Entrepreneurs as health-promoting agents: Community engagement for sustaining maternal and child nutrition practices within the Healthy Village In Urban Programme

Abstract

Background: Amongst the urban poor population in Bangladesh undernutrition of children and mothers remains an important public health concern where progression of care is restricted by high mobility, fragmented health services and socioeconomic constraints. Sustaining behaviour changes in these contexts relies not just on spreading of information but also on effective community-based strategies which facilitate change in the localities.

Objectives: This study aimed to understand how entrepreneurial Health-Promoting Agents engage with communities to support and sustain maternal and child nutrition practices within HVUP intervention areas. Specifically, it explored how Health Promoting Agents (HPAs) build and maintain relationships with community members and identified social, economic, and contextual factors influencing sustained engagement.

Methods: An exploratory qualitative study was conducted in selected urban and peri-urban areas of Lalmonirhat district under Max Foundation’s Healthy Village in Urban Programme (HVUP). The study population included HPAs, mothers/caregivers of children under five, and ESDO program staff who are implementing the project in field. A total of 24 participants were selected using purposive sampling. In-depth interviews (IDIs) with HPAs and mothers, and key informant interviews (KIIs) were conducted with program personnel. Data were collected through semi-structured interviews, audio-recorded with consent, and complemented by a desk review of program documents. Transcripts were analysed using reflexive thematic analysis with an inductive-deductive coding approach to identify key themes related to community engagement, trust-building, and sustainability.

Results: Successful HPA involvement in the community was decided by the relationship with the community was developed slowly by establishing a sense of trust with the mothers. Regular communication, positive experience and perceived good guidance from HPA was key in development of trust. Moreover, HPAs' confidence and efficacy in community interactions were improved through training, applying knowledge and skills from prior experience, and continuous supervision by programme staff. By combining localized health education, improved service delivery through system linkage, and training for entrepreneurship, HPAs played a variety of roles that enhanced their relevance and long-term involvement. Program sustainability and motivation were particularly substantiated through the incorporation of entrepreneurship. Mothers reported noticeable behavioural improvements that progressively emerged through trust and reinforcement, especially in hygiene and childcare routines.

Conclusions: From this study, we can see that consistent presence, self-sustaining mechanisms, trust-building, and supporting program frameworks are key components of entrepreneurial HPAs' long-term community engagement. Their strong presence promotes behaviour change within the community, while providing better access to services. These results emphasize the benefits of establishing entrepreneurial community-based models to enhance long-term maternal and child nutrition outcomes and strengthen urban primary health care methods.