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Evidences for Planning and Decision Making to Determine Potential Approaches for Improving MNH Services in Underserved Unions

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Evidences for Planning and Decision Making to Determine Potential Approaches for Improving MNH Services in Underserved Unions Evidences for planning and decision making to determine potential approaches for improving MNH services in underserved unions USAID’s MaMoni Maternal and Newborn Care Strengthening Project (MaMoni MNCSP) July to September 2020 List of Contributors USAID’s MaMoni Maternal Newborn Care Strengthening Project (MaMoni MNCSP) has initiated a process to collect information from primarily selected unions in the intervention districts through physical verification. Through the process, the project generated information from the primary sources to analyze present status of underserved unions, and produced evidences for district implementation team with the objective to enabling them for using evidences in setting programmatic priorities, making appropriate decisions, and planning interventions. The following individuals have valuable contributions in the process of information collection, data recording & coding, multiple analysis and report preparation: 1. Shumona Shafinaz, Senior Technical Advisor, Program Implementation, MaMoni MNCSP, Save the Children 2. Bal Ram Bhui, Monitoring, Evaluation and Learning Advisor, MaMoni MNCSP, Save the Children 3. Md. Abdus Salam, Managing Director, Partners in Health and Development (PHD) 4. Ashish K Dutta, Director, Partners in Health and Development (PHD) 5. Jatan Bhowmick, Advisor, Local Government and Accountability, MaMoni MNCSP, Save the Children 6. Mr. Salah Uddin, Deputy Director, Program Implementation, MaMoni MNCSP, Save the Children 7. Nakul Biswas, Deputy Director, Program Implementation, MaMoni MNCSP, Save the Children 8. Bivakar Roy, Deputy Director, Program Implementation, MaMoni MNCSP, Save the Children 9. Md. Nashir Uddin Faruq, Deputy Director, Partners in Health and Development (PHD) 10. Implementing Partners staff who are involve in date collection from the field. 11. Md. Ashadur Rahman, Team Leader, MaMoni MNCSP, PHD 12. Ali Hossain, Senior Program Coordinator, MaMoni MNCSP, PHD 13. Umme Salma Mukta, MEL Coordinator, MaMoni MNCSP, PHD 14. Khondaker Rakibuzzaman, Regional Coordinator, MaMoni MNCSP, PHD 15. Md. Muarraf Hossain, Regional Coordinator, MaMoni MNCSP, PHD 16. Md. Abu Nausher Ali Sumon, Regional Coordinator, MaMoni MNCSP, PHD 17. Chapala Rozario, Senior Program Officer, MaMoni MNCSP, PHD Page 1 Table of Contents 1. INTRODUCTION ............................................................................................................................................ 3 2. CRITERIA FOR SELECTING UNDERSERVED UNIONS................................................................................ 4 3. TIMELINE MAINTAINED ............................................................................................................................... 4 4. OUTPUTS GENERATED ................................................................................................................................ 5 5. APPROACH FOLLOWED IN SETTING PRIORITIES AND PLANNING INTERVENTIONS ............................. 5 5.1 PRIMARY SELECTION OF UNDERSERVED UNIONS ............................................................................................... 5 5.2 FINAL SELECTION OF UNDERSERVED UNIONS ................................................................................................... 6 5.3 GENERATE EVIDENCES FOR PRIORITIZING, PLANNING AND DECISION MAKING ..................................................... 6 5.4 PARTICIPATORY PLANNING THROUGH MULTI-STAKEHOLDERS’ ENGAGEMENT ...................................................... 6 6. STRUCTURE OF INFORMATION PROFILE ................................................................................................... 7 7. KEY FINDINGS.............................................................................................................................................. 8 7.1 UNDERSERVED UNIONS DISTRIBUTED BY THE GEOGRAPHIC LOCATION ................................................................ 8 7.2 UNDERSERVED UNIONS PRIORITIZED BY THE YEAR OF INTERVENTION.................................................................. 8 7.3 UNDERSERVED UNIONS CATEGORIZED BY AVAILABILITY OF FACILITY AND KEY PROVIDER ..................................... 9 7.4 UNDERSERVED UNIONS SEGREGATED BY DIFFERENT CHARACTERISTICS ........................................................... 10 a) Size of total population ............................................................................................................................ 10 b) Proportions of underserved population ................................................................................................. 10 c) Access to power supply ............................................................................................................................ 10 d) Count of FWA units ................................................................................................................................... 11 e) Number of FWA in place .......................................................................................................................... 11 7.5 UNDERSERVED UNIONS CLASSIFIED BY THE IMPRESSION OF KEY STAKEHOLDERS ............................................. 12 a) Interests of elected representatives in shouldering leadership roles .................................................. 12 b) Willingness of H&FP supervisors and workers in delivering MNH services ....................................... 12 c) Commitments of H&FP Managers in increasing coverage of MNH services ........................................ 12 8. SNAPSHOTS OF PROGRESSES IN THE GIVEN TIMELINE ....................................................................... 13 9. DISCUSSION AND RECOMMENDATIONS ................................................................................................. 16 9.1 SET PRIORITIES FOR YEAR 4 .......................................................................................................................... 16 9.2 PLAN INTERVENTIONS THROUGH MULTI-STAKEHOLDERS’ MEETINGS ................................................................ 16 9.3 EMERGE INNOVATIONS FOR DEMAND CREATION .............................................................................................. 17 10. CONCLUSION ............................................................................................................................................. 18 ANNEXES TO REPORT ....................................................................................................................................... 19 Page 2 1. Introduction In Bangladesh, around 28 million people are living in the underserved areas, which represent a substantial proportion of country’s total population. According to a Government Survey in 2011 showed 1144 unions of 50 districts as underserved. MaMoni MNCSP supports to MOH&FW for improving equitable utilization of quality MNH services in 10 districts to scale up proven interventions nationwide. The project aims to support alternative service delivery approaches in the underserved unions of project districts for reducing access barriers among the excluded population. As a consortium partner, PHD is responsible to perform technical roles to enable district implementation team in adopting appropriate interventions for the underserved unions for improving availability and accessibility of MNH services. The project develops physical verification report to support district implementation team with evidences in the following areas for better implementation of underserved interventions- Finalizing underserved unions based on verified information Prioritizing underserved unions to intervene in Year 3 and Year 4 Facilitating planning process through Union Parishad or UH&FWC Management Committee led multi-stakeholders’ meetings for developing appropriate action plans to achieve two prime objectives- Activating MNH service provisions in the underserved unions Increasing MNH services coverage among the underserved populations Operating an underserved dashboard to track progresses against the agreed action plans developed in multi-stakeholder’ meetings Combined with this report, MaMoni MNCSP team develops information profiles of underserved unions as a reference document for district implementation team to use in the planning process. As an integral part of this process, MaMoni MNCSP LG&A thematic team has initiated underserved dashboard for tracking progresses as a real-time monitoring tool. The project determined the unions with tea gardens as underserved because of the restricted lifestyle of garden workers with various visible and invisible barriers in assessing MNH services within and outside their territory. Some of the tea gardens have their own health facility with maternal care but many of them are bellow standard with inadequate skilled health care providers, shortage of equipment, drugs and other essentials. Jointly with Dhaka regional and Hobigonj district team, PHD MaMoni MNCSP team selected Teliapara tea garden of Sajahanpur union for piloting, conducted a study, shared key findings with all concerned, developed an agreed action plan with garden authority, and started interventions. The project decides to capture the lessons from Teliapara experiences for prospective replication in other selected tea gardens of the project areas. Page 3 2. Criteria for selecting underserved unions Initially the project determined the term ‘hard to reach (HtR)’ considering services gaps, geographical context, distance & seasonal limitation in accessing facilities,
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