Executive Summary:
"A Healthcare Initiative that Made a Difference in the Garment Factories of Bangladesh"

by M. Abul Kalam Azad, published in the Journal of Asian Business, 22nd Volume #1 (2006).   

The Healthcare Project for the Garment Factory Workers of Bangladesh started as the vision of Andrew Crawford, a professor at the University of Michigan. After being diagnosed with leukemia treatable only through a costly bone marrow transplant. Crawford decided instead to spend the money to provide primary healthcare in a third world country. He believed that a small group of determined individuals utilizing developed nations’ resources and skills could make a real difference in the lives of thousands in developing nations. Professor Crawford, who had been involved in the garment industry in America, chose to focus the project on garment factory workers in Bangladesh.

Professor Crawford formed a 501(c)3 charity, Michigan International Development (MID), to implement the healthcare project. After Professor Crawford’s death in 2001, his son, Alex Crawford, took over his role as manager and sole donor.

MID’s objective was to improve the health status of garment workers in Bangladesh. A local partner was recruited to provide the care, while MID developed the healthcare service delivery model and the monitoring and evaluation systems to provide oversight and enable students to conduct research studies.

MID’s efforts to find a local partner were delayed by differences over fund management, project transparency, and research access. MID’s first attempt, with an internationally-renowned charity organization, was halted after disagreements about overhead costs, lack of transparency, and refusal to provide access for research and independent oversight. In the process, MID lost $30,000. A second attempt also was halted due to another organization’s refusal to comply with transparency standards, independent oversight, and access for students to conduct research studies. Finally, in March 2002, MID contracted with a local NGO, Manab Shakti Unnayan Kendra (MSUK). In May 2002, MSUK began the establishment of 28 in-factory clinics and one base clinic with laboratory for medical tests. From May 2002 through July 2003, a total of 11,210 workers had access to care through the clinics funded by MID, and 17,951 cases were seen. In addition, 3,840 workers were provided with health education, 320 supervisors/workers were trained on first aid and referrals, 861 medical tests were performed, and 1,113 workers received help in buying medicine and other services from an emergency fund.

During the project period, ten students from the University of Michigan conducted research projects in Bangladesh. With their help, MID conducted a cost-benefit analysis that revealed dramatic improvement in the productivity of the factories where healthcare services were provided.  This was an important step towards sustainability, since it demonstrated the program’s value to the factory owners.  

With completion of the final phase in mid-2003, MID transferred the healthcare program to the implementing partner MSUK, and the factory owners.  At the time of transfer 18 of the 28 factories agreed to pay for the services themselves, demonstrating that it is possible to provide factory-based healthcare on a self-sustaining basis. This program developed and demonstrated a working model of how to provide cost-effective and self-sustainable healthcare services to third world factory workers. With its goals met, MID exited the program in Bangladesh.

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Note: M. Abul Kalam Azad is a Program Director at Consortium X & The A. Scott Foundation. Many of the same people who started and volunteered in Michigan International Development continue to do nonprofit work through Consortium X.