MaMoni Health Systems Strengthening Activity (USAID Cooperative Agreement AID-388-LA-13-00004) Quarterly Report April 01– June 30, 2017 Joint Efforts to Restore Confidence in Health Care Delivery System Char Folcon Union Health & Family Welfare Center (UH&FWC) – the image of transformation Submitted August 4 2017 Cover Story: Char Folcon Union is a rural community in Komolnagar Upazila of Lakshmipur district. The Union Health and Family Welfare Center (UH&FWC) was established in 1982 by DGFP of MoH&FW. Since the UH&FWC is the closest access point for health services for the community, its functionality is critical for saving lives and serving the community, particularly women and children who are under privileged and the most vulnerable. Previously, services at the facility were very poor due to scarce resources, limited availability of health workers, and poor quality of care. It was not unusual to find the facility locked and ill-equipped to provide services for maternal emergencies, including stock-outs of key consumables that are life-saving during such emergencies. To compound the situation, the center had very poor infrastructure, including a leaky roof, broken windows, and cracked walls and ceiling; there was also no access road, power, or water supply. This unsanitary situation in the clinic was worsened by the lack of a functional residence and toilet facility for service providers, making it difficult to ensure staff were available to attend maternal and newborn emergencies. The MaMoni HSS program set out to transform this facility into a functional facility where the community could expect to receive quality care and services. As a first step and to ensure the initiative was locally driven and supported, the program conducted an assessment of the facility in collaboration with local government. Identified needs included facility upgrading, staff capacity development, and community engagement. MaMoni HSS has worked hard with local government, facility leadership and the community to address these needs, with the following achievements: • Facility & Infrastructure Upgrades - The approach road and the infrastructure were reconstructed, and power and water supplies were ensured by installing solar panels. In support of this effort, the Char Folcon Union Parishad allocated a budget of 202,000 BDT (do you want to include approximate value in USD?) for the approach road, facility renovation, delivery bed and kits during the 2014-15 fiscal year; a budget of 122,000 BDT for the solar panel in the 2015-16 fiscal year; and 30,000 BDT for furniture in the 2016-17 fiscal year. Additional investments came from MaMoni HSS, with 2,700,000 BDT for dumping pits, a residence for service providers, and a deep tube well in year three of the program. • Effectively Engaging Existing Institutions – Sufficient quantities of relevant drugs and supplies were made available by bridging DGFP and LG, and MaMoni HSS helped to reinforce the UH&FWC Management Committee to engage with the community so that needs and quality issues can be raised and addressed. Under the leadership of UP Chairman, the committee meets bi-monthly at the facility to address high priority issues. As a result, significant improvements have been made in the ability of the facility to apply basic infection prevention practices and maternal, newborn, child health, and family planning (MNCH/FP) standards of care. “Before the renovation of the facility, patients expressed their disgruntlement over the poor state of the facility infrastructure and the environment and the poor quality and absence of services arises from its condition,” she said. “But now, our clients are happy and there is up-trend in the demand of services” - Shumi Majumder, Sub-Assistant Community Medical Officer (SACMO), Char Folcon UH&FWC The program’s initiatives and efforts towards the improvement of the UH&FWC have converged to manifest outcomes that are consistent with the initial goal of providing high quality services that are well-utilized. Prior to 2013, the services provided at the Char Folcon UH&FWC were very poor with low utilization levels. But since the improvement initiatives began, service utilization has increased dramatically from 1120 in 2013 to 2926 in 2017. Furthermore, when 24/7 services began at the facility in 2013, there were no normal deliveries recorded at the center, but usage since then has increased dramatically, with 251 normal deliveries in the first half of 2017 alone. “We the people are happy because of 24-hours service, improved facility, and well trained & well-behaved smiling doctor apa are available for us,” says Mr. Abdul Khaleque, husband of Mosammat Selina Akhter, a mother who received delivery care and services from the facility. “I really appreciate the cleanliness of the facility which is much far better from private clinics. I thank Allah and pray that they will do more.” - Mother-in-Law of Marium Begum (a mother who received services from the facility), Village Zazira, Char Folcon Union. This document is made possible by the generous support of the American people through the support of the Office of Population, Health, Nutrition and Education, United States Agency for International Development (USAID), Bangladesh (USAID/Bangladesh), under the terms of Associate Cooperative Agreement No. AID-388-LA-13-00004 through Maternal and Child Health Integrated Program (MCHIP). The contents of this document are the responsibility of the MCHIP Project and do not necessarily reflect the views of USAID or the United States government. TABLE OF CONTENTS MaMoni Health Systems Strengthening Activity ..................................................................... 1 TABLE OF CONTENTS .................................................................................................................... 3 ABBREVIATIONS ............................................................................................................................. 4 EXECUTIVE SUMMARY .................................................................................................................. 7 Key accomplishments in this quarter include: ......................................................................... 7 Way Forward: ..................................................................................................................................... 9 Introduction ....................................................................................................................................... 9 DATA SOURCES ................................................................................................................................ 9 Program Results for the Quarter ................................................................................................ 10 IR 1. Improve Service Readiness through Critical Gap Management ........................... 10 IR 2: Strengthened Health Systems at District Level and Below .................................... 29 IR 3. Promote an Enabling Environment to Strengthen District Level Health Systems .................................................................................................................................. 40 IR4. Identify and Reduce Barriers to Accessing Health Services ................................... 39 Challenges, Solutions, and Actions Taken ....................................................................................... 45 Appendix 1: Scope and Geographical coverage of the Mamoni HSS program ............... 48 Appendix 2: DATA SOURCES ...................................................................................................... 50 Appendix 3: Program Performance Indicators (April 2017–June 2017) ........................................ 50 Appendix 4: Additional Indicators .................................................................................................... 67 Appendix 5: QIS ACTIVITIES ...................................................................................................... 70 Appendix 6: News Clips Published During ……………………………………………………… 75 Appendix 7: Documentation and Dissemination of MaMoni Program Learning ... Error! Bookmark not defined. MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly Report 3 ABBREVIATIONS ACS Antenatal Corticosteroid ADCC Assistant Director, Clinical Contraceptive AUFPO Assistant Upazila Family Planning Officer AHI Assistant Health Inspector AMTSL Active Management of Third Stage of Labor ANC Antenatal Care APK Android package kit BCC Behaviour Change Communication BEmONC Basic Emergency Obstetric and Newborn Care BSMMU Bangabandhu Sheikh Mujib Medical University CAG Community Action Group CBT Competency Based Training CC Community Clinic CCSDP Clinical Contraceptive Service Delivery Program CDCS Country Development Cooperation Strategy CEmONC Comprehensive Emergency Obstetric and Newborn Care CHW Community Health Worker CHX Chlorhexidine CIPRB Centre for Injury Prevention and Research, Bangladesh CMPM Community Micro Planning Meeting CS Civil Surgeon CSBA Community Skilled Birth Attendants CSI Clinical Severe Infection CV Community Volunteer DDFP Deputy Director Family Planning DGFP Directorate General of Family Planning DGHS Directorate General of Health Services DH District Hospital DHIS2 District Health Information System-2 DN Death Notification DP Development Partner EH Engender Health ENC Essential Newborn Care EoP End of Project ETAT Emergency Triage and Treatment e-LMIS electronic-Logistics Management Information System