Engaging Communities to Help Mothers Engaging Communities to Help Mothers and Newborns: and Newborns:
MaMoni Experience from BangladeshMaMoni Experience from Bangladesh
Rowshon Jahan
Presentation outlinePresentation outline
• MaMoni overview and strategies
• Community mobilization approach
• Results
• Challenges and lessons learnt
• Steps towards sustainability and
scale up
ContextContext
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
Why MaMoni in Sylhet ..Why MaMoni in Sylhet ..
Indicators (BDHS 2007) National Sylhet
Neonatal mortality rate 37/1000
41/1000 ( 2004)
53/1000
63/1000 (2004)
Total fertility rate 2.7 3.7
CPR 56% 32%
Unmet need for family planning 18% 26%
At least one ANC attendance with trained provider
60% 47%
Place of delivery Home: 85% Home: 91%
Skilled attendance at birth 18% 11%
MaMoni overview and strategiesMaMoni 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
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
1 2 3 4 5 6 7 8 9 p1 p2 p3 p4 p5 p6
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 PackageMaMoni package: Integrated Package
Birth preparedness
HW counseling
AMTSL &
referral for
EmOC
Exclusive breastfeeding and
promotion of LAM/PPFP
Highlights of MaMoni approachHighlights 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
CM helps in adoption of healthy practices & increase utilization of services
COMMUNITYEnabling Environment,
Collective actions
WOMEN, NEWBORNS
Healthy Behaviors
HOME/FAMILYSupportive
decision making
Health systems
Health systems
Linkage/ interface
Linkage/ interface
Reinforce demand Reinforce
demand
Support behavior change
Disseminate health messages
Engage community leaders
Explore MNH Explore MNH situation situation
and set prioritiesand set priorities
OrganizeOrganizethe communitythe community
for actionfor action
PlanPlantogethertogether
Act Act togethertogether
Evaluate Evaluate togethertogether
Prepare to mobilize
Prepare to scale-up
Community mobilization approach:Community Action Cycle (CAC)
Community mobilization activitiesCommunity mobilization activities
Selection of villages Resource mapping Orient the community
and invite for participation
Formation of CAGs Capacity building for
community resource persons (CRPs)
Results: gender balance in CAGsResults: 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
Results: emergency fund & transport 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
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
Results: linkage/interfacing with health systems
• 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 challengesLessons learnt and challenges
• 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 challengesLessons learnt and challenges
• 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 Steps towards sustainability and scale-up
Mothers and newborns lives are saved through Mothers and newborns lives are saved through community initiatives . . .community initiatives . . .