News Article | April 17, 2017
Escaping cycles of poverty may depend on how much a person feels he or she can rely on their local communities, according to research led by Princeton University. Published in the Proceedings of the National Academy of Sciences, the study finds that low-income individuals who trust their communities make better long-term financial decisions. This is likely because citizens rely on friends and neighbors for financial support, rather than quick fixes, like payday loans, which further indebt them. The findings show the importance of building strong communities, especially for low-income individuals. The researchers suggest moving away from a focus on low-income individuals, instead focusing on low-income communities through targeted policies. "Instead of cutting funding to community development programs, policymakers should implement changes that give individuals in low-income communities more opportunities to develop community trust," said study co-author Elke Weber, the Gerhard R. Andlinger Professor in Energy and the Environment and professor of psychology and public affairs at Princeton University's Woodrow Wilson School. In addition to Weber, the study was conducted by lead author Jon Jachimowicz, Columbia University; Salah Chafik, Columbia University; Sabeth Munrat, BRAC (an international development organization in Bangladesh); and Jaideep Prabhu, University of Cambridge. To determine why low-income individuals tend to make more myopic (or short-term) financial decisions, the researchers conducted a series of studies, focusing on both the United States and Bangladesh. In the first study, the researchers invited 647 participants from the United States to make several choices between "smaller, sooner" and "larger, later" options, taking into account participants' incomes and how much they trusted their local communities. They found that richer participants were generally less likely to make harmful short-term decisions than those with lower incomes, but that this only applied to low-income individuals who did not trust their communities. In contrast, those low-income individuals who trust their communities more made financial decisions that were very similar to those made by richer participants. "Current financial dilemmas are stressful and leave people with no option but to choose immediate solutions. Our results indicate that lower-income people are less likely to invest in the long-term because of their immediate financial needs," said Weber. "This is in line with work by Princeton's Eldar Shafir and others: that scarcity leads to harmful long-term decision-making." In the second study, the researchers evaluated "payday loans" in the United States, which carry high interest rates and exacerbate cycles of poverty among the poor. After reviewing the Federal Reserve Board's Survey of Household Economics and Decisionmaking, the researchers found that fewer payday loans were taken out in communities where levels of trust were higher. This is because individuals can rely on their communities to help with financial needs (taking out a loan from a friend, for example), instead of resorting to high-interest emergency loans, the researchers said. In the final part of the study, the researchers turned their attention to Bangladesh, where they conducted a two-year field study. Together with BRAC and The Hunger Project, a global nonprofit organization, the researchers worked with 121 of Bangladesh's smallest local government units, known as council unions. They trained community volunteers to act as intermediaries between local government and community residents. Volunteers met with members of their community and helped provide them with access to public services. Volunteers also provided guidance to government units directly. When comparing the unions with community volunteers to those without, the researchers found the two groups differed widely in their levels of community trust. Residents with community volunteers had higher levels of community trust, which also influenced their decision-making. These individuals were more likely to forgo smaller payoffs in exchange for more-profitable, delayed options. Taken together, the findings highlight the importance of building trust in low-income communities. The findings also point to the benefits of programs currently targeted for budget cuts by the Trump administration, the researchers said. "The Trump administration's preliminary federal budget for 2018 recommends eliminating the $3 billion Community Development Block Grant, a program established in 1974 to help communities address a wide range of their development needs," said Jachimowicz. "The budget blueprint reasons that the program is 'not well-targeted to the poorest populations and has not demonstrated results.' The evidence presented in our paper contradicts this claim, and suggests eliminating this line item could lead to devastating consequences, particularly for those on low incomes." The paper, "Community trust reduces myopic decisions of low-income individuals," was published online in PNAS on April 11. This research was made possible in part by a Cambridge Judge Business School small grant, the research facilities provided by the Center for Decision Sciences at Columbia University and the support of the German National Academic Foundation.
Rifat M.,University of Newcastle |
Milton A.H.,University of Newcastle |
Hall J.,University of Newcastle |
Oldmeadow C.,University of Newcastle |
And 4 more authors.
PLoS ONE | Year: 2014
Objective: To determine the risk factors for developing multidrug resistant tuberculosis in Bangladesh. Methods: This case-control study was set in central, district and sub-district level hospitals of rural and urban Bangladesh. Included were 250 multidrug resistant tuberculosis (MDR-TB) patients as cases and 750 drug susceptible tuberculosis patients as controls. We recruited cases from all three government hospitals treating MDR-TB in Bangladesh during the study period. Controls were selected randomly from those local treatment units that had referred the cases. Information was collected through face-to-face interviews and record reviews. Unadjusted and multivariable logistic regression were used to analyse the data. Results: Previous treatment history was shown to be the major contributing factor to MDR-TB in univariate analysis. After adjusting for other factors in multivariable analysis, age group "18-25" (OR 1.77, CI 1.07-2.93) and "26-45" (OR 1.72, CI 1.12-2.66), some level of education (OR 1.94, CI 1.32-2.85), service and business as occupation (OR 2.88, CI 1.29-6.44; OR 3.71, CI 1.59-8.66, respectively), smoking history (OR 1.58, CI 0.99-2.5), and type 2 diabetes (OR 2.56 CI 1.51-4.34) were associated with MDR-TB. Previous treatment was not included in the multivariable analysis as it was correlated with multiple predictors. Conclusion: Previous tuberculosis treatment was found to be the major risk factor for MDR-TB. This study also identified age 18 to 45 years, some education up to secondary level, service and business as occupation, past smoking status, and type 2 diabetes as comorbid illness as risk factors. National Tuberculosis programme should address these risk factors in MDR-TB control strategy. The integration of MDR-TB control activities with diabetes and tobacco control programmes is needed in Bangladesh. © 2014 Rifat et al.
El Arifeen S.,International Center for Diarrhoeal Disease Research Bangladesh Icddr |
Christou A.,International Center for Diarrhoeal Disease Research Bangladesh Icddr |
Reichenbach L.,International Center for Diarrhoeal Disease Research Bangladesh Icddr |
Osman F.A.,University of Dhaka |
And 3 more authors.
The Lancet | Year: 2013
In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specifi c innovative technologies and policies that identify country-specifi c systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the eff ects of climate change, and chronic disease. Past experience should guide future eff orts to address rising public health concerns for Bangladesh and other underdeveloped countries.
Chowdhury A.M.R.,BRAC |
Chowdhury A.M.R.,Columbia University |
Bhuiya A.,International Center for Diarrhoeal Disease Research |
Chowdhury M.E.,International Center for Diarrhoeal Disease Research |
And 3 more authors.
The Lancet | Year: 2013
Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the fi rst paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing womencentred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternityrelated services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health-ie, positives such as women's empowerment, widespread education, and mitigation of the eff ect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh off ers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.
News Article | February 18, 2017
A solar-powered, three-wheel ambulance may look like a crude oddity to those of us who are fixated on whether a Tesla Model S P100D with Ridiculous Mode is faster than a Lucid Air or a Faraday Future FF91. But in the final analysis, all those cars miss the greatest potential of electric vehicles. They are not some baubles for well heeled drivers to wear like an ornament on their charm bracelet. Rather they are the power humanity needs to cleanse the atmosphere of fossil fuel effluent. They are the promise of better health and longer lives. And in certain circumstances, they can mean the difference between life and death when a medical emergency arises. In Bangladesh, many people die because there is no way to get them to a hospital when necessary. The roads are rudimentary and often impassable to conventional transportation. Zahidul Islam, a farmer in Saturia in the Manikgonj district, says when his first child was born, his wife had a difficult delivery and was taken to the nearby clinic in a hand-pulled rickshaw. The trip took too long and his wife died on the way. “If I had taken her to hospital a little earlier, she would have had fewer complications,” he says. But larger vehicles could not reach his home. The government, the local university, and a local manufacturer think they may have the answer — a three-wheeled van built on a rickshaw chassis that is as well equipped as most local ambulances. It has a small battery and electric motor to help propel it. The battery is charged by solar power in 3 to 4 hours. In many areas of Bangladesh, there is no electrical grid, so solar power is the only option available. Kamal Hossain has tested a prototype of the ambulance and says it is safe and comfortable to drive on both smooth and rough surfaces. He also says it moves along at a good speed — certainly faster than a rickshaw. The project’s leader is Abdul Malek Azad, a professor at BRAC University in Dhaka. He says most rural community health clinics cannot afford conventional ambulance services. “I thought a low-cost ambulance service would be a good idea for these rural clinics. And by using solar power we can reduce operational costs and save the environment,” he says. The solar-powered ambulance is expected to cost no more than $2,500 — less than one tenth that of a conventional ambulance in Bangladesh. The inspiration for the solar ambulance came from watching the races for solar-powered cars that take place regularly in Australia. “I thought if researchers can develop a solar racing car, there is potential to develop a solar ambulance,” he says. The new ambulance can accommodate three people. It has a maximum speed of 9–12 mph and a range of up to 30 miles. It has four 100 watt solar panels on the roof that power the motor during the day and also charge four conventional 12 volt lead-acid batteries for nighttime use. “The last layer of the development includes installation of a battery charging station (at a hospital or other site close by) that is completely fuelled by a solar canopy,” Azad said. “This step is taken to ensure complete independence of these electrically assisted rickshaws from the national grid.” So far, Azad said his team has built and tested five prototypes. He expects the solar ambulances to go into production later this year. Officials of the BRAC Health and Nutrition Program have assured the team they will consider using the vehicles in their clinics. Dr. Shahana Nazneen of the BRAC Health and Nutrition Population Programme said that the vehicles are cost-effective and should be affordable for rural hospitals. BRAC University’s Control and Applications Research Center is running the project in association with vehicle manufacturer Beevatech. Financing comes from the World Bank through Bangladesh’s Infrastructure Development Company Limited, with seed funding from the US Institute of Electrical and Electronics Engineers. Now let me slip out of my role as mild-mannered reporter for a moment and assume my alternate identity as wild-eyed activist. Instead of building a $20 billion wall along the Mexican border, why not take some of that money and use it to buy solar-powered ambulances for the people of Bangladesh and other developing countries where getting medical care in an emergency is not as easy as dialing 911? We could even paint a little message on the side: “Donated by the citizens of the United States of America.” That could create some good will for our country instead of the fear and loathing that dropping bombs on people tends to create. A radical idea, I know. But is that any reason not to do it? Source: Thomson Reuters Foundation, the charitable arm of Thomson Reuters, which covers humanitarian news, climate change, resilience, women’s rights, trafficking and property rights. Buy a cool T-shirt or mug in the CleanTechnica store! Keep up to date with all the hottest cleantech news by subscribing to our (free) cleantech daily newsletter or weekly newsletter, or keep an eye on sector-specific news by getting our (also free) solar energy newsletter, electric vehicle newsletter, or wind energy newsletter.
News Article | October 26, 2016
A multipronged approach to supporting healthy breastfeeding among new mothers was effective when implemented at the population level, according to research published in PLOS Medicine. In cluster-randomized evaluations of two programs in Viet Nam and Bangladesh, Purnima Menon of the International Food Policy Research Institute in Washington, DC, and colleagues compared the effect of a program combining intensive interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) to encourage breastfeeding (intensive group) to that of standard nutrition counseling and less intensive MM and CM (non-intensive group). In Bangladesh IPC was delivered through a large non-governmental health program, while in Viet Nam it was integrated into government health facilities. The researchers compared surveyed breastfeeding practices in households with children less than 6 months old before the interventions started and again four years later. They found positive population-level impacts on breastfeeding practices, including higher rates of early initiation of breastfeeding and exclusive breastfeeding, and lower use of prelacteal feeding and bottle feeding, in areas that received the intensive package compared to areas that received the non-intensive program. In Bangladesh, the percentage of mothers reporting exclusive breastfeeding rose from 48.5% to 87.6% in areas receiving the intensive program, and in Viet Nam the EBF prevalence rose from 18.9% to 57.8%. This is compared to much smaller changes in the areas with the non-intensive program (51.2% to 53.5% in Bangladesh and 17.8% to 28.4% in Viet Nam). The authors note that the findings are reliant on self-reporting of the mothers, who may have felt pressure to report "desirable" behavior, and the surveys only asked the mothers to report their behavior from the previous day, and thus would not capture day-to-day fluctuations in breastfeeding practices. However, they note that this study "shows that comprehensive behavior change strategies implemented at scale, under real-life conditions, and delivered through outreach-based (Bangladesh) and facility-based (Viet Nam) platforms have strong and significant impacts on breastfeeding practices." Funding for this evaluation and the implementation of the interventions was provided by the Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360; additional financial support to the evaluation study was provided by the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. JB, TS, NH, SA, KA and RH are part of the implementation team who delivered the interventions described in this paper. They helped conceive and design the study, but played no role in research data collection or data analysis. Their contributions to this manuscript included written inputs to sections on intervention design, critical in-person discussions regarding interpretation of results, and written review of manuscript drafts. Final decisions about results to include, interpretation and conclusions rested with authors from the evaluation team (PM, RR, EAF, MR, PN, KKS, AKh, AKn, LTM). Menon P, Nguyen PH, Saha KK, Khaled A, Kennedy A, Tran LM, et al. (2016) Impacts on Breastfeeding Practices of At-Scale Strategies That Combine Intensive Interpersonal Counseling, Mass Media, and Community Mobilization: Results of Cluster-Randomized Program Evaluations in Bangladesh and Viet Nam. PLoS Med 13(10): e1002159. doi:10.1371/journal.pmed.1002159 Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America Alive & Thrive, FHI360, Washington, District of Columbia, United States of America Save the Children, Washington, District of Columbia, United States of America BRAC, Dhaka, Bangladesh University of South Carolina, Columbia, South Carolina, United States of America IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:
News Article | February 15, 2017
VisionSpring and BRAC seed a new eyeglasses market through national network of community health workers DHAKA, BANGLADESH--(Marketwired - February 12, 2017) - VisionSpring and BRAC provided one million pairs of affordable eyeglasses to low-income customers, achieving major milestones both in scaling a social entrepreneurship model, and in expanding access to vision services in Bangladesh. The Reading Glasses for Improved Livelihoods Program, which began in 2006, has seen marked success, contributing to significant health and economic outcomes. For low-income earners, eyeglasses are a simple, affordable tool that sustains productivity and earning power. Since the program's start, it is estimated to have contributed to $110 million in increased income at the household level, based on an analysis of a study conducted by the University of Michigan. With a philanthropic investment of $3.50 per pair, the return on investment is significant. Eyeglasses can prevent middle-aged workers from experiencing any drop in efficiency and productivity associated with the eye's natural aging. Without the ability to focus up close, mechanics, barbers, tailors, teachers, artisans, and many others whose work requires clear near vision, lose years of income earning potential. BRAC and VisionSpring developed an innovative social entrepreneurship model to reach these low-wage earners, selling low-cost reading glasses through BRAC's network of community health workers (locally known as Shasthya Shebikas). They offer free eye screenings, and have created a referral system for nearly 610,000 customers who need higher-level care for cataracts and other eye conditions. Living in the communities where they work, the female health workers reach customers in the most remote areas of Bangladesh through vision camps and home visits. For 90 percent of customers, this is their first pair of glasses. The community health workers earn a modest commission from the sale of each pair of eyeglasses; since the program's inception, they have earned a total of $450,000 in supplemental income. "Partnerships are central to our success," said Jordan Kassalow, Founder of VisionSpring. "Our collaboration with BRAC exemplifies the power of bringing together two organizations that share a common purpose and ethos and possess complementary core competencies. We feel honored and privileged to have found such a wonderful long term partner." On February 12, 2017, VisionSpring, BRAC, supporters, partners in the social enterprise, and global health community members will gather in Dhaka to celebrate the success of the partnership and honor the health workers and program organizers who have brought improved vision to people in 61 of 64 districts across Bangladesh. Founded in 2001, VisionSpring is a leading social enterprise whose mission is to improve access to eyewear for earners and learners everywhere with radically affordable, durable, attractive glasses. VisionSpring has been internationally recognized by the Skoll Foundation, Draper Richards Kaplan, Ashoka, the Schwab Foundation, the Aspen Institute, and the World Bank; is a three-time winner of Fast-Company's Social Capitalist Award; and a winner of Duke University's Enterprising Social Innovation Award. BRAC is a global leader in developing and implementing cost-effective, evidence-based programs to assist the most marginalized people in extremely poor, conflict-prone, and post-disaster settings. These include initiatives in healthcare, education, microfinance, girls' empowerment, agriculture, human rights, and more. BRAC was ranked the number one NGO in the world for two consecutive years. Based in New York, BRAC USA serves a critical purpose as the North American affiliate of BRAC, building awareness of the important work being done serving poor communities in 11 countries around the world and mobilizing resources to underpin programs. The mission of BRAC USA is to empower people and communities in situations of poverty, illiteracy, disease and social injustice. Our interventions aim to achieve large-scale, positive changes through economic and social programs that enable everyone to realize their potential. Registered in the United States as BRAC USA, Inc a 501(c)(3) non-profit corporation
Chowdhury A.M.R.,BRAC |
Jenkins A.,Impact Assessment Unit |
Nandita M.M.,Research and Evaluation Division
Journal of Development Effectiveness | Year: 2014
BRAC started out as a limited relief operation in 1972 in a remote region in Bangladesh and has become probably the largest nongovernmental development organisation in the world. Organising the poor using communities’ own human and material resources, BRAC has developed a holistic development approach geared towards inclusion, using tools like microfinance, education, healthcare, legal services, community empowerment, social enterprises and BRAC University. Its work now touches the lives of an estimated 135 million people in 12 countries in Asia, Africa and the Caribbean. BRAC established a Research and Evaluation Division (RED) in 1975 that, over time, has grown and developed as a multidisciplinary independent research unit. The division has been playing an important role in designing BRAC’s development interventions, monitoring progress, documenting achievements and undertaking impact assessment studies. It provides an analytical basis for BRAC’s programmatic decisions, fine-tuning it for better performance and making development efforts evidence-based, effective and community-sensitive. This article uses specific examples to demonstrate how a close link between evaluation and research, and project planning and implementation can drive a dynamic process of ‘development’, both in the sense of economic and social development of communities and in the sense of institutional change and innovation within BRAC itself. For example, research on the distribution of benefits in microfinance demonstrated that it rarely reached the ‘ultra-poor’, that is, those spending >80 per cent of income on food and still not reaching 80 per cent of calorie requirements. The ultra-poor tend to have limited social assets; this is a reason why they may not be included as members of self-selected microfinance groups, and there is a considerable literature on this. In 2002, this led directly to the introduction of a package of specific measures, centred on ‘asset-transfer’, which has enabled hundreds of thousands to ‘graduate’ from ultra-poverty and has been replicated in at least 11 countries. Results have been verified extensively through rigorous evaluation and are contributing to a continuing global policy dialogue on the effectiveness of different approaches to ‘social safety nets’. This article also explores how organisational structures in BRAC aid or impede the reporting on results and the documentation of effects. It also examines the relationship between programme Management Information System and rigorous evaluation and the institutional factors encouraging or retarding BRAC’s focus on results measurement and the development of a positive institutional culture. Specifically, BRAC RED focuses on the method that is best suited for each context and frequently conducts research using mixed methodology, with a good blend of qualitative and quantitative research. This has been understood from the beginning, but has also been borne out by experience throughout BRAC’s development. © 2014, © 2014 Taylor & Francis.
Shakur Y.A.,University of Toronto |
Choudhury N.,BRAC |
Ziauddin Hyder S.M.,University of Toronto |
Zlotkin S.H.,University of Toronto
Public Health Nutrition | Year: 2010
Objective: To determine the prevalence of anaemia and maternal and infant factors associated with Hb values in infants at 6 months of age in rural Bangladesh.Design Infants (born to mothers supplemented with Fefolic acid from mid-pregnancy) were visited at birth and 6 months of age. Mothers anthropometric status, and infants birth weight, gestational age at birth, weight and Hb concentration at 6 months were measured. Household socio-economic and demographic data, infant feeding practices and health status were collected using a pre-tested structured questionnaire.Setting Rural Bangladesh.Subjects Four hundred and two infants.Results: For the total cohort (n 402), the range of anaemia prevalence values was from 30.6% using a cut-off value of Hb < 95 g/l to 71.9% using a value of Hb < 110 g/l. Birth weight and month of birth were the only factors positively associated with infant Hb in a linear regression model (P = 0.008 and 0.011, respectively).Conclusions: There was an unexpectedly high prevalence of anaemia in infants at 6 months of age, before the assumed period of vulnerability. Hb at this age tended to be higher in those with higher birth weight. We also found a season effect on Hb, as it tended to be higher as the study progressed. The high prevalence of anaemia at such an early age needs to be addressed to minimize the diseases long-term consequences.
News Article | November 17, 2016
New Bridgespan Group research highlights "needs-equals-demand" fallacy and the need to be proactive in "selling" social change BOSTON, MA--(Marketwired - November 17, 2016) - Seventy percent of nonprofit leaders participating in a survey conducted by The Bridgespan Group reported shortfalls in program participation and half said matters have gotten worse over the past five years. According to Taz Hussein, a Bridgespan partner who led the study, "Our research points to the need for U.S. and international nonprofits to recognize that innovative social programs don't sell themselves. Getting a new idea adopted, even when it has proven effective, is often very difficult." (Click here to access the full article in Stanford Social Innovation Review.) Hussein's co-author Matt Plummer said, "Most nonprofits and funders optimistically operate on the assumption that if they "build it" beneficiaries will come -- but often demand falls short of expectations." Instead, the authors suggest that nonprofits begin to rethink three key steps in creating and implementing solutions suggesting that they: "Insights about the role of program design, beneficiary segmentation and sales and marketing come from decades of research and practical application of 'diffusion of innovation' theory. A wide range of private companies draw on this work to shape their strategies and it turns out that such strategies can also help the social sector," said Hussein. As an example, Hussein points to Omada Health, a for-profit entity with a social mission to spread a nationally recognized diabetes prevention program (DPP). Omada grew from serving 4,000 in its first full year in the market to more than 100,000 this year, five times the number enrolled by all other DPP providers in 2015. Hussein attributes Omada's success to smart design decisions made early on. The program, unlike others, is online rather than classroom-based; it markets its DPP as short and intense (16 weeks) and only after an individual has nearly completed the program does it offer an additional six-eight-month maintenance program. Moreover, Omada allows prospective participants to test its program in advance via free online demos. They rely on early adopters to share information with others, and they have a 55 person sales force. "Investing in a salesforce, while typical in the private sector is unfamiliar in the nonprofit sector at best, and downright taboo at worst," said Plummer." However, according to Bridgespan's research, there is evidence that a robust salesforce has made the difference for nonprofits as well. It cites the development and adoption of a solution called oral rehydration, a remedy for cholera-induced diarrhea that, while effective, went largely unused for years until BRAC, a Bangladesh NGO, in conjunction with the government, deployed thousands of workers to teach villagers about how and why to use the solution. A few short years after they did so in the 1980s, oral rehydration therapy became the new norm for treating cholera." Finally, the Bridgespan report offers a list of resources for nonprofits struggling with the demand issue that can offer assistance in addressing salesforce development issues and deeper understanding of beneficiaries and the barriers that keep them from taking action. The Bridgespan Group (www.bridgespan.org) is a nonprofit advisor and resource for mission-driven organizations and philanthropists. We collaborate with social sector leaders to help scale impact, build leadership, advance philanthropic effectiveness and accelerate learning. We work on issues related to society's most important challenges and to break cycles of poverty. Our services include strategy consulting, leadership development, philanthropy advising, and developing and sharing practical insights.