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

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 Health care status of Bangladesh and comparable countries1) (1/2) Mortality under five years in 2008 [# per 1,000 live births] Female mortality between 15 - 60 in 2008 [# per 1,000] Total expenditure on health in 2007 [% of GDP] Births attended by skilled personnel ‘00-‘08 [%] Myanmar Myanmar 122 Myanmar 304 Bangladesh 18 Indonesia India 69 Nepal 273 India 47 Bangladesh Bangladesh 54 Bangladesh 230 Myanmar 57 India Nepal 51 Indonesia 185 Indonesia 73 China Indonesia 41 India 173 Vietnam 88 Malasyia Brazil 22 Vietnam 110 Brazil 97 Nepal China 21 Brazil 106 China 98 Vietnam Vietnam 14 Malasyia 97 Malaysia 100 Brazil Malasyia China 84 Global top 100 Global top 19 Global top Global top 39 1) Comparable in terms of economical growth, population, or regional focus Source: WHO 2010; Yunus Centre

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) Density of nurses and midwives1)[# per 10k people] Ratio of nurses and midwives vs. doctors1) Brazil 29 Indonesia 8.0 Malaysia Malaysia 2.6 India Myanmar 2.5 Myanmar Nepal 2.5 China India 2.2 Indonesia Brazil 1.7 Vietnam Vietnam 1.3 Nepal Bangladesh 1.0 Bangladesh China 0.7 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 Source: WHO; Yunus Centre

4. 194 By 2020 the population will grow to over 190 million inhabitants, thereby intensifying the social need Population of Bangladesh 2008-2020 [# of inhabitants m] Implications +18% • 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 179 2008 2009 2010 2011 2012 2013 2014 2015 2020 Source: EIU; Yunus Centre

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) 2| Unattractiveness • 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 standard • Lack of qualified teachers and schools • Existing schools have very poor conditions and facilities 1| Source: Yunus Centre

6. Insufficient number of schools and teachers to assure a high standard nursing education Main factors influencing the education standard (2/3) 1 2 3 4 Lack of colleges Quality of schools Lack of teachers Quality of teachers • Only 70 private and public nursing institutions with a seat capacity of roughly 2,000 • Existing schools have mainly very poor facilities such as hostels and lab equipment • Insufficient number of teachers • Teacher vs. student ratio 1:27 – International standard is 1:8 • Lack of proper qualified and educated teachers • Remote from practice and not current with their medical skills Lack of on the job training Lack of language and communication skills 5 6 7 8 Teaching methods Medical equipment • 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 • 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 • 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 • Little opportunity to use medical and sophisticated equipments • In an ever-changing world there are constant medical science and technology demands Source: MOHFW; Yunus Centre

7. The nursing profession is seen as a limited and low paid career opportunity Main factors influencing the unattractiveness (3/3) 1 2 3 4 5 Low salary Bad reputation Career chances No motivation Rural jobs • Low compensation (e.g. clinics: Tk 5k ~7k per month for a Diploma nurse) • Emigration – Better career opportunities in neighboring countries • Regarded as a very low level occupation • Only considered by girls from less affluent society and with relatively weaker educational qualification • Frustration due to the lack of career development and job enrichment • Young generation is keen to study new courses like MBA, etc. • Low standards of education and self-esteem • No interest to work in rural areas where vacancies are high • High tendency to stay in Dhaka or even migrate to Dhaka Lack of role model 6 7 8 9 10 Public opinion Aid nurses Lack of respect Patient care • Media does not play a positive role to improve the image • Cultural sensitivities • Public negative perception decreases the bride value • 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 • Doctors and patients do not show proper respect towards the nursing profession • Nurses are often unprofessional with patients, scolding or ignoring them, and often leaving actual patient care to untrained assistants • There are no existing education role models 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, 2011 Location • 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 Key facts of the GCCN 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) Source: Yunus Centre

9. Grameen selection criteria are strict and more stringent than BNC criteria – Mother must be a Grameen borrower Overview of BNC and Grameen criteria – Student example Selection criteria 1. Wealth: Grameen – Mother of student must be a borrower of Grameen bank 2. Education: Grameen – HSC-GPA must be higher than 3 (BNC – GPA must be higher than 2,5) 3. Subjects: Grameen – Science track mandatory (BNC – Science track preferable) 4. Age: Grameen – 3 years after graduation (BNC – 18 years and above) 5. Marital status: Grameen – Unmarried 6. Fitness: BNC – Medical certificate indicates good health and physical fitness Source: Yunus Centre

10. 1 An education loan and job is granted to each student Sustainability approach for the college Grameen education loan Guaranteed employment 1 2 • 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 3 Payback terms • Approximately 33 % of monthly salary needs to be used for loan repayment Source: Yunus Centre

11. The Curriculum Education and fee details • Length: 3 years • Classes: • 2,688 hours for clinical practice • 1,440 hours for theoretical college classes • Subjects: 34 • 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 • Length: • Option A: 3 years diploma + 2 years Bachelor • Option B: 4 years Bachelor • Classes: • Intensified lessons • According to affiliated university guidelines Diploma Diploma and Bachelor Bachelor Source: Yunus Centre

12. We apply international standards for the nursing education to ensure quality Goals • New teaching approaches and methods • Use of international standard literature • Students taught to independently make decisions • Focus on teamwork • 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 • 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 women Objectives 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