Post on 18-Jan-2016
description
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
12
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