1. 15th November 2016 HSR 2016 Symposium
Leveraging Results from Facility Assessment for Service Readiness to establish 24/7 delivery services at peripheral level facilities in Bangladesh
15th November 2016
HSR 2016 Symposium
Dr. Selina Amin
Senior Advisor-Health system strengthening, MCHIP,
Save the children in Bangladesh

2. Presentation outline
Context and problem
What we have on the ground: findings from a national assessment
Conclusion
Relevance to other developing countries

3. Context and problem

4. Situation of skilled attendance at delivery
58% 42 32
37% Facility delivery
Although improving, facility delivery is still low in Bangladesh. 1%
29% Facility delivery 7%
Source: BDHS

5. Health service delivery system in Bangladesh

6. Why UH&FWCs are strategic for 24/7 normal deliveries
Coverage: 24,000 to 30,000 population
Distance: Most facilities located within minutes from the farthest point of their catchment area
Skilled provider: Designated facility with a provider (family welfare visitor) to conduct normal deliveries
Service continuity: Rapport with provider through repeated interaction during antenatal check-ups
Local ownership: Local committees (such as: UHFWC committee) interested to strengthen and support UH&FWCs
Easy to integrate a package of services: maternal newborn and child health, family planning and nutrition
Pregnant women not willing to travel if there is no complication

7. What we have on the ground: findings from the nationwide assessment

8. Methodology Union list collected from Bureau of Statistics
List of union facilities collected from DGHS and DGFP
at the national level and district levels
List verified with upazila level managers
Data collectors visited every union, collected data
using Tablets
Interviews with service providers at the facility
Quality check through 10% re-assessment by supervisors
Additional validation visits done by supervisors in a sample

9. Assessment Process

10. The sample
Total Union Level Facilities
4,461
UH&FWC: 302
USC: 797
RD: 87
UH&FWC: 3,275
DGFP (3,275)
DGHS (1,186)
Number of Union Level facilities conducting delivery
3,590

11. 14% 69% 17% A B C Categorization Criteria
No significant inputs or resources required
Criteria
Availability of human resources
Staff trained in midwifery skills
Condition of infrastructure
Availability of delivery room
Availability of instruments
Condition of their residences
Condition of approach road B
69%
Minor to moderate level of inputs required C
17%
Major inputs and resources required

12. Delivery related conditions at the union level facilities
Name of Divisions
Total number of facilities equipped to conduct delivery
Delivery Room available in good condition
FWVs having midwifery training
FWVs resides in the center N n %
Barisal
273 68 25 26 10 39 14
Chittagong
724
247 34
132 18
104
Dhaka
957
263 27
115 12 95
Khulna
487
154 32 72 15 35 7
Rajshahi
446
105 24 59 13 33
Rangpur
467
145 31 36 8
Sylhet
236 98 42 51 22 54 23
Total
3590
1080 30
523
396 11
Denominator is 3590 all through

13. Basic infrastructure for safe delivery:
Delivery Room in good condition
30%
FWV Room in good condition
29%
Electricity available
70%
Toilet in good condition
37%
3,590
Hand washing facility in good condition
36%
Delivery table in good condition
37%
Water supply available
49%

14. 3,590 81% 71% 73% 70% Staffing: FWV Posted SACMO Posted Aya available
MLSS available

15. 3,590 59% conducting deliveries
Utilization for delivery care: all facilities at the union
3,590
59% conducting deliveries
“1-60” deliveries in one year: Low performing (n= 1802)
“61-240” deliveries in one year: Medium performing (n=291)
“240+” deliveries in a year: High performing (n=28)
“No delivery”: (n=1802)

16. Delivery Room in good condition FWV trained in midwifery
Utilization for delivery care:
3,590
Delivery Room in good condition
75% conducting deliveries
1,080 +
“1-60” deliveries in one year: Low performing (n= 314)
“61-240” deliveries in one year: Medium performing (n=69)
“240+” deliveries in a year: High performing (n=10)
“No delivery”: (n=130)
FWV trained in midwifery
523
523

17. Delivery Room in good condition
Utilization for delivery care:
3,590
Delivery Room in good condition
82% conducting deliveries
1,080 +
FWV is residential
372
372

18. Delivery Room in good condition FWV is midwifery trained
Utilization for delivery care:
3,590
Delivery Room in good condition
1,080 +
89% conducting deliveries
FWV is residential
372 +
FWV is midwifery trained
211
211

19. conclusion

20. Conclusion
Majority of the union facilities can provide delivery care services with minor to moderate inputs– local level actions are required to address the gaps
Staff availability is not a major constraint – their deployment, training, residency and performance need to be strengthened. However, vacant positions need to be recruited
UH&FWC management committees need to be strengthened for local ownership and oversight
Management and supervision need to be strengthened to improve the performance of facilities that are “ready”
Minor repair, Deploy the support staff etc.
UH&FWC management committee can look after cleanliness, staff attendance, meetings.

21. Conclusion
There are several facilities that have all the basic elements for conducing normal vaginal delivery services, yet they are not currently providing such services.
This is an important missed opportunity and also a “low hanging fruit” for increasing deliveries at union level health facilities.
Most importantly, there are several facilities that have all…………….

22. Relevance to other developing countries
The Bangladesh experience highlights:
Importance of strengthening MNCH-FP services at primary level care
To improve access, especially in rural and under-served areas
To reduce the load in secondary and tertiary level facilities, which should focus on management of complicated cases
For improved tracking and follow up for continuum of care

23. Relevance to other developing countries
2. Ministry of health should emphasize in their plans:
Routine maintenance and repair of facilities
Long-term plans for development of human resources to serve at primary levels
3. Proactive engagement of local level governance structures. It is critical for:
Accountability
Local ownership
Resource mobilization for local level problem-solving

24. Thank you