‘MaMoni HSS’ brings local level solutions to ensure safe motherhood in Bangladesh

Childbirth in the village level health facilities of the north-eastern Habiganj district’s Madhabpur Upazila was unthinkable even two years back.

But, now each government facilities of the unions under Madhabpur can offer normal deliveries, thanks to an initiative that engaged local level policy-makers to ensure safe motherhood.

Childbirth at the skilled hands is a challenge in Bangladesh where everyday 14 women die while giving births. Over 60 percent women deliver with the help of unskilled providers.

The government’s new focus is to increase deliveries at facilities to cut maternal deaths.

“Local level solutions can make a difference,” said Joby George, Chief of Party of MaMoni Health System Strengthening Project or MaMoni HSS that brought the local level solution.

He was talking to bdnews24.com on the ‘safe motherhood day’ celebrated on Sunday in Bangladesh.

The mandate of this USAID funded and Save the Children managed project is to support the Ministry of Health and Family Welfare to strengthen the health systems to improve utilization for maternal and child care by the most under-served communities.

The project is now operating in six districts – Habiganj, Noakhali, Jhalokathi, Bhola and Barisal – with some of the lowest indicators of maternal and child health and family planning.

“We are trying to demonstrate how things can be done differently,” George said.  “We function as facilitators or catalysts to help the health system achieve greater efficiencies and result-oriented”.

In Madhabpur, the MaMoni officials first identified low coverage of maternal care services. None of the union level facilities were offering round the clock normal delivery services and staff were not residing in any of the nine union centres.

The MaMoni project brought Upazila Family Planning Officer, Upazila Health and Family Planning Officer, Upazila chairman and the Upazila administrator together. The chairman then engaged all the Union level chairmen.

“They all took a collective decision that we’ll revive all of our union level facilities,” George said.

Around that time, MaMoni did a study of all the union level facilities across Bangladesh for the government to assess their readiness.

“So we knew exactly what was missing in a particular union centre. We provided that information to the local level policymakers,” he said. For example, one centre needed renovation while the other may be fully functional for normal delivery after giving a simple delivery table.

“Then Upazila chairman made budget allocation. The chairman also advised the Union chairmen to allocate budgets. So local government took care of all additional resources, and we supported them with idea, training, equipment, monitoring and quality control. Now those centres are functioning properly”.

“It was a long journey. But now you will find every union level facility is conducting some normal deliveries,” he said.

He said they share the lessons to the national level. “So the ministry has incorporated our experiences in the ongoing health, population and nutrition sector development programme”.

One of the focuses of this health sector programme is shifting most of the births from home to facilities to reduce maternal deaths to 59 from the current level of 176 per 100,000 live births by 2030 and newborn deaths below 12 per 1,000.

The MaMoni is also supporting the strengthening of newborn care such as the management of newborn infections, management of pre-term and low-birth-weight babies and establishment of Special Care Newborn Units for in-patient care of sick newborns.

“The idea is that without leadership whatever resources you give to the district level would not work,” the Chief of Party said.

“Most decisions are made centrally. Resources are managed centrally. We focused on how we can motivate them locally so that they feel they can change with the limited resources they have.

“We have all the data and we know what is needed to improve the facilities. The local people can give the best answers of what is needed to keep facilities functional that we don’t know centrally,” he said.

“Our long time vision is that all the nearly 4,500 union level facilities will be able to provide minimum package of maternal and neonatal services including normal delivery round the clock”.

He, however, said shortage of human resources is a “big challenge”.

“The government recruits doctors, but there is still inadequate nurses and support staff. There is no assessment of how many doctors or nurses or support staff in the next five years or 10 years,” he said, adding that they were also helping the government to do a study in this regard.

“It will be used for more systematic planning for the next five to 15 years as end of the day if there is no staff then the services will not be ensured despite lot of efforts”.