The world has made impressive progress in health over the past few decades, leading to untold lives being saved. This has been possible due to deliberate efforts in providing prevention and healthcare, and improving the various social determinants of health. Yet, nearly ten million children die before reaching their ﬁfth birthday and half a million women die each year in child birth. Many others die in and as a consequence of natural disasters and pandemics. We now know that it is not realistic to end such threats to public health; the real key lies in increasing the resiliency of individuals, communities and systems to face the odds that lead to death, disease and disability. I am fascinated by the concept of resilience in the public health sector and want to share four poignant examples of how different actors in and around Bangladesh are contributing to building such resilience by implementing innovative ideas and actions.
Saving Lives From Killer Diseases: The Case Of Oral Rehydration Therapy (ORT)
Until recently, diarrhea was a major killer of children. In the late 1960s, scientists in Dhaka and Kolkata simultaneously discovered a simple treatment that revolutionized the management of the disease. Called Oral Rehydration Therapy (ORT), the secret lay in replenishing orally what is lost in diarrhea stools. Unfortunately, this discovery, which The Lancet called "the most signiﬁcant advance" of the century, was conﬁned to hospitals and not available to the vast majority of millions who needed it at home. In this case, the technological solution was relatively simple and the science behind the diarrhea remedy was already complete. Having the answer is only part of the solution, however; the next challenge was to build up the social networks that help provide health care services in places like Bangladesh to build community resilience to diarrhea by replicating ORTat scale. Enter BRAC, a Bangladeshi non-governmental organization (NGO) that developed a home-made version of ORT using salt and unreﬁned sugar. Aiming to educate mothers on how to treat their children's diarrhea, BRAC female health workers visited every household (numbering over 12 million) in the 1980s and taught them face-to-face how to mix a pinch of salt and a ﬁstful of sugar into half a liter of drinking water. A built-in evaluation system monitored the performance of the workers and how well the mothers were learning the method. Bangladesh now has the highest rate of ORT use in the world, and BRAC's work is attributed to a major increase in the resilience -- and the accompanying fall in child mortality rates -- that Bangladesh's public health system has witnessed over the past two decades.
Resilience Through Local Capacity Building: Community Health Workers (CHW)
The global community's effort in scaling modern healthcare to those who need it is hampered by a crisis in the health workforce. There is a perennial shortage of appropriately trained health care workers in low income countries. In addition, in the few places where there are enough workers, there are problems of maldistribution and inappropriate skill-mix. To address this, countries have tried various measures, one of them being the training of ﬁeld community health workers (CHWs). Following China's barefoot doctors concept, BRAC trained over 80,000 such workers in rural Bangladesh. Female and often illiterate, these workers are now trained to treat common illnesses and refer more complicated cases to formal health centers. Availability of CHWs in a village increases access to basic care and connectedness to the broader health system, and thereby resilience against disease. Like Bangladesh, many countries have adopted this as a way to increase their communities' capacity to manage their own health affairs to a great extent.
Reducing Deaths from Natural Disasters
Natural disasters in the form of cyclones, tornadoes, droughts and ﬂoods still cause havoc to people's lives in many parts of the world, and have a particularly negative impact on poor and vulnerable communities. Fortunately, our capacity to deal with such disasters has improved tremendously over the past decade. Bangladesh is common prey to such natural disasters, including ﬂoods and cyclones. But in recent years, the situation has improved dramatically, due mainly to increased individual resilience and concomitant actions from the government, NGOs and development partners. For example, the cyclone that struck the coastal belt of the country in 1970 is estimated to have killed up to 500,000 people. Compare this to a most recent cyclone in 2007 which, at about the same force and fury, killed less than 3,000. This improvement was a result of many actions taken by different stakeholders. The Red Cross and Red Crescent Society trained thousands of volunteers who, upon receipt of early warnings, moved people from their impoverished homes to cyclone shelters built by the government and NGOs.
Similarly, ﬂooding is a common phenomenon in Bangladesh but the damage to the health of the public as a result of ﬂoods has been reduced signiﬁcantly over the years. The work of the government and NGOs has built resilience by making people aware of the value of clean water, and the knowledge of and familiarity with ORT has ensured that nobody dies from diarrhea. As a strategy to empower and capacitate the health systems to face health threats due to climate change, the Life Centre, an NGO in Southern Vietnam, is training functionaries of local health departments in the Mekong Delta. Such an effort is designed to increase the capacity and resiliency of the health systems to face any unpredictable threats.
Building Resilience against Pandemic Threats: Networking In The Mekong Region
Pandemics such H1N1 or Avian Flu remain a constant threat to human health across all countries, rich or poor. With globalization in full swing, outbreaks that swept through Asia in 2002 and 2003 can spread infections across borders continents. The Mekong Basin Disease Surveillance (MBDS), a network of six countries in the Mekong subregion was formed in 1998 to facilitate cross-border collaborations in containing pandemics. MBDS countries collaborate on improving health outcomes, empowering and educating health workers, and slowing the spread of disease by working collaboratively to exchange information, training, response efforts and disaster preparedness. Supported originally by The Rockefeller Foundation, the Network has now become a pioneer in such cross-border collaborations which is based entirely on trust. Just as risk managers have learned it is impossible to eliminate risk, the public health community is learning the value of building resilience -- the ability to absorb and bounce back from chronic shocks and stresses. When we take technological innovation and apply the critical real world experience of bringing solutions to hard to reach communities, we can make a real difference. Further focus on the concept of resilience and applying it to all sectors -- not just public health -- will beneﬁt the world's poor more than we know.
This post is part of a series produced by The Huffington Post and The Rockefeller Foundation on resilience, a topic being discussed at the 2013 World Economic Forum in Davos. To see all the posts in the series, click here.