MaMoni Health Systems Strengthening Activity End of Program Report October 01, 2013 – October 24, 2018 Submitted January 23, 2019 (USAID Cooperative Agreement AID-388-LA-13-00004) 1 | Page Skilled Birth Attendant Rebena Khatun is recognized for her contributions to the Community Rebena Khatum is a 34 year old paramedic and skilled birth attendant who works in the Char Kakra UH&FWC in Companiganj upazila of Noakhali district. The MaMoni HSS program placed her at the Char Kakra UH&FWC in 2015 as a temporary measure to ensure delivery care would be available until the MOHFW could fill the position. This is the second temporary placement that Mrs. Khatum has filled for MaMoni HSS in a program-supported area: she first worked in the Durgapur UH&FWC as a temporary paramedic placed by MaMoni HSS in that union. In the upazila of Companiganj, most pregnant women choose to deliver in expensive private facilities or risk Rebena Khatun enterin data of newborn in her TAB. delivery at home. However, when Rebena Khatum arrived at the Char Kakra UH&FWC, she was able to provide antenatal, delivery, and postnatal care free of charge and in a hygienic environment. She also provides 24/7 normal vaginal delivery services for the women of Char Kakra and surrounding unions. MaMoni HSS also ensured that Rebena is up to date on her skillsets for maternal and newborn care. Project-supported trainings that she has participated in have covered antenatal care, normal vaginal delivery, active management of third stage of labor, postnatal care, essential newborn care, infection prevention, and detection and management of complications, such as SPE/E. She is also trained in electronic records management and uses her tablet to track and report provided care to the MOHFW. In addition to her paramedic course that was completed in 2006, these trainings have qualified her as a skilled birth attendant. Rebena Khatum is now beloved, trusted, and relied on by the women and communities of Char Kakra and the four surrounding unions of Musapur, Rampur, Char Fakira, CharChae Elahi. From October of 2017 to September of 2018, Rebena Khatum conducted 2382 antenatal care visits, 546 normal vaginal deliveries, and 884 postnatal care visits. On the 2018 International Day of Rural Women, Rebena Khatum was honored for this remarkable service and was selected as the best skilled birth attendant in Companiganj upazila. Rebena Khatun Rabena Khatun receiving crest from the Chif Guest. feels proud to provide these services with MaMoni- Photo credits: MaMoni HSS. HSS support, as she noted in her own words: “Today’s achievement is not only for me, it also achievement for the MaMoni-HSS project. MaMoni-HSS project gives me different training like; Antenatal Care (ANC), Basic CSBA, Post natal care (PNC), Active management third stage of labor (AMTSL), Infection prevention, SPE/E etc for my skill development & support to bring me at this stage.” This document is made possible by the generous support of the American people through the support of the Office of Population, Health, Nutrition and Education, United States Agency for International Development (USAID), Bangladesh (USAID/Bangladesh), under the terms of Associate Cooperative Agreement No. AID- 388-LA-13-00004 through Maternal and Child Health Integrated Program (MCHIP). The contents of this document are the responsibility of the MCHIP Project and do not necessarily reflect the views of USAID or the United States government. 2 | Page Table of Contents List of Acronyms…………………………………………………………………………………………………………………. 5 Executive Summary……………………………………………………...…………………………………………............. 8 Summary of Major Achievements…………………………………………………………………………….…………. 8 National Health Systems Strengthening……………………………………………………………………………... 8 District Health Systems Strengthening………………………......………………………………..………............. 9 Community Systems Strengthening…………………………………………………………………………............. 9 Challenges………………………………………………………………………………………………………………………….. 10 Way Forward………………………………………………………...……………………………………………………………. 10 Introduction..………………………………………………………………………………………………………………………. 11 Program Activities and Results…………………………………………………………………………………………… 11 Project Outcomes……………………………………………………………………………………………..………………… 12 IR 1. Improve Service Readiness Through Critical Gap Management…………….….…..…………….. 14 1.1 Increase availability of health service providers……………………………………………..…….……….. 14 1.2 Strengthen capacity of service providers to provide quality services………....………............... 15 Introduction and scale-up of MNCH/FP/N interventions…………………..……………...………………….. 15 Maternal Health………………………………………………………………………………………………………………….. 15 Newborn and Child Health…………………………………………………………………………………….................. 23 Family Planning………………………………………………………………………………………………………………….. 32 Nutrition…………………………………………………………………………………………………………………………….. 35 IR 2. Strengthen Health Systems at the District Level and Below…………………………………………. 36 2.1 Improve leadership and management at district level and below………....………………………. 36 2.2 Improve district level comprehensive planning (including human resources) to meet local needs…………………………………………………………………………………………………………………………. 38 2.3 Strengthen local management information systems (including eMIS)……....…………………… 39 2.4 Establish a quality assurance system for MNCH/FP/N services at district level and below…………………………………………………………………………………………………………………………… 42 Building national capacity and update national standards and guidelines…………………………… 42 National Adaptation of the WHO Quality of Care Framework for Maternal and Newborn Health and Pilot implementation………………………………………………………………………………………… 43 Improving delivery of quality MNCH/FP/N services in MaMoni HSS districts………………………… 46 Strengthening routine supervision system and promoting supportive supervision……………….. 43 Supporting CEmONC through Regional Roaming QI Teams (RRQIT)…………………………………….. 47 Implementation of Quality Improvement Approaches at National, Divisional, District and Facility Level………………………………………………………………………………………………………………. 47 Measuring QI indicators and recognition of achievement…………………………………………………….. 49 Conduct Maternal and Perinatal Death Surveillance and Response for QI……………………………. 49 2.5 Develop comprehensive logistic management systems for essential MNCH/FP/N Commodities at the district level…………………………………………………………………………………….….. 49 Ensure Essential Medicines.………………………………………………………………………………………………… 49 Introduction of eLMIS……………………………………………………………………………………………................. 47 IR3. Promote an Enabling Environment to Strengthen District-Level Health Systems…………… 52 3.1 Policy reforms in place to promote local planning and need-based human resource Deployment in the public sector………………………………………………………………………………………….. 52 3 | Page Technical assistance to the Program and Management Unit (PMMU)………………………………….. 52 National technical assistance for upgrading UH&FWCs as 24/7 delivery facilities Upgrades to Union Level Facilities for 24/7 Delivery Care……………………………………………………. 53 Assessment of Union Level Facilities…………………………………………………………………………………… 53 Costed Plan for Upgrading Union Facilities………………………………………………………………………….. 54 Development of an Accreditation System for Health Services……………………………………………… 54 Health Workforce Management………………………………………………………………………………………….. 54 Implementation of the Central Human Resources Information System (HRIS)…………………….. 55 Strengthened the National Institute of Population, Research and Training (NIPORT) To delivery a capacity-building program for community health workers……………....................... 55 3.2. Enabling environment promoted to strengthen district-level health systems....……………… 56 Advocacy to adopt evidence-based learning in national policy and programs……..……………….. 56 Conduct and Disseminate Operations Research and Program Learning………………………………. 56 National and district level campaign activities on various national days………………………………. 56 Journalist engagement……………………………………………………………………………………………………….. 56 IR4. Barriers to Health Service Accessibility Identified and Reduced……………………………………. 58 4.1 Promotion awareness of MNCH through innovative BCC approaches…………………………….. 58 Aponjon……………………………………………………………………………………………………………………… 59 4.2 Strengthen vital registration system through Local Government....………………………………… 59 4.3 Improve local governance and oversight for MNCH/FP/N……………………………………………… 59 4.4 Enhance community engagement in addressing health needs………………………………………. 61 Management and Partnerships…………………………………………………………………………………………… 62 Program Evolution………………………………………………………………………………………………………………. 64 Compliance………………………………………………………………………………………………………………………… 64 Challenges………………………………………………………………………………………………………………………….. 65 4 | Page List of Acronyms 5S Sort, set, shine, standardize and sustain AHI Assistant health inspector AMTSL Active management of third stage of labor ANC Antenatal care BCC Behavior change communication BMJ British Medical Journal BSMMU Bangabandhu Sheikh Mujib Medical University CAG Community action group CDCS Country Development Cooperation Strategy CHCP Community health care provider CHW Community health worker CHX Chlorhexidine CI Critical illness cMPM Community microplanning meeting CNCP Comprehensive newborn care package CS Civil Surgeon CSA Community sales agent CSBA Community-skilled birth attendant CSG Community support group CSI Clinical severe infection CV Community volunteer DGFP Directorate General of Family Planning DGHS Directorate General of Health Services DH District hospital DHIS-2 District Health Information System-2 DMCH Dhaka Medical College