WHO-Bangladesh: its Support of national MNH Programmes

Introduction

The Bangladesh country office of WHO has contributed to the increased access of rural women to basic midwifery care through the designing and piloting of the Community-based skilled birth attendants (SBA) training programme. This programme is designed to equip Family Welfare Assistants (FWAs) and Female Health Assistants (FHAs) with skills to provide antenatal care, conduct normal deliveries, ensure postnatal and newborn care, and early detection and referral of complications.

Goal

The Goal of the WHO-supported Reproductive Health Programme in Bangladesh is to reduce morbidity and mortality and improve general health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals.

Objectives

- To strengthen human resources for maternal and newborn health (MNH) and management of MNH/Reproductive health (RH) programmes;

- To improve quality of care for maternal and newborn health through adaptation of norms, standards and guidelines, improved programme management;

- To strengthen capacity of key national institutions in research training, research and in promoting evidence-based standards, guidelines and tools in maternal and newborn health and reproductive health;

- To improve practices of health providers and communities for newborn care;

- To promote involvement of families/ communities in maternal and newborn health;

- To advocate adolescent right to information and access to quality health services;

- To promote operational research on Adolescent Friendly Health Services and support expansion of Adolescent/Youth friendly health services;

- To address issues of Gender Based Violence (GBV);

- To advocate and promote healthy and active aging.

Achievements

Considerable progress has been made for the achievement of the programme goal:

- Human resources assessment has been conducted to identify the needs and actions to be taken for maternal and child health human resource development.

- The UN joint project “Accelerating progress toward maternal and neonatal mortality reduction” is being implemented.

- A project “Strengthening National Menstrual Regulation Programme for Reduction of Maternal Mortality and Morbidity” is being implemented.

- A competency 6-month basic midwifery training courses for Family Welfare Assistants (FWA) and Female Health Assistants (HA) has been continuing and the Ministry of Health and Family Welfare is currently scaling up the training and services. Support was also given for the development of an accreditation system to regulate the quality of the training and a supervisory mechanism to enhance the contribution of Community-based SBAs. A curriculum for 3-month additional training for Community-based skilled birth attendants has been developed and utilized to further strengthen the skills of the Community-based SBAs.

- Essential Newborn Care Training courses have been conducted for both trainers and service providers in order to further strengthen their skills in neonatal care and resuscitation.

- Training modules and tools for training of health service provider on prevention and control of micronutrient malnutrition especially in pregnant and lactating mothers has been developed.

- WHO is providing technical assistance for the development of a major Demand Side Financing initiative, which is a maternal health voucher scheme. The aim is to increase utilisation of quality maternal health services through creating equity of access irrespective of the patient’s ability to pay for the same. Under this scheme an estimated 100,000 poor pregnant women will receive free maternal health services annually.

- Tools on District Team Problem Solving (DTPS) adapted for Local level planning have been developed and are in use in 4 districts for planning Maternal and Newborn Health care.

- Working groups have been formed to review documents and to discuss matters related to services and human resource development for Maternal, Neonatal and Child Health (MNCH). A plan has been developed to start the process of reviewing the National Maternal Health Strategy 2001 and developing the National Maternal, Neonatal and Child Health 2009.

- An orientation on capacity building for operation research on maternal, newborn and reproductive health has been provided to selected government officials. Training in operational research is in process.

- Development of Curriculum for Essential Newborn Care training adapted from WHO-PCPNC is under way.

- TOT training courses for District Trainers on Essential Newborn Care (ENCC) have been conducted.

- A model for improving MIS system for maternal and newborn health has been formulated for consideration.

- Two batches of TOT for Districts Trainers on 3-month additional training for Community-based SBA with 15 participants per batch have been conducted for three districts (Tangail, Comilla and Naryangonj).

- One batch of training on 3-month additional training for Community-based SBA has been conducted in each of the 3 districts (Comilla, Tangail and Narayngonj).

- One batch of National Trainers Orientation on Supportive supervision for Community-based SBA has been conducted.

- Two batches of TOT for District Trainers on Supportive supervision for Community-based SBA have been conducted.

- Developing a 6-month advanced midwifery curriculum for existing nurse-midwives is in process.

- Adolescent Reproductive Health Strategy has been developed and operationalised

- Adaptation of WHO Orientation Package (OP) for the health care providers has been completed.

- Training on the WHO Orientation Package and orientation training on the adolescent friendly strategy and standards of Adolescent Friendly Health Services (AFHS) have been conducted at district level.

- The meeting of the Technical Advisory Committee (TAC) on Menstrual Regulation (MR) was held on 8 June 2008. The role, terms of reference, memberships and modus operandi of the TAC have been revised.

- Proposals for challenge funds of the project “Strengthening National Menstrual Regulation Programme for Reduction of Maternal Mortality and Morbidity” have been obtained for reviews.

- A workshop on Strengthening Proposals for the Menstrual Regulation Initiative was held in Dhaka, from 30 November to 4 December 2008 to improve the proposals.

- Support to observation of International Day of Elderly 2008 has been provided.