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MCHIP Bangladesh Community Interventions
Jennifer Shindeldecker, Program Officer
on behalf of the MCHIP/Bangladesh team
Co...
Presentation Overview
• Background, program scale-up
• Design of MaMoni community approach
• Q & A
2
Background
• Abhay Bang’s research shows effectiveness of CHWs to reduce
newborn mortality in India (1990)
• Projahnmo sho...
Geographic Coverage – Projahnmo
Trial
4
Study conducted by:
JHU, ICDDRB, Shimantik
Coverage:
Sylhet District (3 upazilas)
...
Geographic Coverage - ACCESS
5
USAID’s ACCESS
preceded MCHIP
Coverage:
Sylhet (7 upazillas)
Beneficiary pop: 3.4 M
2006-20...
Geographic Coverage - MaMoni
6
MaMoni Project
(MCHIP in Bangladesh)
Coverage:
Sylhet (7 upazillas), and
Habiganj (district...
Geographic Coverage – MaMoni &
DHSS
7
MaMoni Project
(MCHIP in Bangladesh)
Coverage:
Sylhet (7 upazillas),
Habiganj, Lashm...
Geographic Coverage – MaMoni HSS
8
MaMoni HSS Project
(MCHIP in Bangladesh)
Coverage: (7 districts)
Hobiganj, Lakshmipur,
...
MaMoni Results Framework
9
Goal: Improved maternal and neonatal outcomes
1. Increase utilization of services
2. Increase k...
Approach from all levels
10
National
Division
District
Upazila
Union
Ward
Household/Community
MaMoni Integrated MNH-FP Package
11
Technical Area MaMoni Interventions
Maternal
health
ANC, TT immunization, IFA, skilled...
Community Health Workers
12
• 257 women trained on
MNH/FP/N, deployed to fill
vacancies or complement
providers in high po...
Community Volunteers
13
• Over 14,000 community
volunteers:
• Selected from and by local
communities
• Mobilize communitie...
Community Action Groups (CAGs)
14
• 2,132 CAGs formed in Habiganj
• 93% of 2,245 villages in the project area have a CAG
•...
Community Microplanning
15
• Innovative approach to link community members with
frontline health workers to raise health i...
Typical Microplanning Meeting
16
Microplanning Meeting Coverage in
MaMoni Project Areas
17
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
2011 2012 2013
Engagement of Union Parishads in
MNH/FP/N Activities
Local government engaged by:
 Providing cash or in-kind contribution...
MCHIP Community Activities
19
• Training of CVs and formation of CAGs
• Introduction of community microplanning
• Set up o...
MaMoni Preliminary Results in Sylhet
and Habiganj (2010 - 2012)
20
Indicator Sylhet
Dec 2010
Sylhet
Jun 2012
Habiganj
Dec ...
Sustainability of Community
Activities in Sylhet
Responsibility transferred to MOH&FW in September 2011.
As of 2013:
CHWs:...
Lessons Learned
• Integrated and comprehensive approach is key
to cost effective interventions
• Community can take certai...
THANK YOU!
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Thinking Locally and Acting Globally to End Preventable Newborn Deaths_Jennifer Shindeldecker_5.8.14

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Transcript of "Thinking Locally and Acting Globally to End Preventable Newborn Deaths_Jennifer Shindeldecker_5.8.14"

  1. 1. MCHIP Bangladesh Community Interventions Jennifer Shindeldecker, Program Officer on behalf of the MCHIP/Bangladesh team Courtesy: HIP
  2. 2. Presentation Overview • Background, program scale-up • Design of MaMoni community approach • Q & A 2
  3. 3. 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) 3
  4. 4. Geographic Coverage – Projahnmo Trial 4 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
  5. 5. Geographic Coverage - ACCESS 5 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
  6. 6. Geographic Coverage - MaMoni 6 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
  7. 7. Geographic Coverage – MaMoni & DHSS 7 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
  8. 8. Geographic Coverage – MaMoni HSS 8 MaMoni HSS Project (MCHIP in Bangladesh) Coverage: (7 districts) Hobiganj, Lakshmipur, Noakhali, Bhola, Brahmanbaria, Jhalulcathi, Piropur Beneficiary pop: 14.9 M 2013 - 2017 $ 50 M A consolidation of MCHIP investments and an expansion of district and national HSS
  9. 9. MaMoni Results Framework 9 Goal: Improved maternal and neonatal outcomes 1. Increase utilization of services 2. Increase knowledge, skill, practice at home 3. Increase family planning acceptance and understanding 4. Mobilize community to support demand 5. Systems strengthening 6. Increase stakeholder leadership, commitment and action
  10. 10. Approach from all levels 10 National Division District Upazila Union Ward Household/Community
  11. 11. MaMoni Integrated MNH-FP Package 11 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
  12. 12. Community Health Workers 12 • 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.
  13. 13. Community Volunteers 13 • 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
  14. 14. Community Action Groups (CAGs) 14 • 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
  15. 15. Community Microplanning 15 • 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
  16. 16. Typical Microplanning Meeting 16
  17. 17. Microplanning Meeting Coverage in MaMoni Project Areas 17 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% 2011 2012 2013
  18. 18. 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 18
  19. 19. MCHIP Community Activities 19 • 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
  20. 20. MaMoni Preliminary Results in Sylhet and Habiganj (2010 - 2012) 20 Indicator Sylhet Dec 2010 Sylhet Jun 2012 Habiganj Dec 2010 Habiganj Jun 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%
  21. 21. 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 positions CAGs: half of the CAGs continue to meet on a regular basis Community 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
  22. 22. 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 22
  23. 23. THANK YOU!
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