1. Scaling up Healthy Fertility and Postpartum Family Planning Rural Experience in Urban Area of Sylhet, Bangladesh Shimantik Kazi Moksedur Rahman Date: 08 March 2010

2. Purpose Primary objectives are to: Provide integrated FP/MNCH services in the extended postpartum period Improve knowledge through training and orientation to service providers and community workers Increase awareness among community people on HTSP, FP and LAM

3. Reason why this objective was chosen All health indicator performance are low at Sylhet division compare to national IndicatorsBGDSYL Unmet need18%26% CUR (any modern method)45%25% TFR2.83.7 ANC coverage60%54% PNC coverage21%16% NMR3.9%5.3% Sources: BDHS 2007

4. Activity chosen for scaled-up Short description of the activities : HH level counseling: ORWs/CHWs counsel pregnant, postpartum women, their influential family members on ANC, PNC, HTSP, PPFP including LAM and refer to near by health facility for services Training and Orientation: – Training of different level staff on counseling, FP including LAM, HTSP – Orient religious leader about HTSP and LAM Community sensitization: – Advocacy and orientation to community influential persons – Target group meetings with influential Male, Female member of pregnant/postpartum women separately and together of male- female on HTSP,LAM,FP and ANC, PNC

5. Progress Success in meeting objective Provided training to 236 staff Provided training /orientation to 107 religious leaders Orient community leaders, teachers, ward commissioners /counselors, elite persons and other influential persons Targeted group meetings held at community with male, female and both of male and female members of pregnant/postpartum women’s family

6. Progress Training achievement : IndicatorPre-testPost-test Knowledge on return to fertility 13%78% Three LAM criteria19%86% Message of HTSP23%81% Sources : Training register

7. Progress 91% RDW receive counseling on HTSP and LAM within first week of delivery 48% husband of recently delivered women attended group meeting on HTSP and PPFP 49% senior female family member of recently delivered women attended group meeting on HTSP and PPFP

8. Challenges Initially existing UPHCP staff were not well accepted the integration of PPFP. Shortage of period like 15-16 month is one of the challenge to show the result for such scaling up project. Turn over of UPHCP staff like ORW/CHW /SP is one of the great challenge. Religious leaders were not well accepted FP activities initially.

9. Lessons Learned A package of MNH-FP interventions, when delivered through existing community-based workers and existing health facilities, is effective in improving maternal, neonatal and family planning activities Significant family planning contraceptive user increased and necessary services provided from health facility. Birth spacing messages were well accepted by religious leaders rather birth limiting Recommendation The intervention package and delivery system can be scaling up within the existing government and NGO health services after appropriate adoption

10. Plan to Scaling-Up Plan to scaling up this best practices to another district with GoB and NGO health service providers with existing health facility Plan to scaling up this best practices to other urban area where Shimantik implemented primary health care services. (But financial support needed for implementing such scaling up best practices)

11. Modifications Please list and discuss any modifications needed in the intervention before scaling up Number of indicator should be reduced. At least two years time period needed to show result

12. Capacity Building Capacity building that occurred during the course of the project Existing different level of UPHCP staff gained knowledge on FP, LAM and HTSP Through this project, organization has the opportunity to introduce LAM and HTSP among policy maker of GoB. GoB official encourage Shimantik to scale up the activities in other low performing area.

13. Scale-Up Challenges Challenges faced : To get approval from local authority take much time more than expected time. So, to get fund from donor needs more time. Two project officers are very insufficient to monitor / oversee existing 56 ORW/SP UPHCP’s activities Overcome: Organization (Shimantik) provided loan to startup and then continue the project activities smoothly. Management of Shimantik sat together several times to solve the problem and integrated UPHCP’s supervisor with POs activities.

14. Acknowledgement This project is funded by USAID through ESD/Pathfinder International We adopted the concept, intervention and implementation strategy from Healthy Fertility Study that is also funded by USAID through ACCESS-FP

15. Thanks to all