Wednesday, December 31, 1980

oral rehydration
. Let me explain from an example that we have experienced in Bangladesh, as to how culture becomes absolutely essential in terms of designing programs that work. In 1979 it was the international year of the child. At that time in Bangladesh infant mortality was: under one year old mortality used to be 135 per 1000, and under five years old mortality used to be 252 per 1000. We thought that we need to something about that, we found that diarrhea kills more than half the children, under five years old. So we have to tackle diarrheal mortality in Bangladesh. We took up the program to go and teach mothers how to make oral rehydration fluid at home in order to combat diarrheal rehydration and death in the households. So we decided to set up a group of oral rehydration workers who would go and teach one woman in every household how to make oral rehydration fluid at home and how to administrate it.

So first 30 000 houses was visited by our oral rehydration workers and we sent out a group of monitors to test how many of the families who have been taught were using oral rehydration in their household. We found only 6% per cent in the households visited used oral rehydration to combat diarrhea in their household, we were very disappointed but very quickly found out that our oral rehydration workers themselves did not believe in oral dehydration. Therefore if the teacher doesn’t believe in something the kind of teaching that it goes on is not very effective and persuasive, so we had to bring up all oral rehydration workers and teach them exactly how efficacious oral rehydration program is, once they were convinced they went back again and then they went to another 30 000 households we again sent out a group of monitors to find out how oral rehydration programmes were used and at that time it came up to 19%. We were very unhappy about the results of this programme because 81 % of the households who had diarrhea in the household did not use oral dehydration. So we sent out a group of anthropologists to check why 81% of the women having diarrhea in the household did not use oral rehydration and we very quickly found out that the men in the household did not encourage the women to use oral rehydration because they had not been told anything about this programme. We had to redesign the programme, bring men in that, so our programmes were designed only for women teaching women and hoping that the women in the household would take action. Then we redesigned the programme before we went from house to house, we decided to have meeting with all the men in the village tell them exactly what we are teaching the women, and how oral rehydration works. Then we visited mosques we went to market places went to many congregates we taught on about oral rehydration and then suddenly the oral rehydration use rate started growing up dramatically and we followed up with spots and interviews in television and then it went up to 67% to 80% use rate. Over a 10 year period we went to every household in Bangladesh, quarter million households spent out an hour with each woman in the household, and so oral rehydration therapy became used by everybody and diarrhea mortality went down dramatically our infant mortality rate of course now is one of the lowest in South Asia, its less than 40, and under 5 mortality is less than 50. What I wanted to say is that if the programme is not culturally appropriate then it doesn’t work and many of the programmes are not culturally appropriate tend not to work but we 3 were lucky that we were only telling everything that it was going on and as result of it this programme became, of course now Bangladesh has got the highest use of oral rehydration in the world and oral rehydration therapy has become part of the culture itself so when a development programme and the outcome of the programme becomes part of your culture then it became sustainable so what I wanted to say is that in order to be sustainable, sustainable development means in fact at the level of culture a change must take place otherwise it is not sustainable. What Mme Bokova just asked me, with regards to violence against women, child marriage, and all kinds of social ills that we see in our society. We have now set up 400 theatre groups, popular theatre that enact in the Bangladesh countryside and village. People enjoy that because it is kind of education and entertainment at the same time, but we find it extremely effective in terms of transmitting values and messages and perceptions about social problems, and more than 150 000 theatres take place every year in Bangladesh and we are trying to change people’s valu

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