Country Team Action Plan Bangladesh

Goal Reduce Fertility, Maternal and Neonatal Mortality through an integrated Post Partum Care Package

Package components ComponentBest Practices Family PlanningPost partum contraceptive, LAM, PP sterilization ENCC-ENC, F-ENC Prevention of PPH AMTSL, C-Misoprostol PACPAC and FP Nutrition Maternal and Newborn (Exclusive BF) Nutrition, Vit. A, IFA

Where are we now? –Current levels of accomplishment/Progress and challenges since Bangkok 2007 Six Divisional workshop organized by DGHS, DGFP and NGOs on Best practices (Participants: Div. and District level H & FP Managers, Specialist, MO, Nurses, FWV, MA, SACMO, Paramedics, HA, FWA and NGO worker etc.) AMTSL Training – Doctors, Nurses, FWV, C-SBA Key programs: EOC, DSF, C-SBA, Midwifery, MNH, MNCH, MNCS, Prevention & management of Fistula, Blood Transfusion, Prevention of HIV transmission, Com SS for EOC.

Problems/challenges 1.Lack of adequate EOC trained HR at all levels 2.Retention of HR at rural, remote and hard to reach areas 3.Transfer of EOC trained manpower to non-EOC facilities (Retention) 4.Generating demand in the community 5.Lack of Community support system (aware, support) 6.Private practitioner is not aware to address PPH

Where do we want to be? Major Objectives Best Practice Chosen for Scale-Up and Its Components: Integrated PP Care Package focusing PPH Desired levels of accomplishment By 2015 Maternal Mortality due to PPH will be reduced by 40% through implementation of Integrated PP Care Package

What are the gaps? List gap between current status and desired levels of accomplishment PNC coverage is 22% and SBA is 18% desired level of Management of PPH is 40% List reasons for the gap Lack of adequate skill HR (C-SBA is 5000, Target-13,000. EOC trained Doctors -700, Target-1000, Nurses-700, Target-1000) Lack Integrated activities, supportive supervision, monitoring and MIS

What interventions can we use to close the gap? Increase coverage AMTSL, Assisted delivery Intervention will be implemented in Integrated way through DGHS, DGFP, NGO and PPP both at Facility and Community level Intra and inter Ministerial and sectoral collaboration with community involvement

List activities to carry out the interventions Fill up vacant post Training and Refresher training Motivation of service providers (incentive career plan) and clients Supportive supervision Monitoring & Evaluation

What are the possible challenges to the intervention? 1.To increase adequate Skill Service Providers 2.Retention of skill HR 3.Motivation of service providers and Com. Support Group 4.Sustainable supply of logistic 5.Coordinated activities of DGHS and DGFP 6.Leadership, Monitoring, MIS and PPP 7.Effective Referral mechanism and BCC

Who are the possible partners, allies, and stakeholders? Executive agency: MOHFW Implementing agency: DGHS and DGFP Supportive organization: Professional bodies like – BMA, OGSB, Bangladesh Peri-natal Society, Nursing Council Partners: Dev. Partners, Private Providers and NGOs

What is the evidence to support this best practice? Global: Nepal, Ghana, Indonesia, Tanzania, Ethiopia, Ecuador, Dominica Republic National evidence (AMTSL practice at facilities and use of Misoprostol at Community level) What actions are needed to provide additional evidence? Periodic evaluation (process and impact), Maternal Mortality Survey 2010 is going on Is better documentation of the evidence needed? Yes.

What are the modifications needed to improve the intervention’s scalability? After final/periodic evaluation modification will be considered Improve capacity of Govt. to lead the process Coordinated activities of DGHS, DGFP, NNP, Dev. Partners, Private Practitioner and NGOs

Who will be involved in scaling-up? Organizations responsible for scaling-up: MOHFW, DGHS and DGFP. NGOs, DPs, Professional bodies and Private Practitioners Capacity of the organizations to scale-up and what implications this has for scaling-up. Good infrastructure, Needs assessment (Training, supply, monitoring, leadership, MIS, advocacy) Who will be part of the team to support the process of scaling-up? National PPH Task force. (Evaluation will be done and placed to national authority - MOHFW)

What are the opportunities and constraints of scaling-up? Opportunities: Commitment of Ministry, DGHS, DGFP Support from Dev. Partners, NGOs, Professional bodies, Revitalization of Community Clinic Project Constraints of scaling-up and how they will be avoided Constraints: Scale-up country wide, skill HR, supply of logistic, Monitoring and MIS Avoid by: Govt. leadership, Partnership with DPs, NGOs

Strengthening EmOC services Demand Side Financing (DSF): Maternal Health Voucher Scheme Community based Skilled Birth Attendant (SBA) Programme - MNH, MNCH, MNCS, SMPP - National Fistula Program, - Women Friendly Hospital Initiatives, - Adolescent Reproductive Health Programme - Others Reduce Maternal Mortality & Morbidity Program for Reproductive Health & Safe Motherhood Program for Reproductive Health & Safe Motherhood

What policy, regulatory, budgetary, or other institutional steps are needed? Needs national guidelines on Post partum care package and develop monitoring indicators. Coordinated action plan of Govt., DPs, NGOs and Private Sectors lead by MOHFW Inclusion in next SWAp with budgetary allocation Up dating training curriculum (pre and in-service) Ensure uninterrupted supply and logistic

Who will advocate for these? When? How? Who? DGHS and DGFP Others – White Ribbon Alliance (WRA), Bangladesh and EngenderHealth How? Series of consultation, policy dialogue, workshop and media support When? Immediately the Team will report to MOHFW

Where, when and how will the best practice be expanded? Expansion to new geographic sites or populations? Refresher training to 32 districts within one year Expansion (facility level) in rest 32 district within two years Expansion (community level) 25 districts How will the best practice be disseminated to new areas or populations? By developing an action plan for the expansion (Training, budgetary allocation, logistic, develop capacity of the facilities and training institution, increase community support system)

What will be the costs of expansion and how will needed resources be mobilized? The cost will be calculated based on the current demonstration Estimated: Tk. 200 m (30 m u$), mobilized from SWAp (HNPSP)

How will the process, outcomes and impacts be monitored? How will results be fed into decision-making? Through monitoring checklist Periodic evaluation How will results be fed into decision-making? During revision of ADP and OP

Thank you very much