Improving Access & Coverage in PHC Concern EU funded programmes in Bangladesh and Sudan Key inputs from both field Teams & Partners Breda Gahan, Global Health & HIV Adviser 06.11.18

Bangladesh Urban - context Bangladesh is going through significant social and demographic changes, including rapid urbanization. The number of Bangladeshis living in urban centres is expected to rise from the current 53 million to almost 80 million by 2028. A large proportion of poor migrants often settle in slums and squatter settlements and even on the streets of major cities and towns. The key target group under this action is 878,647 extreme poor people living in slums, squatter settlements and on pavements of the four locations – Dhaka north, Dhaka south, Chittagong and Mymensingh (‘urban IDPs’).

Programme Objective & Expected Results - being implemented with Brac & MoLGRD&C The specific objective is to improve and increase sustainable, comprehensive and integrated primary health care (PHC), nutrition and population services to the urban poor in Dhaka and Chittagong cities and Mymensingh Municipality. ER 1: Increased availability of, access to and utilisation of Primary Health Care (PHC), nutrition and population services by poorest people in targeted locations. ER 2: Improved comprehensiveness of existing PHC services by integrating nutrition and addressing other service gaps. ER 3: Enhanced quality coverage of PHC, nutrition and population services at community and facility level ER 4: Strengthened sustainability of urban health, nutrition and population services in partnership and coordination with Government, NGO service providers and community groups.

WHO Health systems building blocks - What is missing? Participatory Health Care Management / the Community Health System

Key issues of successful Governance/Coordination in Bangladesh Urban Programmes with Brac & Sajida Foundation (Inputs from Emran & Team) Partnership (among the existing service providers, no parallel structure) Ownership of Local Govt. (with clear steering structure at Ministry level) Trusted coordination among local level actors/organization System strengthening components accompanied by products (health voucher, micro-health insurance, smart card etc.) Buy in of political leaders (social safety net engage MPs through APPG) In touch with beneficiaries by front line workforce Strong advocacy components at all tiers Research of different options/model to ensure sustainability (products) Effectively identifying and reaching the Poorest and extremely vulnerable Engaging community participation in health in all targeted locations

Improving health and nutrition status – service delivery through Health Voucher ANC visit, Maternal Nutrition Ed. Health Voucher Card

Sudan West Darfur - context In 2017, 4.8 million people (19%) of the population in Sudan required humanitarian assistance – a protracted emergency. Darfur has been particularly affected by the humanitarian crisis and OCHA’s estimated that about 3 million people were in immediate need of humanitarian assistance, part due to the 128K South Sudanese refugees, and in addition the region also hosts the majority (2.1 million) of all IDPs in the country. Currently 41% of the population lives in IDP camps or hard-to-reach areas, limiting access to basic health and nutrition services. The target group under this action is estimated at Kulbus Locality 112,340 and in Jebel Moon Locality 31,098 people.

Programme Objectives The overall objective is to improve the living conditions of IDPs, returnees and local communities, by addressing the root causes of irregular and forced migration by: Strengthening the local health systems to deliver a basic package of health services in West Darfur and to create a more conducive and sustainable living environment for host and displaced populations; Strengthening the governance capacity of states and local authorities for a well-functioning and sustainable health system; Improving the access and quality of primary health care including nutrition services; and Creating a more participatory and inclusive health system through involvement of local communities. Specific Programme Objective: To improve the provision of basic health and nutrition services for vulnerable populations in West Darfur.

Challenges & Learning to date (Inputs from Chizo and Team) - Planning and Budget changes in the project due to input from the SMoH. - Lack of capacity of local partners which has caused additional delays. - Inability to meet women at point of need is difficult, and inability to retain qualified staff in remote areas, and due to insecurity at times. - Infrastructure is grossly inadequate at community level and may require much more than the project can provide. - Bureaucracy in the government at state and federal level causing approval delays. Participatory planning with donor, SMoH, local NGO partner and communities leads to informed action and progress, albeit slow at times! Now focusing on Forcier Consulting Baseline Report recommendations towards accelerating progress on Programme Objective and in the 3 result areas:  Result 1. Access to and quality of health and nutrition services is improved. Result 2. Governance capacity of State and Local Health authorities is improved Result 3. A more inclusive and participatory health care management system is adopted

Expected results in both programmes are in coherence with SDG 3, in emergency, fragile and in development contexts - Alma Ata 1978 principles and revised in Astana 2018 https://bit.ly/2MWfAOv aiming -> increased availability, access, comprehensiveness, and enhanced quality coverage of Primary Health Care Services for the targeted urban poor in Bangladesh and conflict affected populations in Sudan, West Darfur through a health systems strengthening approach. (Thank You – Qs)