Dr. Mushtaque Chowdhury is the Vice Chairperson and advisor to the Chairperson and founder of BRAC. He is also a professor of Population and Family Health at the Mailman School of Public Health of Columbia University, New York. During 2009-2012, he served as a senior advisor and acting Managing Director of the Rockefeller Foundation, based in Bangkok, Thailand. He also worked as a MacArthur/Bell Fellow at Harvard University.
Dr. Chowdhury is one of the founding members of the two civil society watchdogs on education and health called Bangladesh Education Watch and Bangladesh Health Watch respectively. He is on the board or committees for several organizations and initiatives, including the Advisory Board of the South Asia Centre at London School of Economics, Lead Group for Scaling Up Nutrition Movement at United Nations and is the current chair of the Asia-Pacific Action Alliance on Human Resources for Health (AAAH). He is also the President of the Dhaka University Statistics Department Alumni Association (DUSDAA). Dr. Chowdhury was a coordinator of the UN Millennium Task Force on Child Health and Maternal Health, set up by the former Secretary-General, Kofi Annan, along with Professor Allan Rosenfield, Dean of the Mailman School of Public Health of Columbia University, New York.
Dr. Mushtaque had previously received the ‘Innovator of the Year 2006’ award from the Marriott Business School of Brigham Young University in the USA, the PESON oration medal from the Perinatal Society of Nepal in 2008 and Outstanding Leadership Award from Dhaka University Statistics Department Alumni Association. He has a wide interest in development, particularly in the areas of education, public health, nutrition, poverty eradication and environment. Dr. Chowdhury has published several books and over 150 articles in peer-reviewed international journals.
A Ph.D. holder from the London School of Hygiene and Tropical Medicine, Dr. Mushtaque completed his MSc from the London School of Economics and a BA with Honors from the University of Dhaka.
I realized that my role is not just about collecting data, but it is to make the work of BRAC known to broader development community within and outside the country.
You have been a development professional for forty years and have recently been awarded for your achievement. Please elaborate the details of this global recognition.
The award I received recently is called the “Medical Award of Excellence’ which is given annually by the US-based Ronald McDonald House Charities. Connected to the McDonald’s restaurant chain, the Charity was initiated in 1974 and has been providing support for compassionate care to children and their families worldwide. As of now, it works in 64 countries serving over five million families annually. This award, initiated in 1990, was won by many eminent personalities in the past, including former US President Jimmy Carter, former US First Ladies Betty Ford and Barbara Bush, Queen Noor of Jordan, Tennis star Andrea Jaeger and Health Minister of Rwanda Agnes Binagwahu. I am probably the first South Asian recipient of this prestigious award, and I feel very proud about it. An Award committee invites nominations from prominent people from across the world and decides on the winner from a shortlist of outstanding candidates. Recognition is the central aspect of it, but it carries prize money of $100,000, which will be donated to another charity of my choice.
You’ve been a part of BRAC from its inception. Tell us something about its situation back then.
When I joined in 1977 as a statistician, BRAC had only been operating for five years with its headquarters located in a small office at Moghbazar in Dhaka. But the main activities were in the field, in the remote areas of Sunamganj district. Soon after joining I was sent to the Sulla Project in Sunamganj. BRAC had been carrying out community development activities in about 200 villages of the haor region since 1972. There were projects on health, family planning, nutrition, education, agriculture, and microcredit. All the projects were geared towards empowering the poor and women. As the haor population did not grow or consume many vegetables, one of the projects promoted its cultivation and use. My first assignment was to evaluate the outcome of BRAC’s vegetable promotion in the villages. I spent a week in different communities trying to understand what the project was all about and how the villagers accepted it. I developed a simple questionnaire and tested it as a pilot. I was a fresh graduate from Dhaka University, and my knowledge or experience of how to design such an evaluation was rudimentary at best. Ultimately the idea of evaluating this program was abandoned as there was no baseline to compare with. However, this failed exercise taught me about the value of experimental design and non-quantitative ethnographic methods in research. More importantly, this first trip to Sulla gave me an immense opportunity to learn about the problems that the poor and women faced in rural Bangladesh, particularly in the backward haor areas, and see how BRAC was trying to address them through innovative means. The villages where BRAC was working had a very low literacy rate, less than 20%. BRAC designed an innovative adult literacy program called functional education. Following Paulo Freire, the Brazilian educator-philosopher, a significant part of the technical education program was to make people conscious of themselves and their role in society. I was deeply moved and pleasantly surprised by seeing how BRAC was making poor women aware and empowered. I attended several village meetings in which I found the women very vocal and articulate in explaining how they were being exploited in the family and the society. I was convinced and impressed that BRAC was doing some fundamental transformational work in changing the rural community. Such Freirean work that we did in the 1970s and 1980s laid the foundation for BRAC’s work in the years to come. The transformation we see now in the lives of women in Bangladesh has had much to do with what other NGOs and we did during that time.
After the Sulla trip, I was asked to work in BRAC’s second integrated project, Manikganj. Supported by EZE of Germany, the project required a baseline survey to be done. I spent three months in the project and devoted all my knowledge and energy to do a good survey. There was no looking back afterward. I initiated many studies including a survey on Gonokendra, a monthly development journal that BRAC was producing for primary school teachers with UNICEF support. At the same time, I also started collaborating with a researcher at Bangladesh Institute of Development Studies (BIDS) to do some sophisticated analysis of data that we had collected on family planning in Sulla. I used to spend my daytime in BRAC and evenings at BIDS working on the family planning data. The results were dramatic – Sulla had the highest contraceptive prevalence and continuation rates in Bangladesh. I realized that my role is not just about collecting data, but it is to make the work of BRAC known to broader development community within and outside the country. We then started giving attention to publishing the success (and failure) stories of BRAC through scientific publications. The family planning results were published in the BIDS journal, The Bangladesh Development Studies, in 1978. BRAC is an action organization but my first few years of experimenting with research led to the quick realization that there was an appetite for evidence and its use in the organization. My purpose in BRAC was already determined – to help BRAC become an evidence-based organization!
Tell us the story behind BRAC’s success.
The recipe behind BRAC’s success has always been its robust, dedicated and uninterrupted leadership. Sir Fazle Hasan Abed, whom we fondly call Abed bhai, with his vision of a free and exploitation-free Bangladesh, has always been at the helm. He is a versatile genius with immense knowledge about everything. When I shared a draft report of the Manikganj baseline survey, my first output in BRAC, he took two days to read it. While giving his feedback, he asked me a few questions, which surprised me, of course very pleasantly. The questions he asked were about my use of different statistical methods and whether the use of specific other methods would strengthen the analysis. That was the day that I decided to stay in BRAC for the rest of my career and work with Abed bhai. I knew I would have the opportunity to learn and utilize my knowledge here directly. I sympathize with my many colleagues who did not get such opportunities to work with him directly.
Many observers have attributed BRAC’s success to its exceptionally efficient management system. The internal audit department, for example, employs nearly 300 staff. BRAC is large with almost one lac staff, but the management is sufficiently decentralized with a clear information sharing system in place between the field and headquarters. Observers have also pointed out BRAC’s continued and unfailing emphasis on women. Most of the program participants, be it in microfinance, education or health, are all women. BRAC believes in scale. If a solution is effective at a small scale, we feel it is an imperative to bring it to as many people as possible. ‘Small is beautiful but large is necessary,’ as the saying goes in BRAC! BRAC’s programs are large and now reach about 120 million people, most of whom are in Bangladesh.
BRAC works closely with the government but doesn’t shy away when needed to challenge any government action that BRAC thinks goes against the interest of the poor. BRAC also works in close partnership with the development partners. Some of the donors of BRAC have continued supporting it since its inception. BRAC has achieved such trust of our partners. The other distinguishing feature of BRAC is its insistence on sustainability. BRAC has been establishing enterprises since the 1970s. The enterprises support its development programs and generate a surplus for use in other development activities. 80% of the $1 billion annual budget of BRAC is generated internally. BRAC is often its fiercest critiques. The investment in research and evaluation has made BRAC one of the very few evidence-based NGOs globally. And last but not the least is BRAC’s continued commitment to its purpose. It has remained true to its goals but has changed course and strategies based on the changing needs of the poor and the national and global realities.
What is the reason behind the success of NGOs in Bangladesh?
The War of Liberation has brought a massive change in the mindset of the people of Bangladesh. Most of the large NGOs such as BRAC and Gonoshasthaya Kendra are the direct fruits of the War. The NGOs made good use of the changed mindsets. The prestigious medical journal Lancet has recently published a full series of articles on Bangladesh’s progress. Interestingly, one of the reasons attributed to this success is the Liberation War. The promotion of family planning is cited as an example. Before the war, conservatives created obstructions against family planning. However, after liberation, the conservatives were defeated along with their viewpoints, and others were free to live based on their own beliefs and philosophies. The work of NGOs and, of course, the government has led to the family planning revolution in the country. This social reform brought by the liberation war was hastened by NGOs whereas such improvements are not visible in Pakistan or India. In case of sanitation, on another example, Bangladesh has done tremendously well. The rate of open defecation in Bangladesh is 1% compared to India’s 50%. Bangladesh has worked in a similar direction from the 1970s and created a base, which is still contributing to issues such as family planning, sanitation, and microcredit. The NGOs are still working to empower and make people conscious, and I believe this has contributed significantly to their success in the country over time.
What social impacts do the “Ultra poor” and “Adolescence Girls Club” projects run by BRAC have on the society?
BRAC’s program on ultra-poor focuses on the bottom 10 to 15% of the population in poverty scale. They do not have access to microfinance. Initiated in 2001, this program offers a package of interventions including participatory identification of the ultra-poor families, transfer of assets such as cows, goats, chickens or small grocery shops, training on how to take care of the assets, and coaching. We also give them a stipend so that they can concentrate in rearing the assets, as well as health services. Till date, we have been able to reach around 1.7 million families. According to research studies done by the London School of Economics, the participant family members have continued their upward march to earning more income and assets and improving the nutritional status of their children. Experiences suggest that 95% of the participants are able to graduate out of ultra-poverty within two years and gain access to microfinance and other market-based poverty reduction tools. In 2004, the Ford Foundation and the World Bank replicated the model in ten countries of Africa, Asia and Latin America, which produced similar positive results as Bangladesh. At present, this model is being implemented in 40 other nations of the world. This is an example of how a model developed by BRAC in Bangladesh is being used to reach the Sustainable Development Goals (SDGs) globally.
BRAC Adolescence Girls Club model has also been replicated in many countries where BRAC works. In Uganda, for example, thousands of Ugandan adolescent girls are participating in over 1200 such clubs. Research done by the London School of Economics found that participation in adolescent clubs has resulted in higher use of family planning and in lowering fertility rate. This is quite significant in a society where the large family (with 6+ children) is a norm. A vast social change is being ushered in the process.
What measures have you taken concerning the health sector?
Bangladesh has done reasonably well in recent years in improving the health status of its population. This has been possible because of selected public health programs are undertaken by the government and NGOs. Oral rehydration therapy (ORT) program done by BRAC is a good example. Other successful programs include immunization, tuberculosis and family planning. However, there are other issues in the health sector that need to be addressed to reach the SDGs. These include non-communicable diseases such as cancer, hypertension, and diabetics, etc. which is responsible for 65 percent of deaths nowadays. To address such issues we need to have a good health system and definite and sustained steps towards ensuring Universal Health Coverage (UHC). We are currently working on some areas including maternal, newborn and child health (MNCH), TB, nutrition, primary health care, eye care, water, sanitation and hygiene (WASH), malaria, etc.
BRAC has a significant contribution in the country’s educational sector. What new things is your organization planning to bring forward in this regard?
The literacy rate in Bangladesh has gone up over the years, but effective literacy is still not more than 50%. BRAC is doing its part of bringing children to schools. Fortunately, almost all children are enrolled in schools but, unfortunately, many drops out before passing the primary level. The transition from primary to secondary is low. The quality of education remains a major issue. BRAC is experimenting new ways of financing primary and secondary education. We are also in the forefront of using modern technology in classrooms, and in instruction and this respect, we are working closely with the government. We are also experimenting new models of delivering early childhood education from birth to age 5. The BRAC University has already become a major destination for the new generation. It is one of the top universities in the private sector. In a recent rating, BRAC University is third in Bangladesh after Dhaka University and BUET. The University’s School of Public Health is attracting students from over 25 countries of all the continents.
What is the future of prospect of the Bangladesh economy?
Like most Bangladeshis, I am very optimistic about the future of Bangladesh. The poverty situation has improved significantly – proportion of population poor has declined from about 60% in the 1980s to less than a quarter now. This, however, means that 40 million of our citizens are still poor by any standard! This is unacceptable. The recent HIES released by the Bangladesh Bureau of Statistics shows some alarming trend. The gap between the rich and poor is growing very fast. In 2010, the poorest five percent of the population had 0.78% of the national income, which has now reduced to 0.23%. On the other hand, the share of the wealthiest five percent population has increased from 24.6% to 27.9%. There is no alternative to shared growth.