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On Foot and Beyond: The Transportation Struggles of Bangladesh’s Community Health Workers
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Eddy Ingutia

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On Foot and Beyond: The Transportation Struggles of Bangladesh’s Community Health Workers

In Bangladesh, community health workers (CHWs) play an indispensable role in delivering health services to every corner of the country, often under extremely challenging conditions. Their commitment is unwavering, but the path they walk is quite literally filled with obstacles.

The most common mode of travel for CHWs is by foot. While they also rely on local transports like rickshaws, vans, boats, motorbikes, and auto-rickshaws, using these vehicles often costs them valuable time and money or resources they can scarcely afford. Many of the roads they must navigate are poorly maintained, becoming muddy and nearly impassable during the rainy season. In some areas, rivers that serve as main transport routes dry out during the dry season, forcing CHWs to switch between multiple modes of transportation just to reach a single destination.

Beyond these physical and logistical barriers lies a deeper, gendered challenge. In districts where fishing is a major livelihood, a local superstition claims that carrying women on boats will reduce the day’s fish catch. Consequently, boatmen often refuse to transport female CHWs. Even when women are allowed aboard, they frequently face harassment: unfairly inflated fares, verbal intimidation, and, at times, even threats of harm.

For many CHWs, walking long distances remains the only viable option. In numerous upazilas, local transportation is either scarce or nonexistent. Carrying heavy equipment across rough terrains under the scorching sun or pouring rain is part of their daily reality. And as the day stretches on, many CHWs find themselves still providing services as night falls. Getting back home becomes a risky business, with dark, poorly maintained roads posing serious safety threats, especially for female workers traveling alone.

To cope with these persistent challenges, CHWs often take precautionary measures. They avoid certain routes known to be unsafe, even if it means walking longer distances. Sometimes, they wait for long hours just to find a safer or more convenient mode of transport. Many also request their husbands or other family members to accompany them during field visits to ensure their safety. However, all these coping mechanisms come at a personal cost: CHWs frequently have to pay for their commute out of their own pockets, adding financial strain to their already heavy burdens.

Despite these exhausting and often dangerous journeys, transportation allowances, if provided at all are minimal, leaving CHWs to shoulder the physical, emotional, and financial burdens alone.

The struggles of Bangladesh’s CHWs to reach their communities highlight the urgent need for better support systems, fair compensation, and safer transportation options. Their tireless dedication deserves not just recognition, but concrete action to ease their burden and honor their service.

Written by:

Semonty Jahan, Senior Research Associate,

BRAC James P Grant School of Public Health, BRAC University

Walking Miles for an Interview: Lessons from the Household Level Survey in Barishal and Mymensingh

Walking Miles for an Interview: Lessons from the Household Level Survey in Barishal and Mymensingh

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We often walked for hours through fields, woods, and along riverbanks just to find one household. And sometimes, by the time we arrived, the man we were supposed to interview had already left the house for work.

Between February and March 2025, the SHINE Bangladesh team travelled to Mymensingh and Barishal to conduct a baseline survey for the SHINE project.  Our plan was to cover five subdistricts each in the Barishal and Mymensingh districts. The subdistricts in Barishal are mostly river-oriented and remote, where commuting often requires crossing waterways. In contrast, the subdistricts in Mymensingh are largely industrial and host internally migrated communities. There are areas located near the international border where movement by outsiders is often restricted due to political tensions and limited transportation options. It was fulfilling work but also full of twists, turns, and lessons we didn’t expect.

According to the sampling design, we had to move every 10 households to collect data.  The distance between two homes wasn’t just a number. The maps don’t tell you how rough the roads are—or how much your legs will feel it later. Especially in Barishal’s char areas (river islands), reaching homes was a journey in itself. We walked through muddy paths and broken roads and even crossed small rivers. Sometimes, a boat was the only way forward, and we had to wait for hours to get a boat to cross the river. Other times, it was a hired motorbike ride followed by a 30- to 40-minute walk on the edge of a paddy field. Some clusters were so scattered that reaching the next household felt like trekking to a new village altogether.

Even after walking for miles to reach the households with the formed clusters at villages, one thing quickly became clear that in both districts, catching the male household head at home was not an easy task. In most cases, they would be out of their houses for work; some were nearby, others far away. It got even tougher during the harvesting season. We found ourselves going back to those homes more than once, adjusting our timing or rescheduling the interview.

Almost half of the data collection happened during the holy month of Ramadan, and that changed a lot of our daily work patterns. Many women were busy with prayers, preparing iftar, or simply didn’t feel up to talking during the day while fasting. On the other hand, in more conservative char regions, sometimes religious norms made it difficult for male data collectors to speak directly to women, which meant in those cases we had to rely more on female team members or reschedule visits, or sometimes both.

The sampling plan looks good in the office, but in real life, villages don’t always follow our spreadsheets. In some places, there just weren’t enough eligible households, so we had to move beyond the original boundary. That meant more walking, more coordination, and fewer interviews per day. And the “every 10th household” rule? In areas where homes are far apart or irregularly spaced, sticking to that “every 10th household” rule became a logistical puzzle. We had to have an instant short team meeting at field sites with the team lead and field team to make adjustments while keeping the integrity of our data quality.

In the Dhobaura subdistrict, Mymensingh, we hit a difficult situation. A recent incident of sexual violence had shaken the community where we were supposed to collect data, and the atmosphere was tense. Police patrols and local gatherings made it nearly impossible to continue fieldwork for a while. We had to be very strategic and careful during that tense time. And in border-side unions like Dokkhin Maijpara, in Dhobaura subdistrict, where cross-border unrest is common, outsiders (like us) weren’t always welcomed with open arms. Some community members were wary or suspicious, and earning trust became part of the job. Inspection by border guards was common while commuting to the targeted households.

If this fieldwork taught us anything, it is that maintaining methodological rigor while remaining flexible, both in scheduling and in mindset, is essential. In future field plans, we need to consider wider data collection windows, aligned with local routines (i.e., harvesting time, Ramadan, etc.). We should consider gender-matched field teams, especially in culturally sensitive areas like ours. Field plans should have time for community outreach ahead of data collection, to ease suspicion and build rapport, and account for terrain and travel time, not just sample size.

SHINE isn’t just about surveys. It’s about connecting with communities, listening closely, and making sure those often left out are finally counted—and heard.

Written by: .
Ranjan Koiri (Senior Research Associate, BRAC JPGSPH, BRAC University),

Sukamal Chakma (Sr. Officer, Data Management, BRAC JPGSPH, BRAC University),

Md. Arfat Uddin (Sr. Officer, Data Management, BRAC JPGSPH, BRAC University)