Country Team Action Plan

Bangladesh

GoalReduce Fertility, Maternal and Neonatal Mortality

through an integrated Post Partum Care Package

Package components

Component Best Practices

Family Planning Post partum contraceptive, LAM, PP sterilization

ENC C-ENC, F-ENC

Prevention of PPH

AMTSL, C-Misoprostol

PAC PAC and FP

Nutrition Maternal and Newborn (Exclusive BF) Nutrition, Vit. A, IFA

Where are we now?– Current levels of accomplishment/Progress and

challenges since Bangkok 2007Six Divisional workshop organized by DGHS,

DGFP and NGOs on Best practices (Participants: Div. and District level H & FP Managers, Specialist, MO, Nurses, FWV, MA, SACMO, Paramedics, HA, FWA and NGO worker etc.)

AMTSL Training – Doctors, Nurses, FWV, C-SBAKey programs: EOC, DSF, C-SBA, Midwifery, MNH, MNCH, MNCS,

Prevention & management of Fistula, Blood Transfusion, Prevention of HIV transmission, Com SS for EOC.

Problems/challenges1. Lack of adequate EOC trained HR at all levels 2. Retention of HR at rural, remote and hard to

reach areas3. Transfer of EOC trained manpower to non-EOC

facilities (Retention)4. Generating demand in the community5. Lack of Community support system (aware,

support)6. Private practitioner is not aware to address

PPH

Where do we want to be?Major Objectives

• Best Practice Chosen for Scale-Up and Its Components:

Integrated PP Care Package focusing PPH

• Desired levels of accomplishment

By 2015 Maternal Mortality due to PPH will be reduced by 40% through implementation of Integrated PP Care Package

What are the gaps?List gap between current status and desired

levels of accomplishment• PNC coverage is 22% and SBA is 18%

desired level of Management of PPH is 40%List reasons for the gap• Lack of adequate skill HR (C-SBA is 5000, Target-13,000. EOC trained

Doctors -700, Target-1000, Nurses-700, Target-1000)

• Lack Integrated activities, supportive supervision, monitoring and MIS

What interventions can we use to close the gap?

Increase coverage AMTSL, Assisted delivery Intervention will be implemented in Integrated way through DGHS, DGFP, NGO and PPP both at Facility and Community level

Intra and inter Ministerial and sectoral collaboration with community involvement

List activities to carry out the interventions

• Fill up vacant post • Training and Refresher training • Motivation of service providers

(incentive career plan) and clients• Supportive supervision• Monitoring & Evaluation

What are the possible challenges to the

intervention?1. To increase adequate Skill Service Providers2. Retention of skill HR3. Motivation of service providers and Com.

Support Group4. Sustainable supply of logistic5. Coordinated activities of DGHS and

DGFP6. Leadership, Monitoring, MIS and PPP7. Effective Referral mechanism and BCC

Who are the possible partners, allies, and

stakeholders?• Executive agency: MOHFW• Implementing agency: DGHS and DGFP• Supportive organization: Professional

bodies like – BMA, OGSB, Bangladesh Peri-natal Society, Nursing Council

• Partners: Dev. Partners, Private Providers and NGOs

What is the evidence to support this best practice?

Global: Nepal, Ghana, Indonesia, Tanzania, Ethiopia, Ecuador, Dominica Republic

National evidence (AMTSL practice at facilities and use of Misoprostol at Community level)

What actions are needed to provide additional evidence?

Periodic evaluation (process and impact), Maternal Mortality Survey 2010 is going on

Is better documentation of the evidence needed? Yes.

What are the modifications needed to improve the

intervention’s scalability?• After final/periodic evaluation

modification will be considered • Improve capacity of Govt. to lead

the process• Coordinated activities of DGHS,

DGFP, NNP, Dev. Partners, Private Practitioner and NGOs

Who will be involved in scaling-up?

• Organizations responsible for scaling-up: MOHFW, DGHS and DGFP.

NGOs, DPs, Professional bodies and Private Practitioners

• Capacity of the organizations to scale-up and what implications this has for scaling-up. Good infrastructure, Needs assessment (Training, supply, monitoring, leadership, MIS, advocacy)

• Who will be part of the team to support the process of scaling-up? National PPH Task force. (Evaluation will be done and placed to national authority - MOHFW)

What are the opportunities and constraints of scaling-up?

Opportunities: Commitment of Ministry, DGHS, DGFP Support from Dev. Partners, NGOs, Professional

bodies, Revitalization of Community Clinic ProjectConstraints of scaling-up and how they will be

avoidedConstraints: Scale-up country wide, skill HR, supply

of logistic, Monitoring and MISAvoid by: Govt. leadership, Partnership with DPs,

NGOs

Strengthening EmOC servicesStrengthening EmOC services

Demand Side Financing (DSF): Maternal Health Voucher Scheme

Community Community based based Skilled Skilled Birth Birth

Attendant Attendant (SBA) (SBA)

ProgrammeProgramme

- MNH, MNCH, MNCS, SMPP

- National Fistula Program,

- Women Friendly Hospital Initiatives,

- Adolescent Reproductive Health Programme

- Others

ReduceReduceMaternal Maternal Mortality Mortality

& & MorbidityMorbidity

Program for Reproductive Health & Safe MotherhoodProgram for Reproductive Health & Safe Motherhood

What policy, regulatory, budgetary, or other institutional

steps are needed?• Needs national guidelines on Post partum care

package and develop monitoring indicators.• Coordinated action plan of Govt., DPs, NGOs

and Private Sectors lead by MOHFW• Inclusion in next SWAp with budgetary

allocation• Up dating training curriculum (pre and in-

service)• Ensure uninterrupted supply and logistic

Who will advocate for these? When? How?

Who? DGHS and DGFPOthers – White Ribbon Alliance (WRA), Bangladesh and EngenderHealth

How? Series of consultation, policy dialogue, workshop and media support

When? Immediately the Team will report to MOHFW

Where, when and how will the best practice be expanded?

• Expansion to new geographic sites or populations?

• Refresher training to 32 districts within one year • Expansion (facility level) in rest 32 district within

two years • Expansion (community level) 25 districts• How will the best practice be disseminated to

new areas or populations? By developing an action plan for the expansion

(Training, budgetary allocation, logistic, develop capacity of the facilities and training institution, increase community support system)

What will be the costs of expansion and how will

needed resources be mobilized?

• The cost will be calculated based on the current demonstration

Estimated: Tk. 200 m (30 m u$), mobilized from SWAp (HNPSP)

How will the process, outcomes and impacts be monitored? How will results be fed into decision-

making? • Through monitoring checklist• Periodic evaluationHow will results be fed into

decision-making? During revision of ADP and OP

Thank you very much