1. Engaging Communities to Help Mothers and Newborns: MaMoni Experience from Bangladesh Rowshon Jahan

2. Presentation outline MaMoni overview and strategies Community mobilization approach Results Challenges and lessons learnt Steps towards sustainability and scale up

3. Context  Home delivery is the norm  Weak health systems:  vacancy of health workers  quality of care at health care facilities  Traditional healers/practitioners have a strong role  Social inequity prevails – deaths are more in lower strata  Geographically difficult terrain  Successful vertical programs like – EPI, Family Planning  Stronger GO-NGO collaboration

4. Why MaMoni in Sylhet.. Indicators (BDHS 2007)NationalSylhet Neonatal mortality rate 37/1000 41/1000 ( 2004) 53/1000 63/1000 (2004) Total fertility rate2.73.7 CPR56%32% Unmet need for family planning18%26% At least one ANC attendance with trained provider 60%47% Place of deliveryHome: 85%Home: 91% Skilled attendance at birth18%11%

5. MaMoni overview and strategies  MaMoni is an Integrated Safe Motherhood, Newborn Care and Family Planning Project (ISMNC-FP) under the leader award, Maternal and Child Health Integrated Program (MCHIP).  3.3 million pop. coverage in 2 districts  Follow on project of ACCESS (2006-2009)  The prime is JHPIEGO and local partners are –  MOH&FW  Save the children, USA  FIVDB  Shimantik

6. MaMoni results framework Improved maternal and neonatal health outcomes Practice high impact MNH behaviors Use high impact services Increase knowledge, skill, practice at home Increase utilization of services Increase family planning acceptance and understanding Systems strengthening Mobilize community to support demand Stakeholder leadership, commitment and action National goal Project purposes

7. 12345 67 89 p1 p2p3p4p5p6 D IFA Supplementation ANC1 TT ANC2 ANC4 TT ANC3 Pregnancy identification Misoprostol Clean delivery and immediate newborn care PP maternal care, Vit A and management of complications Essential newborn care/KMC Management of newborn complications Immunization Postnatal session promoting LAM, spacing, PoP, FP, transition Supply of PoP, transition to modern method, Supply of FP methods and referral for LAPM MaMoni package: Integrated Package Birth preparedness HW counseling AMTSL & referral for EmOC Exclusive breastfeeding and promotion of LAM/PPFP

8. Highlights of MaMoni approach  MOH&FW key service provider  Partner NGOs play a supportive and facilitative role  Active role of the community  An integrated package  District-wide approach  MOH&FW and community capacity enhanced to ensure sustainability

9. CM helps in adoption of healthy practices & increase utilization of services COMMUNITY Enabling Environment, Collective actions WOMEN, NEWBORNS Healthy Behaviors HOME/FAMILY Supportive decision making Health systems Linkage/ interface Reinforce demand

10. Support behavior change Disseminate health messages Engage community leaders

11. Plantogether Acttogether Evaluatetogether Organize the community for action Explore MNH situation and set priorities Prepare to mobilize Prepare to scale-up Community mobilization approach: Community Action Cycle (CAC)

12. Community mobilization activities  Selection of villages  Resource mapping  Orient the community and invite for participation  Formation of CAGs  Capacity building for community resource persons (CRPs)

13. Results: gender balance in CAGs  Each village has two separate groups: male and female  Membership of male groups slightly higher than female groups (18317 [51%] versus 17455 [49%])  3820 CRPs – equal membership (1909 females and 1911 males) – 60% demonstrated ability to conduct CAC independently

14. Results: emergency fund & transport 56.9% of the groups arranged emergency transportation system 43.4% of the groups developed emergency fund. 396 mothers and newborns used the system to get to the health facility

15.  12 Satellite clinics and 2 EPI center newly opened by the group initiatives  CAGs worked with govt. & NGOs to regularize 69 inactive/irregular clinics/EPI centers  56% CAGs has participation of MOH field service providers Results: linkage/interfacing with health systems

16. Unavailability of services and/or poor quality of care Male CAG members available mostly in the evening Some communities need time to get prepared Difficult to ensuring participation of all segments especially the vulnerable groups Some female community members not permitted to attend meetings by their mother-in-laws Program disruption by natural disaster including floods Lessons learnt and challenges

17. Appropriate community entry essential for successful community interventions Sharing real stories/results increase community engagement Men and women can work together to mobilize their communities in conservative communities Engagement of men in the CAC increase their involvement in MNH activities Communities can be mobilized without any material or financial incentives Formation of CAG with existing group is more effective and sustainable Community Resource Persons demonstrated potential of sustain these initiatives Lessons learnt and challenges

18. Community action cycles are being done by community resource persons/ volunteers Selection of volunteers from existing functionaries Role of volunteers as extended hands of the health workers Stronger linkage with local governments and health systems Community clinic management groups Elected union parishad (local government) Combining female and male groups Integrating family planning Involvement in source for local MNH-FP commodities Component of a number of large MNH programs Steps towards sustainability and scale-up

19. Mothers and newborns lives are saved through community initiatives...