MaMoni Health Systems Strengthening Activity
Quarterly Report October 1, 2014 – December 31, 2014
Submitted February 2, 2015
MaMoni HSS – Year Two First Quarterly Report February 2015 1
TABLE OF CONTENTS Acronyms and Abbreviations ...... 3 1. Introduction ...... 5 2. Program Objectives and Key Activities ...... 6 3. Results for Year 1 ...... 9 3.1 Summary of Major Accomplishments ...... 9 3.2 Narrative Report of Major Accomplishments ...... 10 3.2.1 Transition to Year 2 program and geographic focus ...... 10 3.2.2 Improve service readiness through critical gap management ...... 10 3.2.3 Strengthen health systems at district level and below ...... 14 3.2.4 Promote an enabling environment to strengthen district-level health systems ...... 16 3.2.5 Identify and reduce barriers to accessing health services ...... 18 3.2.6 Challenges, Solutions and Action Taken ...... 19 4. The Way Forward ...... 20 Annex 1. Photos from key events...... 21 Annex 2: Performance Indicators (October-December 2014) ...... 22 Annex 3: Success Stories ...... 31 Annex 4: Key Achievements of Aponjon (MAMA) initiative ...... 34 Annex 5: Special Activity: Collaboration with TRAction project to reduce newborn mortality through targeted intervention in Jaintiapur upazila, Sylhet ...... 36 Annex 6: Quality Assurance Initiatives...... 38
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, Bangladesh (USAID/Bangladesh) under terms of Associate Cooperative Agreement No. AID-388-LA-13-00004 through MCHIP, managed by Jhpiego Corporation. The contents are the responsibility of Jhpiego Corporation and do not necessarily reflect the views of USAID or the United States Government.
Cover Photo Credit: Lubna Begum (25) gave birth to her third son, Amit Hasan Rifat (20 day old in picture) at Sonadia UH&FWC, Hatiya, Noakhali district. This is one of the first union level facilities that started providing round-the-clock delivery services in Hatiya island with support from MaMoni HSS. Photo credit: Abir Abdullah, consultant, Save the Children.
MaMoni HSS – Year Two First Quarterly Report February 2015 2 Acronyms and Abbreviations
AO Agreement Officer AMTSL Active Management of Third Stage Labor BCC Behavior Change Communication BEmONC Basic Emergency Obstetric and Newborn Care BNF Bangladesh Neonatology Forum BPS Bangladesh Perinatal Society BSMMU Bangabandhu Sheikh Mujib Medical University CAG Community Action Group CEmONC Comprehensive Emergency Obstetric and Newborn Care CHX Chlorhexidine CIPRB Center for Injury Prevention and Research, Bangladesh cMPM Community Microplanning Meeting CNCP Comprehensive Newborn Care Package CS Civil Surgeon CSBA Community Skilled Birth Attendants CV Community Volunteer CYP Couple Years of Protection DDFP Deputy Director Family Planning DGFP Directorate General Family Planning DGHS Directorate General Health Services ECEB Essential Care for Every Baby EM Environmental Manual FAOPS Federation of Asia and Oceania Perinatal Societies FWV Female Welfare Visitor GOB Government of Bangladesh HBB Helping Babies Breathe HMIS Health Management Information System HPNSDP Health, Population and Nutrition Sector Development Program HRCI Health Research Challenge for Impact HSS Health System Strengthening icddr,b International Center for Diarrheal Disease Research, Bangladesh IMNCS Improving Maternal, Neonatal, and Child Survival IR Intermediate Result J&J Johnson and Johnson JHU/IIP Johns Hopkins University, Institute for International Programs JSI John Snow, Inc. JSV Joint Supervisory Visit KOICA Korean International Cooperation Agency LAPM Long Acting and Permanent Method
MaMoni HSS – Year Two First Quarterly Report February 2015 3 LMIS Logistics Management Information System MCHIP Maternal and Child Health Integrated Program MCRAH Maternal, Child, Reproductive and Adolescent Health MEO Mission Environmental Officer MNCAH Maternal, Newborn, Child and Adolescent Health MNCH/FP/N Maternal, Newborn and Child health, Family Planning and Nutrition MOH&FW Ministry of Health and Family Welfare MOU Memorandum of Understanding MPDR Maternal and Perinatal Death Review OGSB Obstetrics and Gynecology Society of Bangladesh OP Operational Plan OR Operations Research pCSBA Private Community Skilled Birth Attendants PFM Physical Facilities Management PNGO Partner nongovernmental organization PPH Postpartum Hemorrhage PPIUCD Postpartum Intra-uterine Contraceptive Device QA Quality Assurance QPRM Quarterly Performance Review Meeting RCHCIB Revitalizing Community Health Care in Bangladesh RHIS Routine Health Information System RRQAT Regional Roaming Quality Assurance Team SBA Skilled Birth Attendant SBM-R Standards-based Management and Recognition SC Save the Children SDP Service Delivery Point SIAPS Systems for Improved Access to Pharmaceuticals and Services SMC Social Marketing Company SOP Standard Operating Procedure SSN Senior Staff Nurse TIS Tracer Indicator Surveys UDCC Union Development Coordination Committee UEHFPSC Union Education Health and Family Planning Standing Committee UH&FPO Union Health and Family Planning Officer UH&FWC Union Health and Family Welfare Centers UP Union Parishad USAID United States Agency for International Development
MaMoni HSS – Year Two First Quarterly Report February 2015 4 1. Introduction
The MaMoni Health Systems Strengthening (MaMoni HSS) project is a four-year Associate Award under the Maternal and Child Health Integrated Program (MCHIP), with a period of performance from September 24, 2013 to September 23, 2017. MaMoni HSS builds on MaMoni’s previous work and focuses on strengthening the systems and standards for maternal, newborn and child health, family planning and nutrition (MNCH/FP/N) that will result in declines in maternal, newborn and child mortality within seven districts in Bangladesh. The project supports the Ministry of Health and Family Welfare (MOH&FW) to introduce and leverage support for scale-up of evidence-based practices already acknowledged in Bangladesh.
MaMoni HSS is primed by Jhpiego in partnership with Save the Children (SC), John Snow, Inc. (JSI), and Johns Hopkins University (JHU)/Institute of International Programs (IIP), with national partners International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dnet, and Bangabandhu Sheikh Mujib Medical University (BSMMU). SC serves as the functional operational lead partner for the Award in Bangladesh. MaMoni HSS engages with local government structures and non-governmental organizations (NGOs) to improve delivery of health services and strategically partner at the national level to build consensus around policies and standards that positively drive evidence-based interventions at all levels.
Figure 1: Map of MaMoni HSS project areas Beginning the second year of implementation, the project is using a differential approach to implementation at the district level. Districts and upazilas are categorized into two groups based on the intensity of implementation support. This categorization will be maintained through the project life.
• High intensity areas: MaMoni HSS supports high intensity interventions in a total of 23 upazilas. These areas include all upazilas of Habiganj, Lakhsmipur and Jhalokathi districts, four upazilas of Noakhali, and two upazilas of Pirozepur district. • Health system (HS) capacity strengthening areas: All remaining areas will receive support for implementing selected program components. These areas will also benefit from the district level support for HS capacity strengthening. This covers a total of 17 upazilas – all seven upazilas of Bhola, five upazilas of Noakhali, and five upazilas of Pirozepur.
MaMoni HSS – Year Two First Quarterly Report February 2015 5 Using this differential programming approach, MaMoni HSS supports a total of six districts where implementation started in the first year, including both the high intensity and health system capacity strengthening areas. The seventh district as per the original proposal, Brahmanbaria, was scheduled to start in the second year. This district has been dropped from the project’s direct support.
The map of the program area presented above shows the geographic focus of the project from the second year of implementation.
2. Program Objectives and Key Activities
The goal of MaMoni HSS is to improve utilization of integrated MNCH/FP/N services and will be achieved through the project objective to increase availability and quality of high-impact interventions through strengthening district-level local management of health systems. This objective is well aligned with the Government of Bangladesh’s (GOB) Health, Population, and Nutrition Sector Development Program (HPNSDP) 2011–2016. MaMoni HSS will also directly support the USAID/Bangladesh Development Objective 3 (DO 3) “Health Status Improved” under the Investing in People Objective, of the Country Development Cooperation Strategy (CDCS) Framework of USAID in Bangladesh.
MaMoni HSS has four intermediate results (IRs). Shown below is a summary of the project’s IRs, sub-IRs, and the major activities included in the second year workplan.
IR1: Improve service readiness through critical gap management Sub-IR 1.1 Increase availability of health service providers • Support MOH&FW to develop a human resources information system (HRIS) for the country, including plans for recruitment and deployment of health workforce • Advocate GOB to expedite the recruitment of relevant staff and deploy them to fill all vacant positions, prioritizing positions in Union Health and Family Planning Welfare Centers (UH&FWC), Basic Emergency Obstetric and Newborn Care (BEmONC) and CEmONC facilities • Support temporary gap management of critical service provider positions in strategically located facilities in “high intensity areas”
Sub-IR 1.2 Strengthen capacity of service providers to provide quality services • Adapt/develop training package for different providers for integrated MNCH/FP/N skill development • Establish mechanism for development of trainer’s pool to conduct training of trainers (TOT)/training on MNCH/FP/N packages • Support training of service providers on integrated package(s) of MNCH/FP/N clinical service delivery and quality improvement areas • Continue technical support for national scale up of Helping Babies Breathe • Support MOH&FW to ensure availability of logistics, and supplies for the roll out of new newborn care interventions
Sub-IR 1.3 Strengthen infrastructure preparedness to improve MNCH service utilization • Support MOH&FW to maintain upgraded UH&FWCs to provide MNCH/FP/N services, including 24/7 delivery services • Support secondary and tertiary level referral facilities of MOH&FW for integrated MNCH/FP/N services
MaMoni HSS – Year Two First Quarterly Report February 2015 6 • Strengthen referral systems at community level and at facilities • Upgrade facilities to be prepared for delivering the minimum essential package of MNCH/FP/N services • Support Directorate General Family Planning (DGFP) to scale up skilled birth attendant (SBA) deliveries by strengthening union level facilities
IR2: Strengthen health systems at district level and below Sub-IR 2.1 Improve leadership and management at district level and below • Build leadership and management capacity of MOH&FW managers at district and upazila levels through Strategic Leadership and Management Training Program (SLMTP) • Establish mentorship program for the district and upazila level managers
Sub-IR 2 .2 Improve district-level comprehensive planning (including human resources) to meet local needs • Facilitate MOH&FW decentralized MNCH/FPN planning and review systems • Facilitate regular review by MOH&FW of MNCH/FP/N performance against annual plans at upazila and district levels • Support the use of local data to track progress and make decisions on course corrections • Support MOH&FW to institutionalize community microplanning meetings (cMPMs) and union follow up meetings
Sub-IR 2.3 Strengthen local management information systems • Support MOH&FW at national level to design and pilot an automated comprehensive routine health information system (RHIS) • Support MOH&FW to roll out paper-based RHIS in high intensity areas until the automation is completed • Train managers and other key personnel on utilizing data for decision-making and for facilitative supervision.
Sub-IR 2.4 Establish quality assurance (QA) system at district level and below • Support MOH&FW to strengthen national level QA initiatives • Support MOH&FW to strengthen supervision systems at all levels • Support improved infection prevention / bio-waste management practices at health facilities • Support MOH&FW for the training of service providers on quality improvement and Standards- based Management and Recognition (SBM-R) • Support MOH&FW to activate and support Regional Roaming Quality Assurance Teams • Support MOH&FW to scale up Maternal and Perinatal Death Reviews (MPDR)
Sub-IR 2.5 Develop comprehensive logistic management systems at district level and below • Scale up UIMS/ Service Delivery Point (SDP) dashboard module in high intensity areas • Support Directorate General Health Services (DGHS) to pilot and scale up a logistic management system for essential RMNCH commodities • National level advocacy and support for the procurement of essential MNCH commodities for life-saving interventions Sub-IR 2.6 Strengthen local government planning and engagement in health service provision • Build capacity of local government institutions to actively contribute to MNCH/FP/N
MaMoni HSS – Year Two First Quarterly Report February 2015 7 • Strengthen the Vital Registration Systems (VRS) through improved coordination between MOH&FW and MOLGRD&C • Enhance the role of UPs in MNCH/FP/N budgeting and problem-solving
Sub-IR 2.7 Improve local governance and oversight for MNCH/FP/N (in high intensity areas) • Facilitate activation of Union Education Health and Family Planning Standing Committees (UEHFPSC) in areas where they are not functional. • Strengthen UPs bi-monthly Union Development Coordination Committee (UDCC) meetings
IR3: Promote enabling environment to strengthen district-level health systems Sub-IR 3.1 Policy reforms in place to promote local planning and need-based human resource deployment in the public sector • National level advocacy initiatives for policy reform. • Provide national advocacy and technical support to MOH&FW to scale up SBA delivery by strengthening UH&FWCs to provide 24/7 services • Advocate for national-level support for management information systems improvements.
Sub-IR 3.2 Strengthen advocacy and coordination for adoption of evidence-based learning in national policy and program • National level advocacy to address barriers to utilization of budget allocated to MNCH/FP/N related Operational Plans (OPs) • Promote program Learning and documentation of lessons learned and accomplishments • Process Documentation and Program Learning to learn from ongoing program implementation • Engage brand ambassadors and champions and use of special advocacy events • Advocate for the scale up of evidence-based maternal and newborn interventions in support of the Ending Preventable Child and Maternal Deaths (EPCMD) in Bangladesh.
IR4: Identify and reduce barriers to accessing health services Sub-IR 4.1 Promote awareness of MNCH through innovative Behavior Change Communication (BCC) approaches • Develop and implement a mixed-methods communication campaign designed to catalyze behavior change in target groups. • Contribute to the development of a national FP BCC Campaign and its implementation • Produce / re-produce communication materials (printed and others) and job-aids to support the scale up of priority EPCMD interventions • Use Aponjon technology to disseminate health messages to target populations • Establish BCC units with implementing partner nongovernmental organizations (PNGOs) and at the district level
Sub-IR 4.2 Enhance community engagement in addressing health needs • Recruit, train, and support community volunteers (CVs). • Support Community Volunteers to provide FP counseling and referral • Facilitate Community Action Group (CAG) meetings and establish emergency transport systems for referral transport.
MaMoni HSS – Year Two First Quarterly Report February 2015 8 3. Results for Year 1 3.1 Summary of Major Accomplishments
This report focuses on the period October 1 to December 31, 2014. Key highlights for this reporting period include:
• Implemented the shifts in programmatic and geographic focus, partnerships and management structures in line with the changes proposed in the second year workplan. • Completed close down of district and upazila offices in Bhola, Pirojpur and Lakshmipur districts as part of the differential approach to district level implementation. Health systems capacity strengthening support will continue in these districts and upazilas. • At the end of this quarter, the project has withdrawn all 86 Community Health Workers appointed by the project as temporary gap management staff. The nurses and paramedics continue to serve in vacant government positions. There are 86 paramedics and nurses deployed by the project in strategically located health facilities. • Successfully advocated for the deployment of 19 newly recruited Female Welfare Visitors (FWVs) in high priority union level facilities to facilitate the provision of round-the-clock services, including normal deliveries. • Contributed to the development of a strong partnership of USAID funded partners to lead the design and implementation of a comprehensive, fully automated routine health information system for the MOH&FW. • Supported the GOB to ensure provision of round-the-clock services through 38 UH&FWCs in high intensity areas, including 14 facilities where the project placed temporary staff. • Achieved 18,102 deliveries conducted by skilled birth attendants (SBAs) in six districts, of which 15,901 were conducted at health facilities. This represents around 27.8% of all projected deliveries for the quarter for those six districts. • Generated 181,369 couple-years of protection (CYP), in six focus districts where the implementation started in the first year, including 8,980 who accepted Long Acting and Permanent Method (LAPM), which represents 29.9% of the total CYP in these districts. • Introduced postpartum intra-uterine contraceptive device (PPIUCD) at Daulatpur UH&FWC, Baniachang, upazila, Habiganj district. Seven mothers initially accepted PPIUCD and five continued to use them after 45 days within this quarter. • Trained 1,779 GOB workers, CVs, implementing partner staff, and other community members on various MNCH/FP/N topics. • Trained 228 SBAs on newborn resuscitation protocols following the Helping Babies Breathe (HBB) curriculum, and provided refresher training to 925. • Rolled out SBM-R in 31 GOB health facilities in three districts. Other quality assurance initiatives, such as, MPDR, and Regional Roaming Quality Assurance Team (RRQAT) also initiated this quarter. • Facilitated referral of 807 cases of maternal or newborn complications in three districts to receive care at a higher level facility. These included 643 maternal cases and 164 newborn cases. • Selected, trained, and supported a total of 6,992 new CVs to mobilize communities during the quarter, taking the total number of CVs in program areas to 33,961; a total of 14,726 CAGs have established emergency transport plans. • Aponjon service, the local initiative of Mobile Alliance for Maternal Action (MAMA), reached the milestone of 1 million subscribers in September 2014, and 1,210,858 subscribers in December 2014.
MaMoni HSS – Year Two First Quarterly Report February 2015 9
3.2 Narrative Report of Major Accomplishments 3.2.1 Transition to Year 2 program and geographic focus
(1) Modification of program and geographic focus: In the year 2 workplan, MaMoni HSS modified the program intervention and geographic focus, as per feedback received from USAID, to enhance the emphasis on national level health systems strengthening and policy initiatives and to use a differential approach to program implementation at the district level. By the end of first quarter, MaMoni HSS completed the transition to the proposed new focus and made significant progress in implementing the national level health systems strengthening initiatives. As described earlier, the program intensity has been scaled down in the health systems capacity strengthening areas.
(2) Realignment of implementing partners: As part of the transition, MaMoni HSS closed down offices in Lakhsmipur, Bhola and Pirozepur, and phased out partnerships with five implementing partner NGOs. The PNGOs discontinued at the end of the quarter were: DORP, COAST, ESDO, Sushilan and Lighthouse. Formal close-out procedures have been discussed and agreed upon with these partners. The financial close-out will be completed in the month of January 2015. All formalities related to the closure of offices and handing over of assets have been completed. The project also closed down offices in the aforementioned three districts. The staffing level of all PNGOs operating in other districts has been reduced and the project will continue to reduce staffing presence, with a planned reduction in the number of Field Support Officers by March 2015. MaMoni HSS will maintain the collaboration with BRAC in Nazirpur and Bhandari upazilas of Pirozepur district. In these areas, MaMoni HSS is building on BRAC’s existing initiatives under the Improving Maternal, Neonatal, and Child Survival (IMNCS) project in the district.
(3) Realignment of management structure: The changes in staffing structure of MaMoni HSS team at national and district levels have been implemented. The roles and responsibilities of the team members have been revised to reflect the modifications to the programmatic and geographic focus during the second year of implementation. The job descriptions of district level staff, including PNGO staff, have been revised and communicated to staff.
3.2.2 Improve service readiness through critical gap management
(1) Management of critical human resource gaps of GOB service providers: During the quarter, the project supported three districts with critical human resource gap management through temporary NGO service provider recruitment. MaMoni HSS continued to provide temporary staff to address the vacancies in nurses, FWV and FWA positions in selected facilities in Habiganj, Noakhali, and Lakhsmipur districts, while continuing to advocate for long-term solutions by filling the vacancies through GOB recruitment. In the six districts where implementation is in progress, the project is currently supporting 69 paramedics, and 17 nurses to fill critical human resource gaps. In addition, 86 Community Health Workers (CHWs) continued through December 31st; these CHW’s will be discontinued in the next quarter.
MaMoni HSS – Year Two First Quarterly Report February 2015 10 Table 1: Summary of critical health workforce gap management provided by MaMoni HSS in six districts (as of December 31, 2014) District FWV Nurses Total Vacant MaMoni Vacant MaMoni Vacant MaMoni Posts HSS Posts HSS Posts HSS Support Support Support Habiganj 17 37 28 14 45 51 Noakhali 5 14 36 0 41 14 Lakhsmipur 0 10 31 3 31 13 Bhola 10 4 30 0 40 4 Jhalokathi 4 0 0 0 4 0 Pirozepur 7 4 1 0 8 4 Total 43 69 126 17 169 86
The project recruits and deploys paramedics as a temporary gap management arrangement to address the gaps in the number of FWVs available in GOB facilities to provide essential services, especially at the peripheral levels. In some cases, the number of paramedics deployed exceeded the number of vacant FWV positions. According to DGFP planning, upgraded UH&FWCs should have two FWVs deployed. In keeping with this design, MaMoni HSS has deployed additional paramedics to maintain the delivery services and outreach services in hard-to-reach unions. The project also deployed additional paramedics in several union level facilities to fill the gaps due to service providers’ absenteeism or responsibilities (deputation) at higher level facilities (even though the government does not count them as vacant).
(2) Successful advocacy with MOH&FW to fill critical vacancies: MaMoni HSS continued its advocacy efforts to expedite the recruitment and posting of FWVs to under-served unions. As a result of the project’s advocacy efforts, DGFP prioritized the posting of 19 FWVs to UH&FWCs that are providing round-the-clock services in remote locations or are highly under-served for MNCH/FP/N services. The DGFP has deployed 19 FWVs in the month of December 2014 (four in Habiganj, two in Lakshmipur, seven in Noakhali, five in Jhalokathi, and one in Pirozepur). MaMoni HSS will withdraw the paramedic support when the FWV positions are filled.
The workforce needs assessment also uncovered a significant Figure 2: MOU signing between DGFP and gap in CEmONC in Habiganj, Bhola, and Pirozepur districts. In MaMoni HSS to upgrade all UH&FWCs these three districts, the obstetrician-anesthesiologist “pair” is not available at any level due to several vacancies. MaMoni HSS supported Civil Surgeon of Pirozepur to secure a “pair” through local level transfer as of December 2014. MaMoni HSS has also supported Civil Surgeon of Habiganj to ensure a “pair” at the District Hospital through intra-divisional and intra-district deputation. (3) Supported health facility preparedness for MNCH/FP/N services: MaMoni HSS signed a memorandum of understanding (MOU) with DGFP on November 10, 2014 to provide technical support to DGFP to upgrade all UH&FWCs managed by DGFP in the country to provide integrated MNCH/FP/N services, including normal delivery services 24 hours a day, seven days a week. DGFP and MaMoni HSS have started implementing a joint workplan to support this initiative. As a first step, a national Coordination Cell has been established to lead this initiative and the process for conducting a detailed assessment of all UH&FWCs in the country has already started. DGFP has started to identify
MaMoni HSS – Year Two First Quarterly Report February 2015 11 resources within the MCRAH and Public Facilities Management (PFM) OPs that can be used to upgrade the additional 1,500 UH&FWCs. A total 3,860 UH&FWCs are targeted, which is expected to significantly increase deliveries by SBAs.
In the project districts, MaMoni HSS facilitated a systematic process to identify health facilities that are strategically located and have the potential to provide a comprehensive package of services, including 24/7 delivery care - with some additional elements such as renovated physical infrastructure, filled vacant positions, deployment of additional paramedics, training of staff, and provision of essential equipment and supplies. The project is supporting the MOH&FW to identify and upgrade strategically-located UH&FWCs. As of December 2014, there are 37 out of 328 UH&FWCs in the six focus districts that are providing 24/7 delivery services, including 14 facilities where the project has provided Box 1: Durgapur UH&FWC completes 100 deliveries as a additional paramedics and other 24/7 facility inputs. MaMoni HSS, with The Durgapur UH&FWC was inaugurated on July 23, 2014 as leveraged funding (US$700,000) an upgraded 24/7 delivery facility. Since then, the number of from Save the Children UK, has clients has been increasing at a rapid pace. Though the constructed five new UH&FWCs average number of deliveries is 20 per month, many more in Habiganj district in 2014, and mothers regularly visit the center to receive antenatal and will provide TA to ensure delivery postnatal services. This center, which was abandoned at one services in these facilities as well. stage, was renovated by mobilizing resources and technical MaMoni HSS also coordinated support from DGFP, local government and the project. DGFP assisted in the renovation process and the UP Chairman of with several Union Parishads Durgapur donated some equipment. The project provided (UPs) to allocate resources for training to the staff and facilitated the revitalization of the renovations. There are several health facility. success stories from Noakhali district, where the UPs contributed to renovation of facilities as well as for the procurement of equipment and supplies to provide life-saving MNH services through UH&FWCs.
Trends in number of deliveries conducted at UH&FWC upgraded with project support, Oct-Dec 2014
Noakhali district Habiganj district 45 42 40 100 35 30 80 70 65 25 62 20 21 60 20 18 49 17 16 45 44 4545 15 14 15 40 33 35 11 10 30 27 27 25 23 25 10 1819 20 20 16 4 3 3 10 11 5 5 6 5 8 0 0 4 2 4 0 0
hctober bovember 5ecember hct 14 bov 14 5ec 14
MaMoni HSS – Year Two First Quarterly Report February 2015 12 (4) Adaptation of training packages: MaMoni HSS facilitated the adaptation of a number of training packages from existing modules for use in project districts. These are: • Basic MNCH/FP/N training package for non-technical service providers • Injectable contraceptive training package • Package on active management of third stage of labor (AMTSL), partograph, pre- eclampsia/ eclampsia (PE/E) management • Comprehensive Newborn Care Package, in coordination with the Saving Newborn Lives Program • FP counseling package for volunteers under the leadership of the Clinical Contraceptive Service Delivery Program (CCSDP) of DGFP
MaMoni HSS organized a national stakeholder consultation meeting to share the adapted training packages on MNCH/FP/N and the injectable contraceptive training package. The feedback from this consultation meeting was incorporated in the final versions of these packages.
(5) National scale-up of newborn care interventions: The predecessor MCHIP program had trained all government SBAs in all 64 districts under the HBB initiative, which reached a total of 23,579 SBAs. In this quarter, MaMoni HSS revisited eight districts to review district performance data and provide supportive supervision, conduct refresher training, and train private sector providers. MaMoni HSS also monitored the ongoing need for HBB logistics and took steps to address the gaps.
In the eight districts (Chuadanga, Jhenaidah, Patukhali, Meherpur, Munshiganj, Noakhali and Panchagarh), MaMoni HSS trained 228 providers from private health facilities in 10 batches. Through 68 refresher sessions during monthly meetings, 925 SBAs were assessed for skill retention. A total of 241 district and upazila level health and family planning managers participated in eight district review meetings. Civil Surgeon and Deputy Directors of
Figure 5: Refresher training in Durgapur Family Planning (DDFP) conducted 11 supervision visits in the UHC, Rajshahi eight districts, and a BSMMU master trainer team visited one training site to monitor the training performance in this quarter. The newborn surveillance system in place reported 9,561 resuscitation cases during this quarter from the 91 surveillance units. The cumulative number of deliveries monitored through the surveillance system is 27,450.
In March 2014, MaMoni HSS supported the introduction of 7.1% chlorhexidine (CHX) application for umbilical cord care at health facility and community levels in the Bahubal upazila of Habiganj. For this initial introduction of this intervention, CHX was procured by the project using non-USAID resources mobilized by Save the Children. After the initial six months of implementation, CHX has been scaled up to cover the whole upazila, which consists of seven unions. Results of early intervention were shared with a small group of stakeholders on December 15, 2014, as part of the exploration of USAID support for procurement and supply of CHX for national scale up. Participants of this meeting were USAID, SNL, Save the Children, Systems for Improved Access to Pharmaceuticals and Services (SIAPS), Social Marketing Company (SMC) and MaMoni HSS. During this quarter, CHX was applied to 755 newborns, which represents 61% of projected live births in the upazila during this period. Among these, 95 (13%) received CHX from health facilities while 660 (87%) received it at home. A total of 177 newborns received CHX from GOB providers, which is 14% of projected live births during the period, while 578
MaMoni HSS – Year Two First Quarterly Report February 2015 13 newborns received CHX from traditional birth attendants (TBAs), which is 47% of the projected live births during the period.
3.2.3 Strengthen health systems at district level and below
(1) National level engagement with MOH&FW and Line Directors: MaMoni HSS met with the Revitalizing Community Health Care in Bangladesh (RCHCIB) project of MOH&FW and other senior managers to share the lessons from community microplanning meetings (cMPM). MaMoni HSS and RCHCIB have agreed to adapt the cMPM approach through the community clinics to support better planning and tracking of clients with the clinic catchment areas.
(2) Capacity-building for leadership and management at district level: As part of the project’s initiative to improve the leadership and management capacity of the district and upazila level managers of MOH&FW, MaMoni HSS collaborated with the Health Research Challenge for Impact (HRCI) project to design a Strategic Leadership and Management Training Program (SLMTP). The training program is conducted by the Department of Public Health and Informatics of BSMMU, with technical support from Johns Hopkins University. In this quarter, MaMoni HSS supported the post-training follow up of the trainees from MaMoni HSS districts. The DDFP of Pirozepur attended the Technical Advisory Group (TAG) meeting of HRCI in December to share the action plan generated after the training. MaMoni HSS is working with HRCI and BSMMU to develop a mentoring follow-up program where senior and retired MOH&FW officials would provide regular support via visits to the districts and semi-structured phone follow-ups, resulting in better problem solving, career development, and overall higher motivation of the managers.
(3) Logistics Management Systems: MaMoni HSS continued the collaboration with the USAID-funded SIAPS project in all five upazilas of Lakshmipur district (as part of a 20 upazila pilot) to improve the logistics management of essential MNCH/FP/N commodities. The Upazila Inventory Management System (UIMS), developed by SIAPS, was installed in DGFP computers at upazila and district level. The storekeepers and their supervisors were oriented on the software. MaMoni HSS is also ensuring that the data is entered into this system by the fifth of every month, and is viewable through a dashboard by the DGFP as well as the respective implementing NGO. For DGHS, MaMoni HSS and SIAPS jointly developed a paper-based monthly logistic reporting system. MaMoni HSS has printed auto-carbonated pads for use by DGHS storekeepers, and trained the storekeepers and their supervisors to use these reporting tools. The district and upazila stores and Sadar Hospital store have been sending reports in this format beginning October 2014. The outcome of this report will be presented to the Technical Working Group (TWG) in February 2015. MaMoni HSS is planning to replicate this system in other districts ahead of national roll out.
(4) Strengthening information systems: MaMoni HSS is collaborating with the Routine Health Information System (RHIS) project to roll out a paperless reporting system in Madhabpur upazila of Habiganj. MaMoni HSS met with the RHIS technical team in December to finalize the system and the hardware.
In year 2, MaMoni HSS is collaborating with the other USAID funded partners – MEASURE Evaluation, icddr,b and SIAPS – to form a USAID RHIS Partnership. The partners will support he MOH&FW to design, test and roll out a fully automated and comprehensive RHIS. The USAID RHIS
MaMoni HSS – Year Two First Quarterly Report February 2015 14 partnership has develop a detailed concept note on this initiative and held several round of discussions with the key MOH&FW officials and other stakeholders to take this initiative forward. MaMoni HSS also hosted the RHIS partners during a field visit to Habiganj to help the team learn from previous RHIS initiatives.
(5) District level decentralized planning and performance reviews: The Health and Family Planning Departments of Noakhali, Habiganj, and Lakhsmipur districts conducted data-driven quarterly performance review meetings (QPRM) involving key officials. Planning and review meetings were also held at the upazila level in these districts. The community microplanning meetings (cMPM) are well established in these three districts. By December 2014, a total of 1,303 cMPM units were conducting monthly meetings. The cMPM are helping frontline health workers (FWAs and HAs) to enroll eligible couples and pregnant women into the program early on and to track and follow up for the provision of services. These meetings also help to improve the quality of information collected by the two departments.
(6) Competency-based training: MaMoni HSS facilitated and supported the competency-based training of GOB service providers. The details of the training program and the number of participants are presented in Annex 6. A summary list of the training activities supported by the project during the quarter are shown in Table 2 below:
Table 2: Competency based training undertaken by MaMoni HSS in the first quarter of FY15 Training Type Training Duration Competency expected CHW Training Module Review and Five days Basic FP counseling messages Update - Director MCH Services, DGFP and services Dhaka Injectable Contraceptives Training Two days (one day Skills on safe administration of Module Review and Update – MaMoni theoretical & one day injectable contraceptives HSS Project- Dhaka practical) AMTSL, Partograph and Eclampsia One day for each topic Competency on each of the Management- Training Package (three days) topics Development Infection prevention (IP) training Two days Competency on IP package development Labor Ward Protocol (LWP), ANC, PNC LWP is for five days Management of labor ward from ANC & PNC two days each receiving clients to discharge, Skills on ANC and PNC counseling, examination and services
(7) Joint Supervisory Visit and RRQAT: MaMoni HSS conducted joint supervisory visit (JSV) orientation for Upazila level supervisors in Habiganj district. MaMoni HSS also held a national level orientation meeting to strengthen the Regional Roaming Quality Assurance Team (RRQAT) approach. In Bangladesh, professional organizations are actively involved with MOH&FW initiatives to improve MNCH/FP/N activities. The Divisional level structures of professional organizations - such as Obstetric and Gynecologic Society of Bangladesh (OGSB), Bangladesh Perinatal Society
MaMoni HSS – Year Two First Quarterly Report February 2015 15 (BPS) and Bangladesh Neonatology Forum (BNF) - have the potential to contribute to quality improvement initiatives for clinical services. The RRQAT aims to improve quality of care through supportive supervisory visits by an integrated technical team consisting of DGHS, DGFP, professional organizations and active NGOs working in the MaMoni HSS project areas. In this context, a national stakeholders meeting was organized on December 11, 2014 to share the concept, agree on mechanisms of coordination among stakeholders at the regional level, and identify mechanisms for periodic reviews and to agree on the roll out mechanism. The meeting had participation from DGHS and DGFP managers from the national level, as well as from project-supported areas. Representatives from OGSB, BPS, and BNF also participated in the meeting. The meeting outcomes included an outline of the RRQAT structure and roll out plan. It was also decided that the intervention will roll out in Sylhet region first, followed by scale up in Barisal and Chittagong divisions.
(8) Maternal and Perinatal Death Review (MPDR): MaMoni HSS conducted a joint visit with UNICEF to learn from MPDR implementation in Maulvibazar. MaMoni HSS conducted an orientation of MPDR to district level staff and staff from one upazila of Noakhali, where MPDR will be replicated in partnership with the Centre for Injury Prevention, Bangladesh (CIPRB).
(9) Maternal Health Strategy and SOP: MaMoni HSS led the finalization of the national maternal health strategy and the SOP on maternal health. MaMoni HSS and UNICEF collaborated to organize divisional level consultations in Sylhet and Bogra (for Rajshahi and Rangpur divisions). Approximately 200 participants from different levels attended these consultations and provided their inputs.
(10) Pilot initiative to strengthen birth registration system: MaMoni HSS has developed a model to link the cMPM, immunization clinics and the birth registration system. The model involves facilitating close coordination between the Health Assistant (HAs) and the Union Parishad’s birth registration system so that the birth registrar is immediately notified of births. During the quarter, this model was introduced as a pilot initiative in three unions of Lakhsmipur, Jhalokathi and Noakhali districts. The Health, FP and UP staff were oriented on the initiative. During the first two months, the pilot areas have already started showing very rapid increases in registration of births within 45 days. The pilot implementation will be completed by March 2015 and the model will be scaled up in all project areas.
3.2.4 Promote an enabling environment to strengthen district-level health systems
(1) Capacity-building of media: In this quarter, MaMoni HSS conducted orientations for 34 local journalists in Lakhsmipur districts, with the support from the Civil Surgeon and the DDFP. In total, 127 journalists have been oriented in three districts. The orientation emphasized the role of journalists in reporting maternal health issues and informing their leaders. This has resulted in coverage of maternal health stories, as well as eight stories published on MaMoni HSS engagement of journalists. MaMoni HSS also connected national level journalists with local counterparts to collect and produce stories. Kaler Kontho and Prothom Alo, a national daily, has published a story on MaMoni HSS activities. Prothom Alo, Dhaka Tribune and Daily Star are newspapers which have stories forthcoming on MaMoni HSS successes in hard-to-reach areas.
MaMoni HSS – Year Two First Quarterly Report February 2015 16
(2) Observation of key events: MaMoni HSS supported the MOH&FW in observing World Pneumonia Day (November 12) and World Prematurity Day (November 17). IEC materials on pneumonia were displayed in all six districts on the occasion of pneumonia day. MaMoni HSS participated in the Daily Star roundtable for World Prematurity Day.
(3) Promote MaMoni HSS lessons in International Forum: Aziza Begum, a MaMoni HSS paramedic received Save the Children’s National Child Service Figure 6: Rajiv Shah, USAID Administrator, with Aziza Begum and MaMoni HSS staff at Save the Children’s Award for her commitment to promote facility Illumination Gala in New York. delivery at Shibpasha union, Habiganj district. Aziza was recognized at the Illumination Gala organized by Save the Children in New York to mobilize support for our efforts to give more kids a better start to life with a focus on maternal, newborn and child survival and early childhood education. Aziza Begum traveled to New York to share MaMoni HSS stories and was highlighted in international media.
(4) National policy dialogue: MaMoni HSS co-sponsored the policy session of the 18th Congress of the Federation of Asia and Oceania Perinatal Societies (FAOPS). The session, hosted by BPS, focused on the integration of maternal and newborn health.
(5) Engagement of the Parliament: MaMoni HSS participated in the first meeting of the parliamentary caucus on Child Rights formed by Save the Children to orient 20 parliamentarians on MNCH/FP/N issues. The meeting, held in Cox’s Bazar on December 11-13, 2014, obtained commitment from the parliamentarians to support national initiatives on maternal and child health.
Figure 7: Allyson Bear of USAID speaking at (6) Program Learning Initiatives: A number of learning initiatives the 18th FAOPS policy session are underway. These include:
(i) Operations Research (OR): Under USAID’s TRAction research initiative, two research initiatives have completed the following: • Baseline data analysis on 24/7 delivery and EmONC services in public facilities through health systems strengthening in Bangladesh: This OR is conducted in two district level facilities in Habiganj district. Areas covered in the analysis include availability of infrastructure, essential drugs and equipment for MNH services, availability of human resources based on sanctioned post, quality of care, and availability of different service providers for MNH care. Findings were shared with the project’s national team in August 2014. During the quarter, a district level planning meeting was organized to agree on the follow up actions based on the findings. • Community-based prevention and treatment of severe pre-eclampsia and eclampsia in a low resource setting of Bangladesh: Analysis of baseline and program data collection has been completed by icddr,b to determine the feasibility of management of severe pre-eclampsia and eclampsia cases at the community level prior to hospital referral by community based
MaMoni HSS – Year Two First Quarterly Report February 2015 17 health providers (FWVs/CSBAs) with injectable magnesium sulphate (MgSO4) and other interventions (e.g., Oxidase strip to measure urine protein).
(ii) Performance analysis of pCSBA of MaMoni HSS: Performance of private Community Skilled Birth Attendants (pCSBA) of MaMoni HSS in Habiganj has been analyzed using MIS data. The analysis included services of pCSBAs for both health and family planning from April 2013- September 2014. Findings were shared internally in April 2014. A draft monograph was prepared during the quarter.
(iii) Documentation of the process of CHX introduction for clean cord care: In March 2014, MaMoni HSS supported the introduction of 7.1% CHX application to improve umbilical cord care in Bahubal upazila of Habiganj. Documenting the process of pilot activities, as well as learning from the initiation of CHX for umbilical cord care in two unions of Habiganj, has been completed. The documentation has been updated to reflect expansion into the remaining upazilas of Bahubal, and learning will be shared with MOH&FW, USAID, other implementing partners and other stakeholders supporting the intervention in Bangladesh. An initial stakeholder sharing meeting is scheduled for January 2015.
(iv) Development of OR concept papers: USAID has approved five OR proposals for the second year of implementation. They are: 1) Quality of service delivery for LAPM; 2) use of partographs as a decision making tool for identifying and referring complicated pregnancies; 3) viability of private CSBAs; 4) community behavior on application of CHX; and 5) quality of ANC at satellite clinics and challenges.
MaMoni HSS is finalizing the research protocol and is aiming to submit proposals for IRB approval to icddr,b and JHU in February 2015.
3.2.5 Identify and reduce barriers to accessing health services
(1) Community mobilization: MaMoni HSS has selected, trained, and supported a cumulative total of 33,971 CVs to facilitate CAGs, promote MNCH/FP/N behaviors, and serve as interfaces between the communities and the frontline health service providers through cMPMs. In Habiganj district during the quarter, 29.9% of LAPM referrals were made by CVs.
(2) Behavior Change Communication: The implementing NGO partners of MaMoni HSS have established BCC Units in each of the project districts, with the purpose of conducting focused BCC. A total of 64,167 persons (42,888 women and 21,279 men) were reached through BCC activities. MaMoni HSS participated and contributed to a national level initiative to develop a BCC campaign for FP, to be implemented by USAID partners. The project will support the implementation of the FP BCC campaign plan in the project districts, through existing implementation mechanisms.
(3) Engagement of local government: MaMoni HSS has facilitated the active engagement of local government institutions, especially the UPs, to improve MNCH/FP/N in their communities. As a result of the project’s advocacy and facilitation, a majority of the UPs have allocated budgets for MNCH/FP/N activities. MaMoni HSS has also facilitated the bi-monthly meetings of Union Development Coordination Committees (UDCCs) in Noakhali district, where MNCH/FP/N issues are discussed and progress reviewed.
MaMoni HSS – Year Two First Quarterly Report February 2015 18 (4) MAMA, locally branded Aponjon, was integrated into the MaMoni HSS program starting July 1, 2014. During this quarter, Aponjon acquired 115,645 new customers. A total of 23 partners are supporting customer acquisition in 22 districts. A total of 130 Aponjon agents received refresher training during the quarter. With J&J funding, Aponjon developed content for audio and text messages for mothers of children between one and five years of age. The delivery of these messages will start in the next quarter. Please refer to Annex 4 for a detailed description of the MAMA/Aponjon activities.
3.2.6 Challenges, Solutions and Action Taken
(i) Program scale down affected the morale of the team and slowed activities: As per the proposed changes in the second year workplan, several major scale-down activities were implemented. This included the discontinuation of partnerships with five PNGOs, closure of district level offices in three districts, and laying off over thirty project staff from district and national offices. All these had a significant impact on the morale of the entire team. Project activities slowed down in many areas, especially in the districts Bhola and Pirozepur districts, where the partnerships and district-based staff were withdrawn after the end of the quarter. The project’s senior management staff visited the districts and held meetings with the project staff, partners and government counterparts to brief them about the rationale for the changes. Periodic planning and review meetings were held at upazila and district levels to take stock of the progress of implementation and to identify alternative options where staff attrition was high.
(ii) GOB unhappy with the unexpected scaled down of program: The scale down of program implementation and reduced intensity in several project districts and upazilas caused discomfort among GOB officials. The project’s senior staff members visited the districts and communicated the reasons for the change in project strategy.
(iii) Delayed approval of workplan and budget caused uncertainties about field level activities: Due to the major changes that were being discussed, the approval of second year workplan and budget was delayed until mid-November. This resulted in uncertainty about the continuation of some of the initiatives from the first year workplan.
(iv) Delay in undertaking planned renovation activities: The project has undertaken an environmental assessment and developed the Environmental Manual (EM) for MaMoni HSS, which, at the time of this report’s publication, are awaiting final approval from the Mission Environmental Officer (MEO). Pending the USAID approval of the EM and the proposals for renovation of health facilities, the proposed renovation activities have been put on hold. All preparatory assessments for renovation activities have been completed. MaMoni HSS will obtain USAID/AO approval and necessary concurrence from the Environmental Impact unit and prioritize the renovation as soon as the approvals are in place.
Opportunities
A team of six fundraisers from Save the Children UK visited Habiganj to learn about the work and raise funds for drugs, private C-SBA training and facility renovation. Another team of Korean International Cooperation Agency (KOICA) visited Habiganj and Sylhet to support three MaMoni upazilas of Sylhet using Habiganj model. Save the Children UK has already completed five clinics in Habiganj, and is
MaMoni HSS – Year Two First Quarterly Report February 2015 19 expected to invest US$700,000 to support the establishment of union level facilities in Habiganj. KOICA has promised about US$ 1.6 million to scale up the MaMoni model in Sylhet district.
4. The Way Forward
Below are the highlights of major activities planned for the second quarter:
• Complete the restructuring of the program team at the national level and re-assign roles and responsibilities among the team members in line with the workplan priorities. • Support the HRM unit for situational analysis of human resources and contribute to the development of the National HRH Strategic Plan. Initiate special studies to inform the human resources strategic plan development led by the MOH&FW. • Advance the coordination with USAID RHIS partners and develop the design of automated RHIS for pilot implementation in Habiganj district. Complete the preparatory activities in Madhabpur upazila of Habiganj to introduce the pilot RHIS model. • Fully establish the TA Cell in DGFP for strengthening the UH&FWCs with dedicated team members assigned from MaMoni HSS as well as from DGFP. • Start the data collection on UH&FWCs in Sylhet and Barisal divisions to develop the database of UH&FWCs in these divisions, in preparation for the UH&FWC strengthening initiative. • Complete community-based training activities through the PNGOs: (i) orientation of CVS on FP counseling and referral in 23 high intensity upazilas; (ii) completion of basic training of CVs in Jhalokathi district; (iii) Training on management of malnutrition in Habiganj district; (iv) Training on post-partum IFA in Habiganj; (v) orientation on misoprostol in Habiganj; (vi) community microplanning in Jhalokathi district and union follow up training in four districts through externally contracted training agency. • Support the MOH&FW to roll out of CHX nationally, including facilitation of procurement. MaMoni HSS will procure CHX using non-USAID resources and support roll out in Habiganj district. • Conduct competency-based training of GOB service providers, including QA related training: Training related to the introduction of joint supervisory visit (JSV); pilot introduction of MPDR in Noakhali district; various modules of SBM-R training in phase 1 and phase 2 SBM-R facilities; training on maternal health training package (AMTSL, partograph and eclampsia management) in high intensity upazilas. • Roll out of various newborn care related training through BSMMU: The roll out of comprehensive newborn care package (CNCP) modules in Habiganj district; HBB refresher training. • Complete of health systems gap analysis study, which was initiated in the first year and dissemination of key findings with key national level partners and stakeholders. • Re-submit the project PMP after incorporating changes to the indicators and targets to reflect the changes in the workplan and obtain USAID approval for the revised PMP. • Obtain approval for project’s Environmental Manual. • Submit project proposals for renovation of health facilities for USAID approval and initiate the implementation. • Finalize the gender analysis report and begin implementation of the recommendations.
MaMoni HSS – Year Two First Quarterly Report February 2015 20 Annex 1. Photos from key events
Figure 8: Ishtiaq Mannan discussing the newborn Figure 9: MaMoni HSS presented lessons on hard to reach areas interventions at the 18th Congress of the FAOPS at BICC at the 1st conference on Public Health for Young Professionals at American International University, Bangladesh (AIUB)
Figure 10: Deputy Commissioner of Jhalokathi, Upazila Figure 11: RRQAT National Consultation Meeting attended by Dir Nirbahi Officer and Union Parishad Chairman visited the (PHC), DGHS, Director (MCH), and Director (CCSDP) ongoing CV orientation at Mothbari Union of Rajapur upazila under Jhalokathi district Figure 12: Another 24/7 delivery center initiated in Alyarpur UH&FWC of Begumganj Upazila, Noakhali on December 10, 2014. With this, a total of four UH&FWC are providing 24/7 services in the district with the support of MaMoni HSS. MOH&FW, Local Government and MaMoni HSS team jointly organized the inauguration event. Mr. Mamunur Rashid, Member of Parliament was the chief guest and UP Chairman Mr. Alauddin Khan presided over the meeting. In addition, Dr. A. B. M Abdul Motaleb, UH&FPO, Mr. Mustafizur Rahman Chowdhury, UFPO, Mr. Qamrul Hasan, MO-MCHFP of Begumganj upazila; Mr. Alamgir Hossain, Chairman, Amanullahpur UP, Begumganj, UNO, Upazila Chairman of Begum Gong were present. Around 500 community members participated in the program.
MaMoni HSS – Year Two First Quarterly Report February 2015 21
Annex 2: Performance Indicators (October-December 2014) Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 Project Goal: Improve utilization of integrated maternal, newborn, child health, family planning and nutrition The project PMP is services being revised to incorporate the programmatic changes made in second year workplan Percent of Births Attended by a Skilled Tracer District Doctor, Nurse or Midwife indicator survey report NA1 Bhola DHSS 2013 21.7 25 Brahmanbaria2 BMMS 2010 22.8 25 MaMoni 19.4 29 Habiganj HSS 2012 Jhalokathi BMMS 2010 28.1 31 Lakhsmipur DHSS 2013 34 37 Noakhali DHSS 2013 33.4 36 Pirozepur BMMS 2010 24.1 27 Percent of women with home births who Tracer District consumed misoprostol to prevent post- indicator partum hemorrhage survey report Bhola NA NA
Brahmanbaria NA NA Tracer 2014 39.2 49 Habiganj Indicator survey
1 Data from population-based Tracer Indicator Surveys (TIS) are currently not available. The data collection has been completed in Bhola, Pirozepur and Jhalokathi districts for baseline. Data collection in Habiganj, Noakhali and Lakhsmipur districts. 2 Brahmanbaria is not a program focus district in year 2 and hence will be removed from PMP in the next revision
MaMoni HSS – Year Two First Quarterly Report February 2015 22 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 Jhalokathi NA NA Tracer 2014 7.9 15 Lakhsmipur Indicator survey Tracer 2014 7.2 15 Noakhali Indicator survey Pirozepur NA NA Percent of newborns initiated breastfeeding Tracer District within one hour after birth indicator survey report Bhola DHSS 2013 70.7 75 Brahmanbaria BDHS 2011 46.2 50
MaMoni 64.7 67 Habiganj HSS 2012
Jhalokathi BDHS 2011 43.6 58 Lakhsmipur DHSS 2013 52.6 58 Noakhali DHSS 2013 53.1 57 Pirozepur BDHS 2011 43.6 58 Percent of births receiving at least one Tracer District antenatal care (ANC) visits during indicator pregnancy survey report Bhola DHSS 2013 44.3 50 Brahmanbaria BMMS 2010 56.8 60
MaMoni 37.1 52 Habiganj HSS 2012 Jhalokathi BMMS 2010 53.9 58 Lakhsmipur DHSS 2013 60.1 65 Noakhali DHSS 2013 52.8 58 Pirozepur BMMS 2010 41.3 48
MaMoni HSS – Year Two First Quarterly Report February 2015 23 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 Percent of Births receiving at least four Tracer antenatal care (ANC) visits during indicator pregnancy survey report Bhola DHSS 2013 13.8 18 Brahmanbaria BMMS 2010 17.7 20
MaMoni 8.6 15 Habiganj HSS 2012 Jhalokathi BMMS 2010 20.3 24 Lakhsmipur DHSS 2013 13.6 17 Noakhali DHSS 2013 11.5 15 Pirozepur BMMS 2010 10.2 15 Percent of newborns receiving postnatal Tracer check-up within two days of birth indicator survey report Bhola DHSS 2013 6.8 12 Brahmanbaria BDHS 2011 26 30
MaMoni 17.7 21 Habiganj HSS 2012 Jhalokathi BDHS 2011 26.3 30 Lakhsmipur DHSS 2013 12.1 16 Noakhali DHSS 2013 10.5 15 Pirozepur BDHS 2011 26.3 30 Percent of mothers receiving postnatal Tracer health check within first two days of birth indicator survey report Bhola DHSS 2013 10.1 15 Brahmanbaria BMMS2010 24.2 27
MaMoni 17.7 22 Habiganj HSS 2012 Jhalokathi BMMS2010 14 20 Lakhsmipur DHSS 2013 16.3 20
MaMoni HSS – Year Two First Quarterly Report February 2015 24 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 Noakhali DHSS 2013 12.9 20 Pirozepur BMMS2010 9.6 15 Prevalence of modern contraceptive Tracer methods use indicator survey report Bhola DHSS 2013 54.4 58 Brahmanbaria BMMS 2010 35.4 37 MaMoni 40.6 44 Habiganj HSS 2012 Jhalokathi BMMS 2010 47.4 49 Lakhsmipur DHSS 2013 48.2 50 Noakhali DHSS 2013 44.4 47 Pirozepur BMMS 2010 47.7 50 DGFP Couple years of protection (CYP) in USG- 181,369 MIS 680,452 supported programs Form-4 Bhola 2013 229,705 NA NA Brahmanbaria NA NA 42,685 Habiganj 2013 166,771 201,793
16,839 Jhalokathi 2013 73,814 97,435
35,051 Lakhsmipur 2013 158,305 208,962
53,924 Noakhali 2013 214,571 125,882
32,869 Pirozepur 2013 122,977 46,380
Intermediate Result 1: Improve service readiness through critical gap management
MaMoni HSS – Year Two First Quarterly Report February 2015 25 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 Health Facility Percent of targeted facilities that provide informati Assessment will be 2013 NA 20 NA essential newborn care on completed in Q2 collection checklist FY 2015 targets will be revised after the Health assessment of health facility Percent of targeted facilities that provide facilities in new informati 2013 NA 20 NA family planning services districts on
checklist Assessment will be completed in Q2 Targets to be revised Health after assessment in Percent of targeted facilities providing facility new districts delivery services 24 hours a day, seven days informati 2014 NA 69 NA a week on Assessment will be checklist started in Q2 At the end of Q1, 86 Number of vacant positions filled by Project 2013 81 91 172 positions of CHWs will temporary non-GOB health workers MIS be discontinued Sub-IR 1.2: Strengthen capacity of service providers to provide quality services Number of people trained in Project maternal/newborn health through USG- training 7,676 1,760 supported programs report Project The large number of Number of people trained in FP/RH with training 27,061 19 training for CVs will USG funds report start in Q2 Number of people trained in child health Project Training on child health and nutrition through USG-supported training 2,471 0 and nutrition topics programs report will begin from Q2
MaMoni HSS – Year Two First Quarterly Report February 2015 26 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 Sub-IR 1.3: Strengthen infrastructure preparedness to improve MNCH service utilization These facilities were Number of facilities upgraded to provide upgraded to provide Project MNCH/FP/N services through USG 2013 7 69 MNCH/FP/N services, MIS support without support for renovation of facilities Intermediate Result 2: Strengthen health systems at district level and below Percent of upazilas that used key Project MNCHP/FP/N performance data during 2014 Nil 80 65 report periodic review in the reporting period Targets for Percent of targeted facilities recognized for SBMR achievement of quality 2013 Nil 20 0 achieving set quality standards report standards is set for 2015 The data on stock-outs Percent of USG-assisted service delivery at SDP level is available points (SDPs) that experience a stock out through the web-based LMIS at any time during the reporting period of a 2013 NA <5 5.1 LMIS of DGFP. The report contraceptive method that the SDP is application is currently expected to provide rolled out only in Lakhsmipur district. Sub-IR 2.1: Improve leadership and management at district level and below Data will be available Percent of planned supervision visit JSV from Q2. This is linked conducted where a supervision tool was 2014 NA 90 NA checklist to upazila level used and findings shared with providers MNCH/FP/N plans Sub-IR 2.2: Improve district-level
MaMoni HSS – Year Two First Quarterly Report February 2015 27 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 comprehensive planning (including human resources) to meet local needs The preparatory work for district planning Number of districts with updated Project 2013 Nil 3 0 completed. Planning comprehensive annual MNCH/FP/N plan report cycle will begin from Q2 of 2015 Micro Number of community microplanning units planning 2013 924 2,736 1,303 conducting monthly meeting meeting register Sub-IR 2.3: Strengthen local management information systems Health Facility The FY 15 targets will Number of unions using automated system informati be revised after the to integrate facility and community MNH 2013 Nil 8 10 on year 2 workplan is data collection finalized checklist Sub-IR 2.4: Establish quality assurance system at district level and below Project N/A Orientation of JSV Percent of targeted facilities received visit QA 100 completed. Visit will by a clinical quality assurance team report start from Q2 Sub-IR 2.5: Develop comprehensive logistic management systems at district level and below Number of upazila tracking stock-out of LMIS MNCH/FP commodities using 2013 Nil 21 5 report comprehensive LMIS Sub-IR 2.6: Strengthen local government planning and engagement in health service provision
MaMoni HSS – Year Two First Quarterly Report February 2015 28 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 Project Number Union Parishads (UPs) in a district LG that allocated budget for MNCH/FP/N in 2013 72 213 135 activity the current year report Sub-IR 2.7: Improve local governance and oversight for MNCH/FP/N Meeting Number of Union Parishads (UPs) in a minutes district that have active Health and Family of 2013 72/77 128 92 Planning Standing Committees UEHFPS C Intermediate Result 3: Promote enabling environment to strengthen district level health system Number of critical vacancies filled by GOB Project 2013 N/A 10 19 recruitment in project areas report Sub-IR 3.1: Policy reforms in place to promote local planning and need- based human resource deployment in the public sector Number of policies/ strategies/ guidelines Policy on MNH developed/revised with MaMoni documen 4 2 HSS support t Sub-IR 3.2: Strengthen advocacy and coordination for adoption of evidenced-based learning in national policy and program Project FAOPS Conference; Number of MNCH/FP/N advocacy report on 2013 NA 4 2 World Prematurity initiatives held in reporting quarter advocacy Day Intermediate Result 4: Identify and reduce barriers to accessing health services
MaMoni HSS – Year Two First Quarterly Report February 2015 29 Data Disaggrega Baseline Baseline Targets Achievement Remarks Indicator Source tion Year Value Oct – Dec 2015 2014 MOH&F Number of deliveries with a SBA in USG- W MIS 2013 54,444 55,854 18,102 assisted programs report Number of antenatal care (ANC) visits by MOH&F skilled providers from USG-assisted W MIS 2013 259,041 276,216 149,655 facilities report Sub-IR 4.1: Promote awareness of MNCH through innovative BCC approaches Project Number of people reached through project MIS 2013 NA 400,000 64,167 supported BCC activities report Sub-IR 4.2: Enhance community engagement in addressing health needs Number of trained community volunteers Project promoting MNCH/FP/N through project MIS 2013 14,000 24,925 33,961 support report Number of Community Action Groups Project with an emergency transport system for MIS maternal and newborn health care through report USG-supported programs 20,000 14,726
MaMoni HSS – Year Two First Quarterly Report February 2015 30 Annex 3: Success Stories
A. A Safe Delivery by Ratna Begum of Nijhum Deep - a Distant and Isolated Island In Bangladesh there are a number of hard to reach areas where communication infrastructure is very poor. MaMoni is supporting an upazila called Hatiya in Noakhali district. This is an island located in the Bay of Bengal at the mouth of River Meghna, far away from the mainland Noakhali district, which makes it one of the most remote communities in the Southern part of Bangladesh. People from different parts of the country have migrated to Hatiya for their livelihood, making it a very crowded place.
Figure 12: Ratna Begum with her newborn baby There is a virgin island, called Nijhum Deep, raised on the estuary of the great Meghna channel in the mouth of Bay of Bengal. It is part of a cluster of small islands including Char Osman and Char Kamla and is located adjacent to Hatiya. Cyclones and destructive waves are common features that the islanders face. Since there is no regular river transport or passenger route from Nijhum Deep to Hatiya or Noakhali, it is difficult to reach any of the health facilities that are located in Hatiya or in Noakhali district town. In normal situations, it takes nearly three hours to reach Noakhali if a boat is readily available at the shore.
Ratna Begum, wife of Afsar Uddin of Nijhum Deep had every reason to worry when she became pregnant for the second time. She had suffered a lot during her first delivery. She had experienced three days of labor pain with no access to a health service facility and no trained/skilled providers. Based on her previous experience, she was expecting yet another difficult labor with the hand of an unskilled birth attendant. On 11 November 2014, Ratna Begum started having labor pains, and the traditional birth attendant and a village doctor began to help her with the delivery.
Afsar Uddin, Ratna’s husband, had heard from a relative that the government health center in Sonadia has started round-the-clock operations with trained nurses to conduct deliveries. Afsar also had a relative whose wife had delivered at this facility a few weeks ago. Afsar called his relative to get more information and he received positive feedback, and that it was safe and free of cost. His main dilemma was in finding the money for transportation of his wife Ratna to the Sonadia health center. He borrowed some money from a local brickfield with the condition that he would repay it by working in that brickfield. While in labor, Ratna Begum along with her husband travelled 12 kilometers by rickshaw van to Nijhum Deep boat ghat, and another kilometer by boat across the river. After crossing the river, they had to travel another 15 kilometers by a rickshaw van before they reached the health center in Sonadia. Ratna was admitted by paramedic Hafija Khatun, who has been deployed by MaMoni HSS project. MaMoni HSS has deployed 2 paramedics to ensure the availability of round-the-clock services.
Previously, there were no safe delivery facilities nearby, except an UHC. Most of the Hatiya community could not access safe delivery services before MaMoni HSS supported the district to convert the Sonadia UH&FWC into a 24/7 delivery service center. Since Sonadia FWC started providing delivery services in July 2014, a total of 73 women have safely delivered at the facility.
Afsar was overwhelmed and overjoyed to receive delivery services for his wife. He said “I will tell all in my Union about these safe delivery services so that they all can take advantage of this service.” Ratna Begum said “I didn’t have to suffer like the previous time because of the skilled person at Sonadia
MaMoni HSS – Year Two First Quarterly Report February 2015 31 center. They even did not take any money for the services”. Another member of the community shared that many more are eager to visit the facility for safe delivery services. Now a lot of mothers from far away islands like Nijhum Deep are visiting the facility.
B. CSBA Nurjahan Begum is more confident to deliver babies because of HBB training
Nurjahan Begum is a Health Assistant in Gobindaganj upazila of Gaibandha district. She has been conducting deliveries since 2010 after receiving C-SBA training. She is very active in her community, and travels within her community by a motorcycle. Initially, she had to refer a lot of the delivery cases to the hospital because she didn’t have experience in managing newborn complications, and she was helpless if
Figure 13: Mosne Ara and newborn a baby was born at home with birth asphyxia. After receiving HBB with CSBA Nurjahan Begum training in 2011, Nurjahan now confidently delivers many babies.
Nurjahan Begum provided ANC service to Mosne Ara, a young mother of 15 years, at the Community Clinic, when she was 7 and 9 months of pregnant. Mosne Ara moved to her mother’s house during pregnancy, and hence did not receive any services from a medically trained provider in that locality. On 12th November 2014, Nurjahan was called at 4am to conduct delivery. She referred Mosne Ara to the nearby Kanupur UH&FWC and went there herself to assist the delivery. The following morning, after eight hours of labor, a baby boy was born weighing 2600 Grams. But the baby did not cry or move, and was stained with meconium. Nurjahan quickly cleaned out the nose and mouth and provided bag and mask ventilation. The baby started to move after 7-8 minutes. After continuing the ventilation for another 20 minutes, the baby had started to breathe. Since the baby was not out of risk, she referred the baby to Gobindaganj Upazila hospital. Finally, after another referral to Rangpur medical college and two days of treatment, Mosne Ara’s baby boy was discharged.
Between December 2013 and December 2014, Nurjahan conducted 182 deliveries, an average of 15 per month. She successfully resuscitated 16 babies, 14 of them requiring bag-and-mask intervention.
C. Dramatic increase in Birth Registration in Char Falkon, Lakshmipur
Char Falcon is a remote union of Lakshmipur. In 2013, only 15 births were registered in that union through the Ministry of Local Government, Rural Development and Cooperatives’ (MOLGRD&C) birth registration system. This has been a major gap, since the union parishad has been unable to track child births or deaths through its MIS system. The UP, like most other unions, has no reliable source to be notified of deaths in their community, and are not able to estimate the magnitude of child deaths for their union. MaMoni HSS has initiated a birth registration support through its community micro- planning process. Through this system, the Health Assistants compile the list of new births with the help of volunteers, and then send a notification to the UP, which issues birth registration cards to the children and distributes them through the HA. After conducting training, 150 births were registered in the two following months. The Char Falcon Union Parishad is now involved in tracking all live births, and has the means to make decisions based on complete and accurate data in their union. As evident from the Table 3 below, the percentage of birth registered in Char Falcon Union, just after two months of starting the new intervention, is far ahead of the rest of the unions in the upazila. Still, there is a long way to go to have all births registered within 45 days.
MaMoni HSS – Year Two First Quarterly Report February 2015 32 Table 3: Percentage of births registered within 45 days in unions of Kamal Nagar upazila, Lakhsmipur district – November 2014 Births registered Within 45 Days Location Boys Girls Total Boys % Girls % Overall % 1. Char Falcon 30 12 42 28.04 23.53 26.58 2. Char Kadira 0 1 1 0 2.63 1.43 3. Char Kalkini 0 0 0 0 0 0 4. Char Lawrence 0 0 0 0 0 0 5. Char Martin 0 0 0 0 0 0 6. Hajirhat 1 0 1 2.13 0 1.01 7. Patarir Hat 0 0 0 0 0 0 8. Torabgang 2 0 2 3.92 0 2.13 Total 33 13 46 10.03 5.35 8.04
MaMoni HSS – Year Two First Quarterly Report February 2015 33 Annex 4: Key Achievements of Aponjon (MAMA) initiative
The MAMA initiative, branded as Aponjon in Bangladesh, was fully integrated with MaMoni HSS from July 1, 2014. This Annex presents a summary of key accomplishments of Aponjon during the period of October 2014 – December 2014.
New subscriber acquisition: During the quarter, a total of 115,645 customers were enrolled in this quarter. Among them 17,222 were registered with BRAC health workers; 3,010 with NHSDP; 284 with MaMoni HSS, 113 with SMC and the rest 5,354 were enrolled by TothyoKollyani.
Table 4: Status of subscriber acquisition through different channels Subscriber Type October November December Total Primary Subscribers 86,781 16,151 6,514 109,446 Expecting mothers 27,404 5,566 2,346 35,316 New mothers 59,377 10,585 4,168 74,130 Secondary Subscribers (Gatekeepers) 4,189 1,351 659 6,199 Husbands 543 95 69 707 Mothers-in-law 18 19 1 38 Mothers 16 2 1 19 Other Relatives 3,612 1,235 588 5,435 Total 90,970 17,502 7,173 115,645
With a view to promoting Aponjon’s new services as well as the Aponjon brand itself, the team has decided to do a campaign through local transportation. For this purpose, the team has chosen bus branding as the initial medium. Ten buses plying on five routes have been chosen for the campaign. The bus design has been done. We are expecting an increase in subscription after the campaign.
Communication
• Chief technical adviser of MAMA Bangladesh Dr. Ananya Raihan on Global Post: America's world news site Global Post has featured Dr. Ananya Raihan's views on mHealth for the article "Mobile health unproven but not without potential in South Africa". And the team has communicated this news through social media. (news link: http://www.globalpost.com/dispatches/globalpost- blogs/global-pulse/mhealth-mobile-health-south-africa ) • Aponjon at Third Global Symposium: The Third Global Symposium on Health Systems Research was organized in Cape Town, South Africa from 29 September to 3 October, 2014. Along with the other participants, Dr. Fida Mehran, Head of Content, Dnet and Ms. Rizwana Rashid Auni were also present. This event was also communicated through social media. • Al Jazeera report on Aponjon: Al Jazeera telecast a news story on Aponjon and it was hugely publicized on social media. (news link: https://www.youtube.com/watch?v=Z8Ke7gtDUA0 )
Content • Development of content for early childhood service: With financial support from J&J, Dnet has designed a new service for mothers with children from 1 year+ to 5 years age. Accordingly, contents have been developed in IVR audio and text message format. Initially, the messages are designed only
MaMoni HSS – Year Two First Quarterly Report February 2015 34 for mothers, and the messages for the gatekeepers will be introduced later. The service will follow the same frequency as the existing Aponjon service for mothers with children below 1 year. The messages have been recorded and text messages developed. These are expected to be deployed in January 2015.
• Development of content for Aponjon mobile application: To take Aponjon to the next level, and keeping in mind the constantly expanding market of smartphones, Dnet has taken an initiative to develop a mobile application for smartphone users. Initially the app is being developed for Android. Dnet is developing the infrastructure as well as the platform and server setup for the whole service. Work is in progress for the technical platform and infrastructure development. The first version of the app is expected to be released for public by March of 2015.
• Modification of existing content of Aponjon service: As part of continuous improvement of Aponjon contents, modifications are reflected through new versions of content. Based on a previous Content survey and suggestions made by the Technical Committee, changes have been made in the Content, and an updated version has been created and recording is complete. The new content version is ready for deployment and the Technology team has been working with the Technological platform provider to pave the way in rolling out the new version contents. Due to a few setbacks regarding stability of the technological platform, the content deployment was deferred and is expected to be deployed in February 2015. Accordingly, the subsequent meetings of the Technical Committee on Content and the field study for the next version of content will be postponed.
• Call center management and counseling line services: There were 207 total calls for registration, 9840 incoming calls, 29847 outgoing calls, 1170 Date of Birth updates and 15,254 data entries. The counseling line services received 6,497 incoming calls during the quarter.
MaMoni HSS – Year Two First Quarterly Report February 2015 35 Annex 5: Special Activity: Collaboration with TRAction project to reduce newborn mortality through targeted intervention in Jaintiapur upazila, Sylhet
MaMoni is collaborating with the TRAction project to reduce newborn mortality in Jaintiapur upazila of Sylhet.
Overall the targeted intervention/differential management approach had two sets of activities - surveillance and targeting and management. As part of the intervention, a Special Care Newborn unit (SCANU) was established in Jaintiapur Upazila Health Complex in March 2013. An additional room to care for newborns with sepsis was also established. Figure 14: Inauguration of Special Care Newborn Unit at Jaintiapur UHC by local MP Mr. Imran Ahmed The entire upazila was divided into 21 units with each unit divided into 40 blocks. One Community Health Worker (CHW) was assigned to each of the units and for each block one Community Volunteer (CV) was selected. The average population of each block is 300 individuals.
The six unions of Jaintiapur upazila were divided into four paramedic clusters and one paramedic was responsible for each of the clusters. CHWs of a cluster
Figure 15: An admitted newborn being treated at notified their paramedic for any maternal/newborn Jaintiapur UHC assessments and referrals. All the referred newborn cases receive essential services at the Jaintiapur UHC SCANU. A team of one Medical Officer (MO) and two nurses/paramedics provide services round the clock at the SCANU. The project has placed four MOs and six nurses (MATS certified Paramedics/Diploma nurses) under local supervision of Upazila Health and Family Planning Officers (UH&FPO). All of the service providers have received training on ETAT from BSMMU and hands-on (in service) training from the Pediatric Department of Sylhet Osmani Medical College Hospital. The project has supplied all necessary equipment, drugs and logistics required for SCANU.
From October 2014, the targeted intervention approaches were reduced in intensity while services continued from the SCANU. This reduction was part of phasing out activities, particularly the CHWs surveillance approach. During the quarter October – December 2014, CHWs visited each and every household of the upazila to share information on the phase-out scenario at the family level. Union advocacy meetings were organized to share the phase out scenario with the stakeholders/gatekeepers, elected public representatives and informal leaders. Objectives of the meetings were to continue identification of sick newborn and referral by the community. During the period of intervention 840 CVs’ referral network has been identified as the most effective referral network. During this quarter, structured monthly meetings were conducted with all the CVs in CHWs Units to strengthen and continue their referral networks. All CHWs and paramedics have been withdrawn after December 31, 2014. SCANU, CV network and minimum community mobilization activities will be continued with Save Korea support from January 01, 2015.
MaMoni HSS – Year Two First Quarterly Report February 2015 36 The total population of Jaintiapur upazila under the coverage of the intervention is 174,449; and the number of married Women of Reproductive Age (MWRA) is 28,981. During October 2014- December 2014, the CHWs visited 34,422 household and shared phase-out information with 35,233 persons. Six (06) union advocacy meeting were conducted where 314 community stakeholders and gatekeepers attended. A total of 139 sick newborns were admitted in the SCANU and 362 sick newborns were provided services in the outdoor of the Jaintiapur UHC. The causes of the 139 admissions were: infection/sepsis – 48 (35%), birth asphyxia – 68 (49 %), pre-term/low birth weight related complication – 17 (12%) and jaundice – 06(04%). Total neonatal deaths in Jaintiapur upazila during this period was 07.
MaMoni HSS – Year Two First Quarterly Report February 2015 37 Annex 6: Quality Assurance Initiatives
A) National level Stakeholders’ meetings:
Table 4: Summary of National Stakeholder meetings SL # Name of Training Events Location Date Category of Participants Number Number of Total of Participants Batches Male Female 01 Meeting with National Nutrition Services IPHN 27th Director, Deputy Director, AD, (NNS), IPHN for developing joint work Conference November Program Managers, DPMs, Jr. 01 18 04 22 plan to support implementation of room 2014 Clinicians and representatives from operational plan of HPNSDP MaMoni-HSS 02 Consultation meeting at DGFP along with MCH 9th Director MCH Services, LD CCSDP, professional bodies to develop Basic Conference December DD, AD, PM(QA), PM, Professor MNCH/FP/N training package for non- room, 2014 (Gynae & Obs), Associate Professor 01 16 07 23 technical service providers DGFP (Pediatrics); MFSTC, representatives from MaMoni-HSS 03 Conduct national level orientation on MIS 11th Directors from DGHS & DGFP, BNF, RRQAT to share the concept, strategy and conference December BPS, OGSB, representatives from 01 17 11 28 develop next course of action to room, 2014 MaMoni-HSS implement RRQAT concept DGHS
B) District level Orientation/Training/Workshops:
Table 5: Summary of district level capacity-building events SL # Name of Training Events Location Date Category of Participants Number Number of Total of Participants Batches Male Female 01 Injectable Contraceptive Lakhsmipur 22 Dec’14 Newly recruited FWA 01 00 19 19 02 District level orientation on joint Lakhsmipur, 23 Dec’14 CS, MO-CS, DDFP,UH&FPO, UFPO, 04 71 08 79 supervisory Visit(JSV) Noakhali 30 Dec 14 MODC, MOMCH, Senior Health
MaMoni HSS – Year Two First Quarterly Report February 2015 38 Habiganj 30 Dec 14 Education Officer, MaMoni HSS Jhalokathi 30 Dec 14 staff. 03 JSV Orientation at Ramgonj UHC Lakhsmipur 24 & 29 HI, AHI, FPI & TO 02 23 00 23 Dec’14 04 JSV Orientation at Sadar UHC Lakshmipur 31 Dec’14 HI, AHI, FPI & TO 01 20 02 22 05 Workshop on Field activity for 4th Batch Habiganj 20/10/20 pCSBA 01 00 21 21 pCSBA 14 06 Workshop on "Operation research to Habiganj 29/10/20 CS,DCS,MO-CS, MO-MCH-FP, MO, 02 52 23 75 improve 24/4 delivery and EmONC service 14 Consultant(Gynae), Consultant in public facilities by Health Systems 13/11/20 (Pediatrics), Sr. Manager, Manager- Strengthening in Bangladesh" 14 QA, FC-QA, FWV, SSN, SN 07 Clinical Session on Partograph and Habiganj 22/11/20 MO (Clinic), MO (Gynae), 01 09 21 30 Management of PE/E 14 Consultant(Gynae), FWV, Nurse 08 Training on AMTSL, Partograph & Habiganj 20 & Mo, FWV, Paramedic, Nurse, FC-QA 01 01 23 24 Management of Pre-eclampsia/ Eclampsia 21/12/20 14
C) Scaling up Quality Assurance interventions:
1. Preparation for implementation and scaling up Maternal and Perinatal Death Review (MPDR): The project initiated effective partnership with Center for Injury Preventions and Research, Bangladesh (CIPRB) and UNICEF for scaling up MPDR as a quality improvement approach. The project organized a joint trip with UNICEF and CIPRB to Maulvibazar district, one of 10 districts currently implementing MPDR with support from UNICEF and CIPRB. During the trip, the project conducted a review of the process of MPDR implementation in the district and assessed the level of data collection and utilization. As a result, the project prepared for scaling up MPDR in MaMoni HSS project’s areas taking into consideration the UNICEF and CIPRB experience and challenges. During the reporting period, the project initiated the plan for introducing MPDR in one Upazilla in Noakhali district. In addition, the project has developed a scope of work to engage CIPRB as a lead organization in implementing MPDR in Bangladesh to collaborate with MaMoni HSS project to scale up MPDR in Noakhali, Habiganj, and Lakshmipur Districts. The implementation of MPDR will improve maternal, perinatal, and neonatal mortality notification and will entail conducting reviews of each mortality case, focusing on the identification of gaps in health care seeking and in quality of services, and engaging district level policy makers and community leaders in taking actions to avoid future maternal and newborn mortality.
MaMoni HSS – Year Two First Quarterly Report February 2015 39 2. Initiating a plan for developing Regional Roaming Quality Assurance Teams (RRQAT): The project has developed a plan for the development of RRQAT to contribute to improving the quality of clinical services in project areas. The teams are composed of selected staff from medical colleges and professional associations, such as OGSB and BPS, who will pay visits accompanied with district level supervisors to selected health facilities at MaMoni HSS districts. RRQAT will use the supportive supervision approach to provide guidance to health providers in improving maternal and newborn care services. In addition, RRQAT will conduct clinical updates in selected topics based on the results of the supervisory visits. RRQAT will discuss results of the supervisory visits with district health officials and identify specific improvement actions. The project intends to start RRQAT in Habiganj district of Sylhet Region and will be followed by teams in Barisal and Chittagong to cover other project districts.
3. Support the implementation of Standard Based Management and Recognition approach: During the reporting quarter, the project supported 31 health facilities in three districts (12 in Habiganj, 8 in Lakshmipur, and 11 in Noakhali) in implementing their quality improvement workplan.
4. Implementation of Joint Supervisory Visits (JSV): The project conducted orientation for district level supervisors and government managers in Habiganj, Lakshmipur, and Noakhali districts on the supervision tools and guidelines. Plans for conducting routine supervision using the developed tools will start next quarter. The JSV will contribute to conducting regular and effective supervisory visits to health facilities in project areas with particular emphasis in applying the supportive supervision approach to improve quality of MNCH/FP/N services.
MaMoni HSS – Year Two First Quarterly Report February 2015 40