National Institute of Population Research and Training Ministry of Health and Family Welfare

 Background of BDHS surveys  BDHS as monitoring tool for health sector program  Utilization of BDHS data  BDHS data dissemination approaches

 BDHS surveys are designed to provide estimates for HPNSDP program indicators for:  National level  urban and rural areas, and  seven administrative divisions

Bangladesh Fertility Survey (BFS) Bangladesh Contraceptive Prevalence Survey (CPS) Bangladesh Demographic and Health Survey (BDHS)

 Survey design and implementation goes through constant review process by  Technical Working Group  Sampling Committee  Technical Review Committee  Ethical clearance from BMRC

 Four weeks training for data collection staff  At least 3 days stay in each EA  Four stages of quality control  Each team has Field Editor for spot editing  Independent quality control team  Field check table and debriefing  Data consistency check and secondary editing

 Produces demographic and health data to support MOHFW for monitoring and evaluation of HPNSDP  Collects and analyses socio-economic, programmatic and community information  Provides regional differentials, equity analysis, public-private-NGO contributions, and gender segregated data  Provides trends data  Provides compatible data with other countries  Provides data for advanced studies, postgraduate and doctoral research

 BDHS provides 6 out of 8 indicators Indicators Baseline BDHS 2011 Target 2016 Neonatal mortality rate Infant mortality rate (IMR) Under 5 mortality rate Total fertility rate (TFR) Stunting among <5 children (%) Underweight among <5 children (%) Goal: Ensure quality and equitable health care for all citizens of Bangladesh

 BDHS provides 8 out of 9 indicators Indicators Baseline BDHS 2011 Target 2016 Delivery by skilled birth attendant Antenatal care coverage 4+ Postnatal care within 48 hours Contraceptive prevalence rate Unmet need for family planning Measles immunization by 12 months <5 Children with ARI receiving antibiotics Children (6-59 months) receiving Vitamin A in last 6 months 26% 20% 21% 62% 17% 82% 38% 83% 32% 26% 27% 61% 12% 84% 71% 60% 50% 72% 9% 90% 50% 90%  Result: Increase utilization of essential HPN services

 BDHS provides 2 out of 3 indicators Indicators Baseline BDHS 2011 Target 2016 Proportion of births in health facilities by wealth quintiles Use of modern contraceptives in low performing areas 1:8 Syl:25% Ctg:38% 1:6 Syl:35% Ctg:45% <1:4 Syl & Ctg:50%  Result: Improve equity in essential HPN service utilization

 BDHS provides 2 out of 2 indicators Indicators Baseline BDHS 2011 Target 2016 Rate of exclusive breastfeeding in infants up to 6 months Children 6-23 months fed with appropriate IYCF practices 43% 42% 64% 21% 50% 52%  Result: Improved awareness of healthy behaviour

 3 of 7 divisions are at replacement fertility (RF = 2.1).  Sylhet is 48% and Chittagong is 33% above replacement fertility.

 West divisions high CPR  Dhaka & Barisal medium CPR  Eastern divisions (Sylhet & Chittagong) below national CPR.  National CPR = 61.2  National CPR = 61.2

 Data on contraceptive method mix over time shows no increase in use of long acting and permanent methods (LAPM) like sterilization, IUD and implants. Findings resulted in a number of interventions to:  improve the quality of service provision related to LAPM  create demand for LAPM through behavior change and communication activities

 Data showed that to reach MDG 4, Bangladesh needed to reduce neonatal mortality  This led to:  advocacy for development of the Bangladesh Neonatal Health Strategy 2009  introduction of programs to improve newborn care

 DHS shows high inequity in use of maternal health by wealth Interventions on demand-side financing being tried to increase use of maternal health services by the poor. Improving equity gap now a national target  DHS highlights that Bangladesh women are marrying and bearing children at a very young age. Led to strong advocacy for assessing interventions that can raise age of marriage and delay childbearing.

 Data revealed drowning to be a major cause of child death  This led to:  operations research to test appropriate interventions  activities to raise awareness against child drowning  teaching swimming skills to children

 National Nutrition Services has launched a media campaign to focus feeding practices for infant and young children.  This is in response to BDHS, which showed little improvement in children’s malnutrition.  Currently 41% of children under age five are stunted or too short for their age.

 Data show no increase in exclusive breast- feeding practices between 1993 and 2007  Government enacted law increasing maternity leave for 6 months  Efforts continue to enforce a law against promoting infant formula and breast milk substitutes

 BUDGET SPEECH 2012: “ According to BDHS 2011, under-5 mortality rate has been reduced to 53 from 65 per thousand over the past four years. Currently, one third of women receive the assistance of the trained health workers during child birth. To increase this number further,  taking initiative to train 40,000 health workers of various tiers  ‘Maternal Health Voucher Scheme’ will be expand to another 27 upazilas  24-hour emergency maternal care service will be provided in 96 upazila health complexes.”

 BUDGET SPEECH 2012: “ We want to increase the rate of contraceptive use by 80% within 2021 to address the problem arising from the growing population.  We have made adequate budget allocation  We have built up sufficient stock of contraceptives  Contraceptive use has increased to 61% from 56% during the period from 2007 to 2011.”

Using BDHS: Feedback from users “ BDHS has been used by the government and the development partners for annual review of the Bangladesh health sector program. …… I could not live without it” Senior Health Economist, South Asia Region, The World Bank “UNFPA uses BDHS for advocacy, in policy dialogue with government, and in reviewing program strategies. It is an invaluable source of information for us” UNFPA Representative, Bangladesh “BDHS is the Bible of the health sector. It gives us direction on where we need to focus to improve performance. Use it as your guide” Director of Family Planning, Khulna Division, Bangladesh

 Release of preliminary results within 3-4 months of completion of field survey  National dissemination of final report and policy issues  Divisional dissemination  Special dissemination in all upazilas of Sylhet division

 Dissemination for targeted audience  HPNSDP evaluation team  Professional bodies  Internee medical students  Private medical practitioners (unqualified doctors, pharmacists)  Journalists

 31 articles in national newspapers, 37 articles in local newspapers and 5 television reports were made by the 20 national and local fellow journalists.

 One of the fellows, Mahbuba Zannat, staff reporter for The Daily Star, received the World Population Day Media Award 2010 by Ministry of Health and Family Welfare for an article on maternal mortality which she published under the fellowship program.

 Another fellow, Mintu Deshwara, staff reporter of The Daily Shyamol Sylhet reported on shortage of health care providers that was limiting the effective -ness of the FP program at Sylhet.  Story prompted the upazila authorities to begin active recruitment of new personnel.

 BDHS is a part of health sector program  Tries to produce quality data  Ensure participation of stakeholders and professionals in the implementation process  Comprehensive efforts have been made to increase utilization of data using targeted approach