Accelerating Progress Towards Maternal and Neonatal Mortality Reduction Using a Rights-based approach A joint project by GOB, UNFPA, UNICEF and WHO

Goal To contribute to the HNPSP objectives of reduction of maternal and neonatal mortality and morbidity, with emphasis on equity issues to achieve MDGs 4 and 5

Rationale To work for reduction of maternal and neonatal mortality and morbidity - a priority both for Govt,civil soceity and DPs,part of HNPSP. Greater participation of citizen and decentralized approach with local level planning increasing health system accountability - addressing prevailing voicelessness and social exclusion of the poor.

Purpose Purpose 1: To contribute to increased utilization of maternal and newborn health (MNH) services by enhancing the capacity of MNH teams at district and below, to ensure quality and continuum of maternal and newborn care, that is inclusive and equitable Purpose 2: To contribute to women, families and communities practising key behaviours for improving maternal and newborn health and exercising their right to care

Outputs and Interventions Output 1.1: Enhanced capacity of district and sub-district health and family planning management teams in participatory planning, implementation, monitoring and evaluation Interventions –1.1.a: Capacity-building of the district and sub-district health and family planning management teams in participatory planning and the plan endorsement process, implementation, monitoring, supervision and evaluation. – 1.1.b: Instituting a functional MNH QA system, including an HMIS, for facilities at upazila and district levels.

Outputs and Interventions Output 1.2: Increased availability of a quality continuum of MNH care and services Interventions –1.2.a: Ensuring availability of quality continuum of MNH care and services at all service levels (including specific piloted services in selected facilities) and strengthening the MNH referral system. –1.2.b: Ensuring availability of quality EMONC services 24 hours a day, 7 days a week. –1.2.c: Ensuring availability of quality FP services –1.2.d: Establishing partnerships /alliances /networking with NGOs, CBOs, other civil society groups and private sector service providers to ensure increased availability and access to quality MNH care and services for communities

Outputs and Interventions Output 1.3: Increased availability and quality MNH HR for assured delivery of MNH services through capacity-building and planning Interventions –1:3:a: Improving availability and quality of MNH HR, including implementation of innovative strategies for deployment recruitment and retention of staff. –1.3.b: Increasing the number of community-based SBAs. – 1.3.c:Strengthening the competencies of the staff at EMONC facilities. – 1.3.d: Piloting creation of midwifery cadres.

Outputs and Interventions Output 2.1: Developed capacity of women, family decision makers and communities to practice selected MNH behaviours, most importantly in obtaining skilled care at birth and responding to obstetric and neonatal emergencies Interventions –2.1.a: Developing an evidence-based strategic BCC plan – for women, families and communities - for providing and acting on information, and for supportive interpersonal communications and counseling on healthy MNH practices. –2.1.b: Building capacity of the GOB, NGOs, CBOs and social networks to implement all types of BCC activities. –2.1.c: Promoting birth planning interventions to women, key family decision-makers (husbands, mothers-in-law, others) and community level service providers.

Outputs and Interventions Output 2.2: Enabling environment created to support women to increase their rights to MNH care, by working with women, families and communities Interventions –2.2: Developing and implementing strategies to encourage informed and dignified demand for services, especially by the poor, vulnerable and marginalized groups.

Outputs and Interventions Output 2.3: Developed community support systems that strengthen linkages among women, families and communities, as well as between them and the health system Interventions –2.3: Establishing new or strengthening existing consumer and community support groups to sponsor dialogues and design and implement effective linkages

Outputs and Interventions Output 2.4: Strengthened participation of community groups to improve quality of care and provider accountability Interventions –2.4.a: Developing and implementing a community participation plan that includes specific routine or emergency support activities to improve quality of MHN care and services at household and community level –2.4.b: Increasing dialogue between community groups and providers for mutual examination of provider accountability issues and development of strategies to improve provider accountability.

Added Values Decentralized and local level planning with an equitable, inclusive, and rights-based approach A quick start to reduction of Maternal and Neonatal Mortality Reduction – in line with the HNPSP Transparancy of the district plan including fund transactions Acknowledging demand and supply side factors Diversification of service provision by partnering with NGOs and Private sector Building capacity of service providers and clients (women, families and communities) Effective monitoring and supervision along with the stakeholders and Health Watch Groups Synergies of 3 UN Agencies working together

Coordination Structure PCC UNFPA, UNICEF, WHO and PC National Steering committee UN Field Unit Upazila MNH Committee NGOs, CBOs, CSO DfID Project team PC, Programme Officers, MO, FO District MNH Committee UN Working group with FP & PC Union level Task Force Line Directors National Steering committee UN Field Unit Upazila MNH Committee DfID District MNH Committee Union level Task Force Line Directors NGOs, CBOs, CSO Project team PC, Programme Officers, MO, FO UN Working group with FP & PC National Steering committee UN Field Unit Upazila MNH Committee DfID District MNH Committee Union level Task Force Line Directors PCC Unicef, UNFPA, WHO & PC

Operation and Fund Management Plan Appraised & approved District MNH Plan Technical Appraisal Committee Funds Management UNICEF & UNFPA NGOs CBOs CSOs Community Principal UN Agency District MNH Committee District MNH Plan Principal UN Agency Technical Appraisal Committee Overseas Procurement Endorsed District MNH Plan Activities at National Levels UpazilaMNH Committee Upazila MNH Plan District/Upazila cost centres Funds Management one UN Agency NGOs CBOs CSOs Community Technical Appraisal Committee District MNH Task Force Upazila MNH Task Force Field Office staff of Unicef & UNFPA, WHO Endorsed Upazila MNH plan Union

District Selection Criteria 1.Human Poverty Index 2.IMR 3.TFR 4.CPR 5.ANC coverage during last pregnancy 6.Last delivery assisted by Skilled Persons 7.Female Literacy Rate

Planning of Programme 6 months 18 months 2 years Full implementation 4 districts Startup and prep phase Scale up period 18 districts Total 22 districts to be covered in 4 years Phase 1 Phase 2

Activities at District / Upazilla MNH and EMO NC 22 districts = 44 ”cost centers” –Development of Plans –Facility and Provider Improvements Training Service Upgrades to Facilities (avaiability, quality) –Improving linkages with community, including transport –Improving retention of staff and addressing other HR issues –Equipment/Supplies –Improving facility ”culture” = bbetter/quicker service for incoming patients/clients (reduction in waiting time) –Other facility-related improvements to services

Activities at District / Upazilla –NGOsCSOs Involving them in: –Community mobilization –Consumer-related ”watch groups=accountability –Service delivery improvements –Private Providers Selected improvements to services as per national standards –Community level support To increase knowledge/awareness To change behaviours – increase demand To strengthen links with facilities (including community transport schemes and other support for woman/family) To strengthen confidence of women and key family decisio-makers To enable women and communities to monitor services

Proposed Budget  Total Budget : $M 28 for 4 Years  Duration: July 2006 – June 2010  Year-wise Budget: $M 1.0 for 2006 (jul- dec), $M 7.2 for 2007, $M 7.7 for 2008, $M 7.6 for 2009, $M 4.5 for 2010 (jan- may)