1. Identify the Workload of Fieldworkers (FWAs) under Changed Circumstances Prof. Dr. M. Nurul Islam Associates for Research Training and Computer Processing (ARTCOP)

2. Objectives The general objective of the study is to identify the workload of the field workers (FWAs) under changed circumstances. The general objective of the study is to identify the workload of the field workers (FWAs) under changed circumstances. The specific objectives were The specific objectives were a. To determine the specific reasons for workload of the FWA workload of the FWA b. To assess how far family planning program is affected due to workload program is affected due to workload

3. c. To assess the impact of workload on the FP performance the FP performance d. To investigate the measures to be taken to reducing the workload of the FWAs

4. Methodology Study design: The study followed a cross-sectional design. Data sources: Primary Primary Secondary Secondary

5. Respondents: Program Managers Service Provider & Field Workers Females - UFPO - AUFPO - MO (MCH-FP) - AUFWO (MCH- FP) - SACMO - FWV - FWA - Women of reproductive reproductive ages ages Basically three categories of samples were selected for the study purpose, viz.

6. Multi-stage sampling procedure was followed to select the samples. At the first stage, all the upazillas of Bangladesh were listed according to population size. From the list 20 upazillas were selected by Probability Proportional to Size (PPS) method. From each selected upazilla 6 unions were selected by simple random sampling technique. One village was selected randomly from each selected union. Sampling

7. Data collection tools: Instrument Quantitative In-depth interview Qualitative Observation

8. Specific reasons for work load Increase in the number of couples Increase in the number of couples Increase in the number of other activities like 1. CC 2. EPI/ NID 3. Arsenic searching 4. Satellite clinic etc. Increase in the number of other activities like 1. CC 2. EPI/ NID 3. Arsenic searching 4. Satellite clinic etc. Required to be engaged on various dibosh Required to be engaged on various dibosh Have to render other health services Have to render other health services Have to be engaged in other government assigned extra work from time to time Have to be engaged in other government assigned extra work from time to time CSBA trained FWA have to perform ANC, normal delivery, PNC, new born care and refer the complicated cases CSBA trained FWA have to perform ANC, normal delivery, PNC, new born care and refer the complicated cases Key findings

9. AreaP-value Before 2000 Present Population3319.55046.20.00 Household738.61065.80.00 Family764.11173.30.00 Eligible couple 677.6963.10.00 Pregnant35.629.20.00 Average coverage

10. Organi- zational activity Family Planning Organizing Satellite Clinic ANC, Delivery & PNC services Nutrition Education - Planning - Prepare advance advance program program - Other - Counseling - Motivation - Method distribution distribution - Take client to service to service center center - Advise or refer for refer for side effect side effect - Door to door door campaign campaign - Prepare advance advance work plan work plan - Take client for side for side effect effect - Send client to center client to center or worker or worker - Identify complicated complicated cases & refer cases & refer - Provide TT vaccine vaccine - Encourage mother for mother for Satellite clinic Satellite clinic - Provide vaccine at Satellite clinic at Satellite clinic Provide advise on Provide advise on - Nutrition of pregnant pregnant mother mother - Nutritious food for food for children children - Importance of breast of breast feeding feeding Activity of FWA

11. In addition to these they require to prepare report on their activities to submit it the higher officials In addition to these they require to prepare report on their activities to submit it the higher officials

15. Major reasons to fail to cover the area Major reasons Percentage Work at community clinic 78.4 Extra pressure 75.4 Large working area 52.0 A large number of field workers failed to cover the target due to: Extra pressure of work Being involved with other projects

16. Factors affecting proper performance ActivityReason Large working area Work at CC Poor communica tion Work at various dibosh Shortage of manpower Planning-39.1--- Counseling80.080.0-70.0- Motivation56.248.045.1-62.4 Method distribution 64.3---47.4 Take client to center 54.964.7-51.3-

17. ActivityReason Large working area Work at CC Poor communic ation Work at various disbosh Shortage of manpower Advise/ refer for side effect 45.863.5 Door to door campaign 50.735.761.4 Send to efficient worker 59.568.955.936.5 Identify complication during pregnancy and refer 59.4

18. ActivityReason Large working area Work at CC Poor communic ation Work at various disbosh Shortage of manpower Provide TT 54.4 Encourage to go to satellite clinic 51.0 Provide advise on nutrition 61.368.232.656.7 Give idea about usefulness of breast feeding 63.5

19. Effects of excessive workload on family planning services The number of permanent method users is not increasing as expected. The number of permanent method users is not increasing as expected. Clients suffering from various complications fail to get proper treatment / services / advice or facilities. Clients suffering from various complications fail to get proper treatment / services / advice or facilities. Sufferings of the clients create a negative impact on the other people of the locality and they become de- motivated towards permanent and long term methods. Sufferings of the clients create a negative impact on the other people of the locality and they become de- motivated towards permanent and long term methods. Field workers cannot render proper services to pregnant mothers resulting in creation of complications during pregnancy. Field workers cannot render proper services to pregnant mothers resulting in creation of complications during pregnancy.

20. In the absence of effective follow-up services, most of the complicated patients failed to get proper services and this may ultimately increase the maternal and child death. In the absence of effective follow-up services, most of the complicated patients failed to get proper services and this may ultimately increase the maternal and child death. People of the locality remained deprived of MCH services. People of the locality remained deprived of MCH services. Number of underweight and ill health children is increasing. Number of underweight and ill health children is increasing. New–born suffer from various diseases after their birth and many of them died within a year. This is likely to increase the infant and child mortality. New–born suffer from various diseases after their birth and many of them died within a year. This is likely to increase the infant and child mortality.

21. Suggestion TargetBefore2000Current level Revisiondesired % reduction desired Population33195046399920.7 Household738106562241.6 Family764117364145.4 Eligible couple 67796359438.3 Pregnant women 36291548.3

22. TargetBefore2000CurrentlevelRevisiondesired % reduction desired Counseling4.25.72.949.1 Motivation40.373.619.373.8 Method distribution 146.4275.3103.762.3 Take clients to service center 8.117.76.364.4 Referring clients 2.83.61.461.1

24. Lesson learned/Impact Partial coverage of the assigned works thus has left negative impacts in the implementation of family planning program and service delivery. Partial coverage of the assigned works thus has left negative impacts in the implementation of family planning program and service delivery. Number of permanent method users is not increasing as expected. Number of permanent method users is not increasing as expected. Clients suffer from various complications but fail to get proper treatment/services/advice or facilities. Clients suffer from various complications but fail to get proper treatment/services/advice or facilities. People become de-motivated towards permanent and long term method People become de-motivated towards permanent and long term method

25. Creates complications during pregnancy. Creates complications during pregnancy. Increase the number of maternal and child deaths. Increase the number of maternal and child deaths. Increase the number of malnourished children. Increase the number of malnourished children.

26. Recommendations A revision of the existing target in terms of the coverage should be considered to lessen the burden on the workers However, an assessment to this end is required to determine the feasibility of this target. A revision of the existing target in terms of the coverage should be considered to lessen the burden on the workers However, an assessment to this end is required to determine the feasibility of this target. Field workers should be withdrawn from the community clinics. Field workers should be withdrawn from the community clinics. Field workers should not be engaged in the programs of the various dibosh of the family planning. Field workers should not be engaged in the programs of the various dibosh of the family planning.

27. Proper steps should be taken to reduce the extra burden of the imposed other programs on the workers. This may include recruitment of more field workers. Proper steps should be taken to reduce the extra burden of the imposed other programs on the workers. This may include recruitment of more field workers. An efficient and supportive supervision system should be introduced for smooth operation and functioning of the family planning program to undertake the responsibilities referred to above. An efficient and supportive supervision system should be introduced for smooth operation and functioning of the family planning program to undertake the responsibilities referred to above. Steps should be taken to provide further training on issues not covered thus far. Steps should be taken to provide further training on issues not covered thus far.

28. Thank You