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Strengthening reproductive services by close to community providers: Lessons from REACHOUT, Bangladesh
The REACHOUT project is funded by the European Union
Dr. Mahfuza RifatAssistant Professor, Coordinator REACHOUTJames P Grant School of Public HealthBRAC UniversityJune 12, 2016
Background
• REACHOUT, a five year implementation research project -To understand and strengthen the role of close-to-
community (CTC) health workers
• REACHOUT Bangladesh, focuses on menstrual regulation (MR), a procedure to safely establish non-pregnancy up to 6-12 weeks after a missed menstrual period
Context analysis
• Poor women remain vulnerable to unsafe and uninformed choices
• Inadequate supervision and referral structure: major gaps identified by the partners
• A range of CTC health service providers to provide MR services: formal, Informal
Objective
• To conduct implementation research and strengthen the role of close-to-community (CTC) health workers, focusing menstrual regulation (MR)
Implementing Partners
Marie Stopes Bangladesh (MSB)
Reproductive Health Services Training and Education Program (RHSTEP)
CTC providers
Community
Close-to-Community Providers
Health Centre
Majority female (71%)Education: Secondary and aboveMean age: 31 yearsMean years of service: 2.7 Paid staffVisits community
Interventions
Facilitative referral training for CTC providers
Supportive supervision training for supervisor of CTC providers
Introducing revised, structured referral card
Method
• Combination of quantitative and qualitative methods • Ongoing process documentation• Observations in terms of trainings and supervision• Data collection of first phase ended in November, 2015
Key findings
• CTC providers feel motivated in contributing to well-being, maintaining good relations and gaining positive recognition
• After intervention: more confident, comprehensive information, networking with other providers, and saving clients from clandestine operators
• Positive changes in supervision style of the supervisors
Key findings…
• New referral card helped in documenting activities, tracking referred clients and ensuring referral fees to the referrer
• Many of the CTCs mentioned low pay as a demotivating factor• Commonly faced challenge by the CTCs:
– Access to all households– Insufficient time to engage in discussions
Key findings..
• Implementing organisations were supportive • Perceived benefits were recognised by CTCs and women• Regular meetings and dialogues was critical to avoid
implementation disruption • Joint development of training manuals, involving trainers from
organisations promoted ownership
Lessons learnt
• Implementation research is a continuous process and should be developed and adapted according to context
• Innovative interventions was feasible and acceptable • Strengthening monitoring process, accountability and
recognition of hard work of the CTCs is critical• Intervention targeting multi-layer of supervisors is
necessary for sustainability
Acknowledgement
• Implementation partners– Marie Stopes Bangladesh– Reproductive Health Services Training and Education Program
• The team REACHOUT Bangladesh Sabina, Malabika, Rifat, Sadia, Salauddin, Irin, Riaz, Sumona, Tamanna, Tahmina and Sushama
• All close-to-community providers
Thank you All