Small inputs can make a big difference in Bangladesh’s maternal, neonatal health, finds study

A new assessment suggests that most of the government facilities in rural Bangladesh can be kept functional round the clock to offer key maternal and neonatal health services with “little inputs”.

The government’s family planning services (DGFP) conducted this first-of-its-kind exercise through the USAID’s MaMoni Health Systems Strengthening (MaMoni HSS) project to determine the readiness of those facilities for 24/7 normal delivery and essential newborn care services.

bdnews24.com obtained a copy of the report which will be disseminated on Wednesday in Dhaka.

This has been prepared ahead of the government’s next five-year programme that would replace the ongoing Health, Population and Nutrition Sector Development Programme (HPNSDP) at the beginning of 2017.

One of the focuses would be shifting most of the births from home to facilities to reduce maternal deaths to 59 within 2030 from the current level of 176 per 100,000 live births and newborn deaths below 12 per 1,000.

“This assessment will guide us what to do and where to invest,” Director General of the DGFP Mohammad Wahid Hossain told bdnews24.com.

“We need to strengthen our union level facilities to achieve ending preventable child and maternal deaths (by 2030)”.

What is in the assessment?

Speaking to bdnews24.com, Chief of Party of the MaMoni project Joby George said the primary focus of the assessment was on Union Health and Family Welfare Centers (UH&FWCs).

But they also included other government health facilities located at the union level such as Unions Sub-centers (USC) and Rural Dispensaries (RDs) in the assessment.

They looked at the number of staff posting there, whether they are residing there or not, their training including midwifery skills, equipment and supplies, and approach road to the facility.

Through this assessment, 4,461 union level facilities have been identified, which include 3,590 facilities functioning as UH&FWCs who are supposed to offer 24/7 normal delivery services and newborn care with the Family Welfare Visitors or FVWs and paramedics.

Of them, 14 percent (489) are found in the category ‘A’, which is defined as already functional or needs minimum resources to make them fully ready.

A total of 69 percent of those facilities (2480) are in category ‘B’, which will need medium to moderate level of inputs.

The rest 17 percent (621) facilities are in ‘C’ category, which means these facilities need major inputs in several areas, including physical renovation, staffing, supplies and equipment.

MaMoni’s George said, on the whole, over 80 percent facilities can provide delivery care services with “little inputs” as categorised in the A and B category.

For example, he said, sometimes a lack of delivery table can stop the service in a facility. “Now we have this assessment about what is required”.

Shift from home to facility delivery

Since the late 70s, Bangladesh has been taking different types of approaches to ensure skilled attendants during childbirths. Still, 63 percent deliveries take place at home, despite a rise in facility delivery in the last decade.

But most of the women go to the private facilities where the surgical deliveries, C-section, rate is 80 percent.

As the government in the new sector programme will target to reach 65 percent deliveries by skilled birth attendants, the question is where these deliveries will take place to achieve the shift from home to a facility. Are we prepared?

The assessment found that in 2014, 53 percent of all UH&FWCs provided normal delivery care services, and only 21 percent of them provided the services round the clock. Forty-eight percent did not conduct any deliveries in that year.

Save the Children Deputy Country Director Dr Ishtiaq Mannan told bdnews24.com mothers would go to the government facilities if those are prepared.

“We have evidence to say that,” he said, citing the MaMoni project’s initiative in Sylhet region.

Save the Children is implementing the MaMoni project that shows that women can be attracted to public facilities when a better environment is provided.  

During a recent visit, bdnews24.com found that women were giving birth to a Dighalbak Union Health and Family Welfare Centre, in a far-off village in the north-eastern Habiganj district, when the building was renovated to give a modern look and relevant staff were posted there.

There was no foul smell inside the facility and the privacy of the would-be-mothers was well maintained. Local leaders were encouraged to maintain the hospital.

Dr Mannan said the MaMoni project was “an eye-opener for us when we saw women came out of their homes to deliver at facility, despite traditional norms”.

“All normal deliveries can be handled in union facilities,” he said, “with a good referral linkage so that complicated cases can be shifted to the upazila hospital”.

“If we can give that little input which is needed, then we’ll see a good impact in the next five years.”

He said there must be a threefold increase in public facility deliveries in the next 15 years to achieve the desired scenario.