Expert asks Bangladesh to find inbuilt solutions to raise childbirths in rural facilities

The deputy country director of Save the Children has urged the health minister to adopt solutions that are available in the system for increasing the rate of childbirths at rural facilities in Bangladesh.

Dr Ishtiaq Mannan (File Photo) Dr Ishtiaq Mannan (File Photo)

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Dr Ishtiaq Mannan, citing a study on Wednesday, says since the late 70s, Bangladesh has been taking different types of approaches to have skilled attendants, but 63 percent of all the deliveries still take place at home.

He says after the traditional birth attendants (TBAs) failed to deliver as expected, the government had trained Community Based Skilled Birth Attendants (CSBAs) to assist childbirths.

But they, too, had failed to live up and a 2010 study found their contribution less than 1 percent of the total childbirths.

Now the government is focusing on training midwives which is a lengthy procedure as it is a three-year course.

Dr Mannan has showed that it will take the whole SDGs period, which runs until 2030, to get the number of midwives needed to attend childbirths at facilities.

Dr Ishtiaq Mannan (File Photo)

But he says their new assessment, which he presented at a discussion in Dhaka, showed that the existing union-level facilities can offer the round-the-clock normal delivery facilities with little inputs.

He was speaking at the dissemination of the assessment that suggests that 3,590 union-level facilities are capable of providing delivery care services. 

Among these, 83 percent facilities could become round-the-clock delivery care centres with minor to moderate level of inputs.

“It’s a low-hanging solution which is inbuilt in our system. We can work on it,” Dr Mannan said, urging the minister to stop the CSBA training and instead, focus on this approach.

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 their facilities.

Mohammad Nasim (File Photo)

Minister Mohammed Nasim reiterated his government’s commitment to improve the services for mothers and children. He also stressed on making government services available to the people, particularly for the poor.

There must be a change in mindset among the service providers, he said, asking the staff of two wings of his ministry – family planning and health – to work together in the field.

He said he found a disconnect in their work.

Nasim also blamed the greed of doctors for the increasing trend of surgical deliveries at private facilities.

State Minister for Health Zahid Maleque, Health Secretary Syed Monjurul Islam, Director General for Health Services Prof Dr. Deen Mohammad Noorul Huq, Director of USAID’s Office of Population Health, Nutrition and Education (OPHNE) Melissa Jones, BMA Secretary General Prof M Iqbal Arslan and Chief of Party of the MaMoni HSS Project Joby George also spoke at the discussion.

The assessment was 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.

The speakers urged the government to incorporate the recommendations of the assessment in the new sector programme.