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PBAAJ613.Pdf TABLE OF CONTENTS Page EXECUTIVE SUMMARY.. .. .................... ... ............ .. .. ................ ... .. ......... ................... iv A. INTRODUCTION.. ... ......... .. ................... .... .. ............. ............... ............ .. ......... l 13. PROJECT RESUL,TS ... .. .......... ...... ................... ..... .. ... ... ... ....... ........... .. ...... ..... 2. Bl. IR l INCREASED AVAILABILITY AND REACH OF COMMODITY..... .... .......... ... ... ... 2 Bl.l INCREASED SALES AND DISTRIBUTION BY PRIVATE SECTOR NETWORKS. .... 2 B 1.2. EXP ANDED PRIVATE SECTOR NETWORK. ............................... .. ... ............ .. .. 9 B2. IR 2: IMPROVING KNOWLEDGE AND HEALTHY BEHAVIORS.. .. .. .. ......................... 11 B2. l IMPROVED HEAL TH COMMUNICATION ACTIVITIES . ... 11 B2. l. l NOTUN DIN COMMUNITY MOBILIZATION PROGRAM...... .. .......... .... ..... 11 B2.l.l.l ACTMTIES THROUGH IPC AND GROUP MEETINGS.... .................. 12 B2.1. l .2 ENGAGING WOMEN AS ENTREPRENEURS AND EFFECTIVE BEHAVIORAL CHANGE AGENTS... .......... ........ ........... ........................... 17 B2.l.l.3 ACTIVITIES THROUGH OTHER COMMUNICATION CHANNELS........ 19 B2.1.1.4 PROGRAM PLANNING AND PERFORMANCE REVIEW MEETING . .. 21 B2.1.2 MASS MEDIA CAMPAIGN. .................... ........... .. .......... ................. ..... 22 B3. IR3: IMPROVE AND SUSTAIN PROGRAM QUALITY ........................................ ......... 22 B3.l INCREASED TRAINING AND REFERRALS............................................ ......... 22 B3.1.1 BLUE STARPROGRAM.............................. ....................................... 22 B3.l.2 LONG ACTING REVERSIBLE CONTRACEPTIVE PROGRAM................ ..... 26 B3 .1.3 PRIVATE COMMUNITY HEAL TH PROVIDERS TRAINING PROGRAM .. ...... 29 B3.2 STRENGTHENED LINKAGES WITH PUBLIC AND PRIVATE SECTOR ........... .. .. 30 C. CONTRIBUTION OF SMC TO THE NATIONAL PROGRAM.. ....... ........................ ..... 32 D. TECHNICAL ASSISTANCE OF PROJECT PARTNERS AND OGSB.. ....... ... ........... ........ 33 E. MONITORING, RESEARCH AND EVALUATION................................... ............... 36 El MONITORING ACTIVITIES...................................................... ... ........... .......... .. 36 E2 QUALITY ASSURANCE INITIATIVES.. ........ .............................. ....... ...... ... .... ...... 40 E3 RESEARCH ACTIVITIES . .. 42 E4EVALUATION .. ....... .. .................... ........................... ................ .......... .. ........ .. 45 F. FAMILY PLANNING COMPLIANCES.... ...... ............................ .. ................ ......... 46 G. ENVIRONMENT COMPLIANCE.. .................. ............. ..................................... ... 47 H. CAPACITY DEVELOPMENT ACTIVITIES... ..... .. ........... .. .. ......... .. ............... .... ..... 47 I. IMPLEMENTATION CHALLENGES......... ... ............. ............ ........ ................ .. .... 48 J. LESSONS LEARNED...... .. ................ ... .. ............ ........ .. .. ... ... .. ..................... ..... 50 K. RECOMMENDATION FOR FUTURE PROGRAM..... ............ ....... ............... .. .......... 54 L. FINANCIAL ANALYSIS OF MIH..................... .. .... 57 ANNEX 1... .. ...... ................ .. ... ................................... ... ........................................ .... 59 ANNEX2... ..... ... ................... ..... .. ... ..... .. ................................................................... 60 ANNEX3....... ... .. .. ....................... .... ..... ... .... ...................... ... ... ................................. 68 ANNEX4. ... ..................... ............................ ............................ ... .. ............................ 69 MIH Final Report Pagei ACRONYM LIST ARI Acute Respiratmy Infection BCC Behavior Change Communication BRAC Bangladesh Rural Advancement Committee BS Blue Star BSP Blue Star Provider BTV Bangladesh Television CA Cooperative Agreement CSA Community Sales Agent CM Community Mobilization CBA Community Birth Attendant coc Combined Oral Contraceptive CPR Contraceptive Prevalence Rate CYP Couple Year of Protection CWFD Concerned Women for Family Development DOTS Directly Observed Treatment Short Course DGFP Directorate General of Family Planning DQA Data Quality Assessment ECP Emergency Contraceptive Pill EH EngenderHealth FP Family Planning FY Fiscal Year GOB Government of Bangladesh HTSP Healthy Timing and Spacing of Pregnancy IEC Information, Education and Communication IMCI Integrated Management of Childhood Illness IUD Intra Uterine Device IPA Iron Folic Acid IR Intermediate Result LAPM Long Acting and Permanent Method LARC Long Acting Reversible Contraceptive MAMA Mobile Alliance for Maternal Action MOU Memorandum of Understanding MFP Mobile Film Program MCH Maternal and Child Health MIH Marketing Innovation for Health MNP Micronutrient Powder MWRA Married Women of Reproductive Age M&E Monitoring and Evaluation NGMP Non Graduate Medical Practitioner NGO Non Government Organization NTP National TB Program OCP Oral Contraceptive Pill ORS Oral Rehydration Salts OGSB Obstetrical and Gynaecological Society of Bangladesh PCHP Private Community Health Provider POP Progestin Only Pill Page ii PO-TSD Program Officer-Training and Service Delivery PSTC Population Services and Training Center PSI Population Services International RFP Request for Proposal RH Reproductive Health RDC Radio Conunercial SBCC Social and Behavior Change Communication SDK Safe Delivery Kit SMC Social Marketing Company TB Tuberculosis TOT Training of Trainers TVC Television Conunercial USAID United States Agency for International Development WHO World Health Organization MIH Final Report Page iii EXECUTIVE SUMMARY Social Marketing Company (SMC) implemented the Marketing Innovation for Health (MIH) Program funded by USAID from 26 July 201 2 to 25 July 2016. The program aimed to support the Government of Bangladesh's efforts to further reduce fertility rate and address critical public health concerns such as high maternal, neonatal and child morbidity and mortality, spread of tuberculosis (TB) and poor malnutrition. The goal of the MIH program was to "contribute to sustained improvements in the health status of women and children in Bangladesh by increasing access to and demand for essential health products and services through private sector." Under the MIH program, SMC delivered 16.08 million couple years of protection (CYPs) which helped ave1t 3.29 million unintended pregnancies, 0.57 million deaths of children under-5, and 49 .43 million disability adjusted life years (DALY s) . Some of the key results, contributions and accomplishments of the program by Intermediate Results (IR.s) are elaborated below: IR 1: Increased availability and reach through expanded commodity sales and distribution through private sector networks SMC ensured wide reach of its health products and services across Bangladesh through expansion of three major distribution channels: i) commercial outlets, wholesale and retail; ii) local NGOs and community-based distribution points; iii) private sector health facilities and health provider networks. Some of the major achievements in this IR during the life of MIH (FY 2013 to FY 2016) are as follows: ~ Over 16 million couples protected from unwanted pregnancies mostly through sales of 150 million cycles of oral contraceptive pills (OCPs) and over 525 million condoms and 5.7 million injectables. As per the 2014 BDHS, SMC contraceptives contributed to 34% of all contraceptive use nationally, having increased its share of oral contraceptive use to above 44% and condom use to 61 %. ~ During the program period, SMC introduced a number of new products and brands to provide wider choices to family planning consumers. These include two long acting contraceptive methods - IUD and Implant and a new injectable Sayana Press, all donated by USAID; an emergency contraceptive pill branded as N01ix; two new combined oral pill brands; and a premium condom brand, all supported through SMC's own funds. ~ Sold almost 2 billion sachets of its ORS brand ORSaline-N to cater to an increasing demand stemming from use to treat dehydration due to diaIThea as well as excessive sweating. Of these, 1,080 million sachets or 56% of the total sales quantity were manufactured at its own production facility while the remaining were sourced through contract manufacturing. Around 60% of all SMC revenues are generated through ORS sales. ~ Introduced a low priced sanitaiy napkin that has sold over 6.5 million packets and has reached a share of more than 13% of the market since its launch in 2013. Because of its quality, affordable price and wide availably, its use and acceptance among adolescents and first time pad users have been impressive. ~ Sold over 48.3 million sachets of its micronutrient powder brand MoniMix, thus making slow and steady inroads into the hugely important child nutrition market. ~ Introduced a community based distribution model engaging over 800 rural women as entrepreneurs which is showing a strong promise for growth and sustainability in rnral and hard-to-reach areas. Page iv IR 2: Improved knowledge and healthy behaviors, reduced harmful practices and increased care-seeking practices MIH implementing partners worked to increase knowledge of health products and healthy behaviors through a community mobilization and behavior change communication (BCC) program called 'Notun Din' and mass media communication to create national level awareness and reinforce the community
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