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Maternal, Child and Reproductive Health Service Delivery Programme in Bangladesh Dr. Jafar Ahmad Hakim Director (MCH-Services) in-charge and Line Director.

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Presentation on theme: "Maternal, Child and Reproductive Health Service Delivery Programme in Bangladesh Dr. Jafar Ahmad Hakim Director (MCH-Services) in-charge and Line Director."— Presentation transcript:

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

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

3 Bangladesh Scenario of Maternal Health About 90% deliveries occur at homeAbout 90% deliveries occur at home Only 12% deliveries are conducted by Medically trained personnel.Only 12% deliveries are conducted by Medically trained personnel. Low ANC (56%) and PNC (18 %)Low ANC (56%) and PNC (18 %) Poor knowledge of community on danger signs of pregnancyPoor knowledge of community on danger signs of pregnancy Socio-economic differentia:Socio-economic differentia: –Do not have access to any ANC 69% in lower wealth quintile69% in lower wealth quintile 22% in richest quintile22% in richest quintile

4 MMR in Bangladesh by Geographic Division:

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

7 Causes of MMR Causes of maternal death Complication of unsafe abortionComplication of unsafe abortion Severe BleedingSevere Bleeding EclampsiaEclampsia Obstructed labourObstructed labour Infection/sepsisInfection/sepsis ViolenceViolence Maternal Morbidities due to Child Birth Fistula (VVF & RVF)Fistula (VVF & RVF) ProlapseProlapse InfectionInfection SterilitySterility

8 Barriers to Safe Motherhood Limited access to good and quality health services for antenatal, postnatal and delivery care.Limited access to good and quality health services for antenatal, postnatal and delivery care. Socio ecoinomic factorsSocio 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 First Delay- Decision making at home Second Delay- Transportation to service centre. Second Delay- Transportation to service centre. Third Delay-Delay in receiving treatment in 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 skill attendance at birth from 12% to 50%; to increase met need of EOC from 27% to 70%;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 andto 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%.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.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.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.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.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 MotherhoodMen to be sensitized on their role in Safe Motherhood Political commitmentPolitical commitment Address three delays- delay in decision- making by families, delay in transportation to hospitals/clinics and delay in getting emergency obstetric care services.Address three delays- delay in decision- making by families, delay in transportation to hospitals/clinics and delay in getting emergency obstetric care services.

13 Four pillars of Safe Motherhood

14 Trends in total fertility rate, Bangladesh

15 Trends in contraceptive Use

16 Trends in Current use of Family Planning methods (Method mix-%) Pill IUD Injectables Norpltant Vaginal methods UU Condom Female sterilization Male Sterilization.50.6 Periodic abstinence Withdrawal Other traditional method Total54%58%

17 Discontinuation rate of Contraceptives (%) Method Reason for discontinuation Method failure Desire to become pregnant Side effects or health problem Other reasons Total Pill Injectables Condom Periodic abstinence Withdrawal All methods

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

19 Major MCH & RH activities/strategis under taken during HNPSP ( ) To ensure domiciliary visits by FWAs for providing MCH-FP services.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.Use of unit-wise FWA Registers for proper recording and ensuring of MCH-FP services. Organization of satellite clinics:Organization of satellite clinics: –8 sat. Cl. per union per month Increasing coverage for conducting safe deliveries close to clients by skilled personnelIncreasing 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.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 MCWCsExpansion 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 holdersDeveloping Adolescent Health Strategy in collaboration with all stake holders Establishing EOC services in ten newly constructed MCWCs.Establishing EOC services in ten newly constructed MCWCs.

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

22 ………….Contd… 862 UH&FWCs selected for upgrdation of MCH-FP services.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.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.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.Adequate quantity of D.D.S kits procured under Revenue and Development budget. Drugs for RTI/STI case management procured.Drugs for RTI/STI case management procured. RH-EOC equipment procured with UNFPA assistance for the MCWCs.RH-EOC equipment procured with UNFPA assistance for the MCWCs. Revenue and Development allotment given to MCWCs for purchase of drugs and MSR.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 MCWCsContinuing 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.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 services67 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.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.Skilled Birth Attendant (SBA) training for FWAs &FeHAs is going on in 28 districts. ECP training completed in almost all Upazilas (75%)ECP training completed in almost all Upazilas (75%) RH-EOC training for Doctors and FWVs in Medical Colleges Hospitals, MCHTI and ICMH.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.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 computersClient 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;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.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.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.Improve management skills, supportive supervision, performance monitoring and program evaluation.

27 Maternal, Child and RH Service Delivery program under HNPSP “ CPR % “ TFR “ NMR per 1, (BDHS-2000) IMR per 1, (NMMS ) MMR per 1,000 Projection by Projection by Current status Current status Indicators Discontinuation (%) rate of contraception 48 “ <30

28 Maternal, Child and RH Service Delivery program

29 Performance of 64 MCWCs

30 Lessons Learned and Conclusion MCWC programme has been considered as one of the successful programmes of MOH&FW;MCWC programme has been considered as one of the successful programmes of MOH&FW; Praised in home and abroad including UN;Praised in home and abroad including UN; Commendable success with limited manpower (only 02 MOs and 04 FWV/MCWC);Commendable success with limited manpower (only 02 MOs and 04 FWV/MCWC); Possible reasons of success: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.We hope that this success would be further strengthened and replicate in other fields of our national programme.

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