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Maternal, Child and Reproductive Health Service Delivery Programme in Bangladesh

Maternal, Child and Reproductive Health Service Delivery Programme in Bangladesh. July 2005. Dr. Jafar Ahmad Hakim Director (MCH-Services) in-charge and Line Director (MC&RH Service Delivery) DGFP. Bangladesh Country Profile. Population: 135 million MMR: 320/100,000 LB CPR: 58%

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Maternal, Child and Reproductive Health Service Delivery Programme in Bangladesh

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  1. Maternal, Child and Reproductive Health Service Delivery Programme in Bangladesh July 2005 Dr. Jafar Ahmad Hakim Director (MCH-Services) in-charge and Line Director (MC&RH Service Delivery) DGFP

  2. Bangladesh Country Profile • Population: 135 million • MMR: 320/100,000 LB • CPR: 58% • TFR: 3/ woman • Total annual births: 3 million • IMR 65/1000 LB • NMR: 41/1000 LB • U5MR: 88/1000 LB

  3. Bangladesh Scenario of Maternal Health • About 90% deliveries occur at home • Only 12% deliveries are conducted by Medically trained personnel. • Low ANC (56%) and PNC (18 %) • Poor knowledge of community on danger signs of pregnancy • Socio-economic differentia: • Do not have access to any ANC • 69% in lower wealth quintile • 22% in richest quintile

  4. MMR in Bangladesh by Geographic Division: 1999- 2000

  5. Safe Motherhood-Definition Safe motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and child birth.

  6. Safe Motherhood- Elements • Antenatal care (ANC) • Safe Delivery including Emergency Obstetric Care: C-section etc. • Postnatal care (PNC) • Family Planning • Prevention of Unsafe Abortion and management of complications of abortion. • Neonatal care

  7. Causes of MMR Causes of maternal death • Complication of unsafe abortion • Severe Bleeding • Eclampsia • Obstructed labour • Infection/sepsis • Violence Maternal Morbidities due to Child Birth • Fistula (VVF & RVF) • Prolapse • Infection • Sterility

  8. Barriers to Safe Motherhood • Limited access to good and quality health services for antenatal, postnatal and delivery care. • Socio ecoinomic factors • Inadequate community awareness • Family beliefs, norms, objection • Distance • Lack of transport • Cost

  9. Barriers to Safe Motherhood The Delays for Safe Motherhood • First Delay- Decision making at home • Second Delay- Transportation to service centre. • Third Delay-Delay in receiving treatment in service centre.

  10. National Maternal Health Strategy By 2010: • to increase skill attendance at birth from 12% to 50%; • to increase met need of EOC from 27% to 70%; • to achieve universal knowledge about danger signs of pregnancy/child birth and referral to centres with EOC services and • to increase CPR from 54% to 70%.

  11. Possible Remedies • Good quality maternal health care is the single most important intervention to prevent maternal and newborn mortality and morbidity. • Maternal health services, including essential obstetric care for complications, must be made accessible and available to all women during pregnancy and childbirth. • Families and communities have to play critical role in ensuring that safe motherhood is achieved.

  12. Possible Remedies Contd… • Education program should focus on improving nutrition for girls and women; facilitating women’s access to maternal health care before, during and after pregnancy. • Men to be sensitized on their role in Safe Motherhood • Political commitment • Address three delays- delay in decision-making by families, delay in transportationto hospitals/clinics and delay in getting emergency obstetric care services.

  13. Four pillars of Safe Motherhood

  14. Trends in total fertility rate, Bangladesh 1971-2004

  15. Trends in contraceptive Use

  16. Trends in Current use of Family Planning methods (Method mix-%)

  17. Discontinuation rate of Contraceptives (%)

  18. RH-EOC Services in MCWCs • 67 MCWCs are providing EOC services in district, Upazila and union level. • Services including ANC, PNC, Safe delivery, C-section, Treatment of complication of abortion etc. • Family Planning services especially clinical contraception. • Counseling for adolescents, male services and VAW • Syndromic approach for RTI/STI case management and HIV/AIDS prevention services.

  19. Major MCH & RH activities/strategis under taken during HNPSP (2003-2006) • To ensure domiciliary visits by FWAs for providing MCH-FP services. • Use of unit-wise FWA Registers for proper recording and ensuring of MCH-FP services. • Organization of satellite clinics: • 8 sat. Cl. per union per month • Increasing coverage for conducting safe deliveries close to clients by skilled personnel • SBA Training (6 months) for FWAs & FeHAs • Six months Midwifery training for FWVs

  20. ----------------- Contd.. • Improvement of MCH-FP services in 1,500 UH&FWCs (average three in each Upazila) including safe delivery and VSC services. • Trained manpower (FWV, SBA) • Equipment & furniture • Physical expansion/renovation • “User-friendly” environment • Expansion of coverage of EOC services in MCWCs • Expansion of beds in MCWCs (from 10 to 20 beds in 30 MCWCs) • Ten new EOC MCWCs is being constructed. • Developing Adolescent Health Strategy in collaboration with all stake holders • Establishing EOC services in ten newly constructed MCWCs.

  21. ------------- Contd… • Expansion of beds & services in MCHTI, Azimpur (from 100 to 173 beds) • Expansion/construction of MFSTC into 100 beds MCH-FP hospital including EOC services. • Introduction of Emergency Contraceptive Pill (ECP) • Essential newborn care for reducing Neo-natal mortality. • Other Child Health activities such as EPI, IMCI, ARI etc.

  22. ………….Contd… • 862 UH&FWCs selected for upgrdation of MCH-FP services. • 16,000 B.P. machines and 16,000 stethoscopes procured and now being distributed to all service centres of the country. • 1,000 Labour Tables and 1,000 Baby Weight machines procured and being distributed to the upgraded UH&FWCs.

  23. ………….Contd… • Adequate quantity of D.D.S kits procured under Revenue and Development budget. • Drugs for RTI/STI case management procured. • RH-EOC equipment procured with UNFPA assistance for the MCWCs. • Revenue and Development allotment given to MCWCs for purchase of drugs and MSR.

  24. Major Activities of the TA project “Strengthening Delivery of RH Services” assisted by UNFPA • Continuing support for providing RH-EOC services in 67 MCWCs • Ten MCWCs selected as Centre of Excellence and providing Male services, Adolescent and Youth Friendly service, VAW case management and referral. • 67 MCWCs are developed to provide IP/PAC Syndromic Approach for RTI/STI case management, HIV/AIDS prevention services

  25. …… Contd. • Training of service providers from selected 16 MCWCs on early detection of Cervical Cancer through VIA method. • Skilled Birth Attendant (SBA) training for FWAs &FeHAs is going on in 28 districts. • ECP training completed in almost all Upazilas (75%) • RH-EOC training for Doctors and FWVs in Medical Colleges Hospitals, MCHTI and ICMH. • Continuing Medical Education (CME) training for the service providers of MCWCs on updated knowledge and concept every year. • Client Data Recording System (CDRS) training of service providers of 64 MCWCs for keeping clients information in computers

  26. --------------- Contd.. • Making all MCWCs and UH&FWCs women, baby and adolescent friendly in phases; • To ensure high quality of RH: MCH-FP care in all service centers. • Strengthen the provision of pro-poor reproductive health care services in disadvantaged geographic areas including urban slums. • Improve management skills, supportive supervision, performance monitoring and program evaluation.

  27. Maternal, Child and RH Service Delivery program under HNPSP 2003-2006 Current status 2003 Indicators Projection by 2006 MMR per 1,000 2.75 3.2 (NMMS-2001) IMR per 1,000 66 (BDHS-2000) 48 NMR per 1,000 42 “ 32 TFR 3.3 “ 2.9 CPR % 54 “ 62 Discontinuation (%) rate of contraception <30 48 “

  28. Maternal, Child and RH Service Delivery program 2003-2006

  29. Performance of 64 MCWCs

  30. Lessons Learned and Conclusion • MCWC programme has been considered as one of the successful programmes of MOH&FW; • Praised in home and abroad including UN; • Commendable success with limited manpower (only 02 MOs and 04 FWV/MCWC); • Possible reasons of success: • Commitment of doctors and other staff; • Team spirit of the service providers; • Support from programme managers of all level;

  31. …. Contd…. • Support of the community and field workers; • Linkages with upper and lower service centres; • Support of other departments and agencies; • Regular in-built supportive supervision by QAT, NPPP and MCRH unit, DGFP. • We hope that this success would be further strengthened and replicate in other fields of our national programme.

  32. Thank you

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