Evaluation arrangements for Improved
Implementation: The OTEP case of BRAC
Md. Hasib Reza
Research and Evaluation Division (RED)
BRAC, Bangladesh
Presentation for the workshop on- Evaluation for Policy Making
27-31 October 2014, Suzohu City, Jiangsu Province,
China
www.brac.net
Outline
BRAC: At a Glance
Overview of OTEP
Taking Science Where the Diarrhoea Is
Piloting and Continuous Learning: Ingredients
for Scale Up
Linking Evaluations to Actions for Improved
Implementation of OTEP
Lessons Learned
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BRAC: At a Glance
Established in 1972 in Bangladesh
Goal: Empowering people to lift themselves out of
poverty
Currently operates in 11 countries
Served 135 millions of lives
1,20,000+ Staff
Budget in 2014: US$ 900m (70% self)
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Overview of OTEOP
Oral Therapy Extension Programme
An ORW teaching a mother; PC- BRAC
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Overview of OTEOP
10 year-long (1980-90) > 13 million mothers >
75,000 villages > Treat diarrhoea at home > Semiliterate ORWs
Phases
Year
1979 (Feb-Apr)
1979-80
1980-90
HHs taught
145 HHs
0.06 m
11.80 m
2.5 m
Phase II
1980-83
1983-86
Phase III
1986-90
4.3 m
Field trial
Pilot project (OTP)
Extended prog. (OTEP)
Phase I
Total
5.0 m
12.6 m
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Taking Science Where the Diarrhoea Was
In 1970s, diarrhoea was the major cause of infant
mortality in Bangladesh
Ideas took shape: Options for interventions
1. Treat all diarrhoea patients by trained
personnel
2. Diarrhoea prevention through safe water &
sanitation
3. Marketing of Oral Rehydration Solution (ORS)
4. Teach mothers how to make ORS at home
with easily available ingredients
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Taking Science Where the Diarrhoea Was
Challenge emerged
Developing a simple formula for home-made ORS
The ‘kitchen experiment’:
Lobon (salt)-Gur (brown sugar) Solution (LGS)
Harinagar & Anandapur: From Kitchen to the field
- Contents of educational message
- The recipients of education
- Method of teaching
- The teachers
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Taking Science Where the Diarrhoea Was
Lessons learned from the first field trial
-Rural mothers were capable in preparing ORS
-ORWs could provide education on ORT
-Quality enhancing monitoring and
corresponding logistic systems could be
developed
Should BRAC go for a national level programme?
“Small is beautiful but big is necessary”
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Piloting and Continuous Learning:
Ingredients for Scale Up
Oral Therapy Programme (OTP): The pilot project
Solved crucial implementation and management
issues and served as the blue-print for OTEP
-Developed team building and training
methods for ORWs
-Introduced incentive based salary system
-Ensured safe and effective solution
-Developed monitoring and logistic systems
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Piloting and Continuous Learning:
Ingredients for Scale Up
Felt importance of continuous learning through
real-time evaluations from BARD case of 1970s
Chowdhury and Cash (1998)
In-house Research and Evaluation Division
(RED) emphasized on real-time process evaluation
of OTEP
Arranged supports from ICDDR,B, Government
agencies and Technical Advisory Committee (TAC)
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Linking Evaluations to Actions for
Improved Implementation of OTEP
Altering LGS formula: ORWs showed the way
A pinch of salt (lobon);
A fistful of brown sugar (gur);
PC- BRAC
PC- BRAC
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Linking Evaluations to Actions for
Improved Implementation of OTEP
Improving quality of teaching and learning
An ORW teaching mother
using flipchart; PC- BRAC
A mother preparing LGS under
the watchful eye of an ORW
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Linking Evaluations to Actions for
Improved Implementation of OTEP
Increasing male involvement in the programme
as well as medical professionals
Village men were taught by male staff; PC-BRAC
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Linking Evaluations to Actions for
Improved Implementation of OTEP
Ensuring higher usage of LGS
Problems identified
-Misperception about ORWs
-Mothers were not convinced
-Fear of becoming ‘sterile’
-Local perception about diarrhoea- 4 types
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Linking Evaluations to Actions for
Improved Implementation of OTEP
Ensuring higher usage of LGS
Devised solutions
-Extended length of stay of ORWs and the team
-Tasting LGS by ORWs in front of the mothers
-Revised “Ten points” messages
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Linking Evaluations to Actions for
Improved Implementation of OTEP
Ensuring higher usage of LGS
Results
% using LGS
Types of
diarrhoea
Areas taught
24 months
previously
Areas taught
12 months
previously
CRP areas taught
12 months
previously
Dud-haga
2.0
12.2
12.3
Ajirno
4.0
7.9
9.8
Amasha
1.6
2.9
4.0
Daeria
25.6
31.6
52.2
Source: Chowdhury and Cash (1998)
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Linking Evaluations to Actions for
Improved Implementation of OTEP
Impact evaluation on mortality
Type of mortality index
Neonatal (per 1000 live
births)
Post Neonatal* (per 1000 live
births)
Before OTEP
After OTEP
85.3 (519)
78.0 (424)
71.3 (434)
60.9 (331)
26.5 (451)
17.2 (306)
Childhood** (per 1000 live
births aged 1-4 years)
Figures within parentheses indicate the number of deaths.
* p < .05;
**p < .01
Source: Chowdhury and Cash (1998)
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Lessons Learned
NGOs can implement national level programme
Up scaling must take into account organization’s
capability
In-house research and evaluation can play a critical
role in programme’s development
National and international support can be obtained
if the process is opened and information is shared
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Thank you
Website of RED: www.brac.net/research
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