MCHIP Bangladesh Community Interventions

Jennifer Shindeldecker, Program Officeron behalf of the MCHIP/Bangladesh team

Courtesy: HIP

Presentation Overview

• Background, program scale-up• Design of MaMoni community

approach• Q & A

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Background

• Abhay Bang’s research shows effectiveness of CHWs to reduce newborn mortality in India (1990)

• Projahnmo shows effectiveness of CHWs to reduce newborn mortality in Bangladesh (2001-2006)

• ACCESS delivers community based newborn interventions using CHWs in Sylhet (2006-2009)

• MaMoni works through the public health system to deliver MNCH/FP/N in Habiganj (a district model) (2009-2014)

• DHSS is an interim expansion of the district model to two new districts funded by USAID opportunistically in advance of the HSS procurement (2012-2014)

• MaMoni HSS strengthens national and district health systems to strengthen delivery and improve utilization of MNCH/FP/N in 7 districts (2013-2017)

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Geographic Coverage – Projahnmo Trial

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Study conducted by: JHU, ICDDRB, Shimantik

Coverage: Sylhet District (3 upazilas)Beneficiary pop: 742,000

2001-2006

SNL and USAID funded

A randomized control trial to determine effectiveness of community based intervention

Geographic Coverage - ACCESS

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USAID’s ACCESS preceded MCHIP

Coverage: Sylhet (7 upazillas)Beneficiary pop: 3.4 M

2006-2009

$ 5.8 M

Initial USAID investment to implement community based program at modest scale

Geographic Coverage - MaMoni

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MaMoni Project (MCHIP in Bangladesh)

Coverage: Sylhet (7 upazillas), and Habiganj (district wide)Beneficiary pop: 5.5 M

2009-2014

$ 13.5 M

An expansion of the package to include child health and nutrition. A switch to working through and supporting district public health systems

Geographic Coverage – MaMoni & DHSS

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MaMoni Project (MCHIP in Bangladesh)

Coverage: Sylhet (7 upazillas), Habiganj, Lashmipur, Noahkhali

Beneficiary pop: 10.4 M

2009-2014

$ 6 M

An expansion of the district model to two new districts in anticipation of MaMoni HSS

Geographic Coverage – MaMoni HSS

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MaMoni HSS Project (MCHIP in Bangladesh)

Coverage: (7 districts)Hobiganj, Lakshmipur, Noakhali, Bhola, Brahmanbaria, Jhalulcathi, PiropurBeneficiary pop: 14.9 M

2013 - 2017

$ 50 M

A consolidation of MCHIP investments and an expansion of district and national HSS

MaMoni Results Framework

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Goal: Improved maternal and neonatal outcomes

1. Increase utilization of services2. Increase knowledge, skill, practice at home

3. Increase family planning acceptance and understanding

4. Mobilize community to support demand5. Systems strengthening

6. Increase stakeholder leadership, commitment and action

Approach from all levels

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National

Division

District

Upazila

Union

Ward

Household/Community

MaMoni Integrated MNH-FP Package

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Technical Area

MaMoni Interventions

Maternal health

ANC, TT immunization, IFA, skilled attendance at birth, referral for EmOC, use of misoprostol for prevention of PPH, prevention and management of PE/E (including calcium supplementation)

Newborn health

ENC, breastfeeding, managing newborn complications, ETAT

FP Promotion of modern methods, LAM and PPFP (inclusion of LAM/PPFP counseling), referral for LAPM, compliance with USAID regulations

Handwashing

Handwashing (focus on perinatal period)

IYCF (added in 2012)

Immediate and exclusive breastfeeding, complementary feeding up to 2 years

Community Health Workers

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• 257 women trained on MNH/FP/N, deployed to fill vacancies or complement providers in high population areas

• 43 private community skilled birth attendants trained and supported to establish private-practice delivery services in their communities (covering 20% of the population)

 

• 2,000 depot holders (all women) trained and linked to local supply chains- many of whom earn enough income to support their families.

 

Community Volunteers

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• Over 14,000 community volunteers:

• Selected from and by local communities

• Mobilize communities around health issues and jump-start community action group (CAG) meetings.

• Unpaid• Receive 8 days of training• Workload: ~12 hours per

month

Community Action Groups (CAGs)

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• 2,132 CAGs formed in Habiganj

• 93% of 2,245 villages in the project area have a CAG

• 100% of CAGs have a health worker as a member

• 98% of CAGs have local government participating

• 100% of CAGs have emergency transport• 89% of CAGs in Habiganj have a collective

emergency fund available for maternal and newborn emergencies

Community Microplanning

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• Innovative approach to link community members with frontline health workers to raise health issues and streamline surveillance data

• Meetings in 396 units in Habiganj, 257 units in Sylhet

• After monthly EPI sessions, health workers and CVs:

• Share MNH/FP information and update health worker registers

• Update list of pregnant and high-risk mothers

• Update unit map to facilitate service delivery

• Prepare monthly action plan for service delivery, targeting identified individuals

• Identify problems raised by communities and jointly develop solutions

Typical Microplanning Meeting

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Microplanning Meeting Coverage in MaMoni Project Areas

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2011 2012 201350%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Engagement of Union Parishads in MNH/FP/N Activities

Local government engaged by: Providing cash or in-kind contributions for

MNH/FP/N services from public funds and human resources

Supporting birth and death registration, particularly neonatal deaths

Overseeing health facility/worker performance to ensure increased access and quality to services

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MCHIP Community Activities

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• Training of CVs and formation of CAGs• Introduction of community microplanning• Set up of referral system and emergency funds• Introduction of supportive supervision and

joint supervision visits• Engaging local government to support MaMoni

activities• Orientation of TBAs/depot holders to promote

key behaviors and ensure essential commodities at village level

• Training of private CSBAs to expand service coverage in hard-to-reach unions

MaMoni Preliminary Results in Sylhet and Habiganj (2010 - 2012)

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Indicator SylhetDec 2010

SylhetJun 2012

HabiganjDec 2010

HabiganjJun 2012

A. Percentage of recently delivered mothers who:Sought care for obstetric complications during delivery

55.4% 58.0% 37.7% 47.5%

Sought care for newborn complications 51.5% 54.2% 42.0% 46.1%

Used an SBA (including CSBA)

21.0% 25.8% 15% 19.4%

Received early PNC visits within 24 hours of childbirth

19.5% 23.0% 13.7% 17.7%

B. Percentage of married women who:Currently use a modern contraceptive method

34% 40.3% 39.1% 40.6%

Sustainability of Community Activities in Sylhet

Responsibility transferred to MOH&FW in September 2011.As of 2013:CHWs: Out of 259 MaMoni CHWs, 14 hired by MOH&FW, 88 employed by other GOB departments/NGOs, 6 elected to UP positionsCAGs: half of the CAGs continue to meet on a regular basisCommunity microplanning: 250 out of 257 community microplanning meetings and 52 out of 56 union follow-up meetings held. UPs: 52 out of 56 UPs allocated budgets for MNH/FP/N activities in the last fiscal year 21

Lessons Learned

• Integrated and comprehensive approach is key to cost effective interventions

• Community can take certain responsibilities in health care services

• Community interfacing with health systems is possible

• Local government institutions can play an important role in facilitating health care services

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THANK YOU!