This presentation provides an update on our research on close-to-community providers and Menstrual Regulation services

1. Strengthening reproductive services by close to
community providers:
Lessons from REACHOUT, Bangladesh
The REACHOUT project is funded
by the European Union
1
Dr. Mahfuza Rifat
Assistant Professor, Coordinator REACHOUT
James P Grant School of Public Health
BRAC University
June 12, 2016

2. Background
• REACHOUT, a five year implementation research project
-To understand and strengthen the role of close-to-
community (CTC) health workers
• REACHOUT Bangladesh, focuses on menstrual regulation
(MR), a procedure to safely establish non-pregnancy up to 6-
12 weeks after a missed menstrual period

3. Context analysis
• Poor women remain vulnerable to unsafe and uninformed
choices
• Inadequate supervision and referral structure: major gaps
identified by the partners
• A range of CTC health service providers to provide MR
services: formal, Informal

4. Objective
• To conduct implementation research and strengthen the role
of close-to-community (CTC) health workers, focusing
menstrual regulation (MR)

5. Implementing
Partners
Marie Stopes Bangladesh
(MSB)
Reproductive Health Services Training and
Education Program (RHSTEP)

6. CTC providers
Community
Close-to-Community
Providers
Health Centre
Majority female (71%)
Education: Secondary and above
Mean age: 31 years
Mean years of service: 2.7
Paid staff
Visits community

7. Interventions
 Facilitative referral
training for CTC
providers
 Supportive supervision
training for supervisor
of CTC providers
 Introducing revised,
structured referral card

8. Method
• Combination of quantitative and qualitative methods
• Ongoing process documentation
• Observations in terms of trainings and supervision
• Data collection of first phase ended in November, 2015

9. Key findings
• CTC providers feel motivated in contributing to well-being,
maintaining good relations and gaining positive recognition
• After intervention: more confident, comprehensive
information, networking with other providers, and saving
clients from clandestine operators
• Positive changes in supervision style of the supervisors

10. Key findings…
• New referral card helped in documenting activities, tracking
referred clients and ensuring referral fees to the referrer
• Many of the CTCs mentioned low pay as a demotivating factor
• Commonly faced challenge by the CTCs:
– Access to all households
– Insufficient time to engage in discussions

11. Key findings..
• Implementing organisations were supportive
• Perceived benefits were recognised by CTCs and women
• Regular meetings and dialogues was critical to avoid
implementation disruption
• Joint development of training manuals, involving trainers from
organisations promoted ownership

12. Lessons learnt
• Implementation research is a continuous process and
should be developed and adapted according to context
• Innovative interventions was feasible and acceptable
• Strengthening monitoring process, accountability and
recognition of hard work of the CTCs is critical
• Intervention targeting multi-layer of supervisors is
necessary for sustainability

13. Acknowledgement
• Implementation partners
– Marie Stopes Bangladesh
– Reproductive Health Services Training and Education Program
• The team REACHOUT Bangladesh
Sabina, Malabika, Rifat, Sadia, Salauddin, Irin, Riaz, Sumona, Tamanna,
Tahmina and Sushama
• All close-to-community providers
Thank you All