the following considerations:
- Core competencies and consistency with mission: BRAC's core competencies in community development, healthcare delivery, and social entrepreneurship align with the proposed recommendations. These strategies will strengthen BRAC's mission of empowering communities and improving health outcomes.
- External customers and internal clients: The recommendations address the needs of rural communities, Shasthya Shebikas, and BRAC's stakeholders by improving healthcare access, enhancing the work environment for CHWs, and ensuring program sustainability.
- Competitors: The recommendations aim to differentiate BRAC from competitors by leveraging partnerships, innovation, and sustainable financing mechanisms, creating a competitive advantage in the rural healthcare landscape.
- Attractiveness: The proposed strategies are expected to yield positive social and financial returns, including improved health outcomes, increased program reach, and enhanced financial sustainability.
6. Conclusion
By implementing a multi-pronged strategy focused on strategic partnerships, innovation in service delivery, and sustainable financing mechanisms, BRAC can significantly enhance the effectiveness and reach of the Shasthya Shebikas program. This will enable BRAC to address the challenges of reaching rural populations, scale the program for greater impact, and contribute to the sustainable development of Bangladesh.
7. Discussion
Other alternatives not selected include:
- Government takeover: While this could provide financial stability, it may lead to bureaucracy and loss of BRAC's flexibility and innovation.
- Focusing solely on fundraising: This could lead to dependence on external funding and hinder long-term sustainability.
Key risks and assumptions:
- Partner commitment: Ensuring consistent commitment and collaboration from partners is crucial.
- Technology adoption: The successful adoption of telemedicine and mHealth technologies requires adequate infrastructure and training.
- Community acceptance: Community acceptance of new services and financing mechanisms is essential for successful implementation.
8. Next Steps
BRAC should:
- Develop a detailed implementation plan: Define specific objectives, timelines, and roles for each recommendation.
- Pilot test new initiatives: Conduct pilot programs to evaluate the effectiveness and feasibility of proposed solutions.
- Monitor and evaluate progress: Regularly monitor the program's impact and make adjustments based on data and feedback.
- Build capacity: Invest in training and development for Shasthya Shebikas and BRAC staff to effectively implement new strategies.
By taking these steps, BRAC can ensure the long-term success of the Shasthya Shebikas program and contribute to the health and well-being of rural communities in Bangladesh.
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Case Description
BRAC was the largest non-governmental organization in the world, reaching out to 138 million people. It made a significant contribution to reducing poverty in Bangladesh by employing more than 117,000 community workers (Shasthya Shebikas) to improve the health and nutrition of the rural poor. The manager of BRAC's Health, Nutrition and Population program was faced with two significant challenges. First, she had to find a way to encourage more people to use BRAC's services; more than 60 per cent of the population sought the services of unqualified health care service providers, despite the significant contribution made by Shasthya Shebikas. Second, she had to bring down the 10 to 20 per cent turnover rate of the Shasthya Shebikas.
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