1. Jhuma Halder,P.O., PRADG-HumanRights Unit,CU-B
Reduction of Infant Mortality: A Case study in Chittagong Hill Tracts
Fact of the case study
The indigenous families are matriarchal, with women taking on the majority of the
responsibility for generating household income. Each ethnic group has its own dialect,
distinctive dress and rites and rituals. The region is much poorer than the rest of the
country.
The CHT consists almost entirely of hard-to-reach areas except the district towns. Most of
the region is inaccessible with no health infrastructure and government health positions are
chronically understaffed. People do not have knowledge of modern medical facilities; still
they depend on shamanism and faith healing. The death rate is very high in this area. The
severest problems recognized by all concerned across the rural and quite often remote
areas of CHT are high rates of maternal & child mortality and almost absence of safe
drinking water and sanitation facilities.
It was learned that neonatal mortality was not our concern when we started intervention
but now we do realize that without reducing neonatal mortality we can’t reduce child
mortality. Reducing maternal mortality & child mortality clinics need some live saving
equipment like nebulizer, portable oxygen cylinder etc. The project model considering its
good practices, achieved outputs and learning can be replicated in entire CHT as similar
health related problems exist and other underserved areas in Bangladesh.
Project Implementation through local NGOs
The project ‘Scale Up of Community Managed Local Health Services’ is funded by Cordaid
and implemented in Rangamati & Bandarban in partnership with local NGOs SPACE,
GRAUS and EKATA since January 2012.
The health service delivery component of the ‘Scale-Up of Community Managed Local
Health Services’ pproject covers 129 villages (‘para’) with a total of 36,356 direct
beneficiaries (15,270 are women, 10,907 men and 10,180 children) divided in 20
community clinic service areas. Awareness raising activities and capacity building activities
target an even larger area, with a population of 45,445 people in six unions of three sub-
districts Upazila in Bandarban and Rangamati districts.
Action taken: Linkage with community and clusters representatives in CEC, Women
Group, Adolescent Group and volunteers
Selecting clinics sites, community choice and interest for suitable locations where
catchment people can easily come, to be considered. During the establishment of the
clinics optimum community contributions in terms kind or cash will be ensured. At the
same time, catchment area will be marked based on how far people can come to this
clinic. Based on our previous projects, 7-8 villages fall into one clinics and accordingly
catchment area map showing clusters is drawn where status of people and households are
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identified. For reaching the awareness program in each corner of the catchment the total
catchment areas is divided into four – five clusters and from each of the clusters,
representatives for CEC, women groups, adolescent groups and volunteers are selected.
The clusters representatives in CEC, Women Group, Adolescent Group and volunteers are
usually responsible for that particular cluster for awareness raising. For delivering static
and satellite health services, local based Community Health Workers and Health
Promoters are selected for avoiding drop out, considering their existence beyond of the
project duration and relevant cultural practices. Other advocacy, collaboration,
coordination with GoB and other stakeholders, monitoring, capacity building,
documentation and knowledge management activities to be carried by CU along with other
implementing partners.
The community clinics and Community Health Workers were active throughout the project
period and provided health services to a total of 15,499 patients (9,611 women, 4,553 men
and 1,285 children). The Kollyani have a developed a good reputation and, as a result of
excellent networking efforts of the project partners, GoB has started to use the clinics as
hubs in their Immunization and Family Planning campaigns. In some of the clinics private
companies have started to sell drugs at discounted prices. These linkages contribute
greatly to sustainability.
Review of the project:
As it is three year's project, a systematic progress review followed by a mid - term review
has been carried by Concern Universal at the end of 2nd year. The project intervened
areas, which is the CHT, has high demand of many things among the people for living.
And one such important component is the health issue, which to a greater extent is being
supported and made possible by the project. In this context, the appreciation and
acceptance of this project work was evident clearly among the stakeholders. The project
has been running at its third and final year, and so a Mid – Term Review of the project has
been conducted during December 2013 with the objective to review the progress of the
project interventions in line with the objectives in respect to its target indicators.
Result of midterm project:
The analysis of the data showed that, 79.2% of the households know about the importance
of ANC & PNC, 89.9% knows about the nutritional care of woman during pregnancy and
82.2% knows the danger signs of pregnancy. Similarly, 86.9% of the households do know
about proper child care and 86.3% knows about the proper menstruation care. It was also
found out that 88.8% of the households have knowledge about safe water and sanitary
latrine requirement for healthy living. The households claimed that around 89.6% of such
information was gathered from the HPs of the project. In this aspect, Kollyani was very well
appreciated by the local people, which were analyzed through getting the data that around
50.3% of the households took the required services for curing from the Kollyani clinics.
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This statement was reflected through getting the data that around 40.4% of the woman
took the ANC & PNC services from the Kollyani in which for safe delivery purpose in
35.2% cases assistance for delivery was taken from the CHWs and HPs of the Kollyani
and 33.1% assistance was taken from the SBA of the project. The EPI system in the
community has improved in the way that currently 63.7% of the households were found to
take the EPI program for their child. Through the collection and analysis of the data, it can
be said that the project activities are running at its desired pace to achieve its outcome and
objectives in due time.
The project concerned persons like the CHWs, HPs and the WG, AG and VG were found
to be productive in contributing to the project objectives. But yet better learning through
more capacity building activities in the form of training or refresher can enhance the skill to
a greater extent and help them to play the role better for dissemination of such knowledge
among the community people who are targeted to be the beneficiaries of the project. The
Kollyani clinics have started its full operation for around one year time period till date and
in that aspect, its impact has just started to show its color. In this point of time, the project
would need proper guidance and motivation to move up the ladder. Despite some few
weak licks found the project is clearly seen running in the right path for achieving its goal
though if possible then some extension or expansion of the project phase would help in to
show greater impact and effect of the project, as the community people as per the CHT
context do need some more support to be capable enough to manage such clinics on their
own right away after the project phase out in this year.
Conclusion
Considering the action plan of 2nd year, the project has achieved satisfactory results in
relation to the target objectives. Though few activities were not undertaken on due time,
due to the incompletion of other related activities, but those have been planned to adjust
optimally. Some constraints to the context of CHT and recent political unrest in
Bangladesh have been noticed, but through active mobilization of the local partners, and
also by coordination with the local government and the CHT authorities; currently
everything is on track and going as per the plan. Project implementation is going on both
qualitatively and quantitatively by focusing the stated outputs having vision towards
converting it into long term outcomes.
