MaMoni Health Systems Strengthening Activity USAID Cooperative Agreement AID-388-LA-13-00004 Quarterly Report October 01, 2017– December 31, 2017 Submitted February 07, 2018 MaMoni Health Systems Strengthening Activity: FY18 Q1 Quarterly Report 1 Cover Photo Story: Paramedic Kirtonia recognized for her work The Union Health and Family Welfare Centre at Putijuri union in Bahubal Upazila, Habiganj was in bad shape when Smriti Kirtonia, a paramedic supported by the MaMoni HSS project, joined the facility in May 2016. The facility infrastructure was inadequate and there was little interest in the community to seek health services from the facility. Over the next year and a half, the situation improved considerably, thanks to the efforts of Kirtonia. Kirtonia started conducting eight satellite sessions a month in her catchment area to provide maternal, newborn, child health, family planning and nutrition services and used the platform to encourage mothers to visit the health facility to access services. In the union follow-up meetings, she entreated health workers to keep contact with expectant mothers over the phone. Like many paramedics or FWVs, she did not limit her services to only the official timeline (8:30 am to 2:30 pm). Instead, she started living in the FWV quarter and would readily extend her services around the clock with a smile on her face, effectively making the facility a 24/7 service delivery point. Very soon her reputation spread in the community and to villages even further out and mothers from the neighboring unions started coming to her. The service utilization in her facility started to soar - ANC visits rose from counts of about 30-40 to around 200, while the number of deliveries conducted at the facility increased from 3-5 per month to 18-20 per month. Kirtonia’s skill and dedication - reflected in the ever-growing flow of health service seekers - earned her official recognition in December 2017. Amarillo Kibria Keya Chowdhury, a Member of the Parliament from Bahubal, handed over the best service provider award to Kirtonia. “If I can help people and serve them, that’s what I consider as my biggest achievement,” says Kirtonia upon her receipt of the award. Photo credit: Md. Johirul Alam Sikder, Upazila Facilitator, Bahubal 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. MaMoni Health Systems Strengthening Activity: FY18 Q1 Quarterly Report 2 TABLE OF CONTENTS Abbreviations ............................................................................................................................... 4 Executive summary .................................................................................................................... 7 Introduction ............................................................................................................................... 10 Data Sources .............................................................................................................................. 11 Program results of the year ................................................................................................... 11 IR 1. Improve service readiness through critical gap management ........................... 11 IR 2: Strengthen health systems at the district level and below .................................. 36 IR 3. Promote an enabling environment to strengthen district level health systems ........................................................................................................................................................ 58 IR 4. Identify and reduce barriers to accessing health services .................................. 61 Challenges, Solutions and Action taken ............................................................................. 65 Appendix 1: Scope and Geographical coverage of MaMoni HSS program ................ 69 Appendix 2: Data Sources ....................................................................................................... 70 Appendix 3: Program Performance Indicators (Oct–Dec 2017) .................................... 71 Appendix 4: Forums where MaMoni HSS lessons were disseminated ........................ 82 Appendix 5: List of process documentation activities .................................................... 83 MaMoni Health Systems Strengthening Activity: FY18 Q1 Quarterly Report 3 ABBREVIATIONS 5S Sort, Set, Shine, Standardize and Sustain AHI Assistant Health Inspector AMTSL Active Management of Third Stage of Labor ANC Antenatal Care APK Android Package Kit BCC Behavior Change Communication BIRDEM Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders BNF Bangladesh Neonatal Forum BPA Bangladesh Paediatric Association BSMMU Bangabandhu Sheikh Mujib Medical University CAG Community Action Group CBHC Community-based Health Care CC Community Clinic CCSDP Clinical Contraceptive Service Delivery Program CCU Coronary Care Unit CDCS Country Development Cooperation Strategy CEmONC Comprehensive Emergency Obstetric and Newborn Care CHCP Community Health Care Provider CHW Community Health Worker CHX Chlorhexidine 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 DC District Commissioner DDFP Deputy Director- Family Planning DG Director General 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 Hospital DQA Data Quality Assessment EDD Expected Date of Delivery eLMIS Electronic Logistics Management Information System eMIS Electronic Management Information System ENC Essential Newborn Care EPCMD Ending Preventable Child and Maternal Deaths FGD Focus Group Discussion FP Family Planning FPI Family Planning Inspector FSO Field Support Officer FTC Field Training Centre FWA Family Welfare Assistant FWV Family Welfare Visitor FWVTI Family Welfare Visitor Training Institute GMP Growth Monitoring and Promotion GOB Government of Bangladesh GPS Global Positioning System HA Health Assistant MaMoni Health Systems Strengthening Activity: FY18 Q1 Quarterly Report 4 HBB Helping Babies Breathe HI High Intensity HID Health Identity Document HNN Healthy Newborn Network HPNSP Health, Population and Nutrition Sector Program HR Human Resource HRD Human Resources and Development HRIS Human Resource Information System HSCS Health Systems Capacity Strengthening HSM Hospital Services Management Icddr,b International Centre for Diarrhoeal Disease Research, Bangladesh ICHW Improving Community Health Worker program performance through harmonization and community engagement to sustain effective coverage at scale ICU Intensive Care Unit ID Identity Document IDD Iodine Deficiency Disorder IFB Fast Breathing as a Single Sign of Illness IMCI Integrated Management of Childhood Illness IMCI-N Integrated Management of Childhood Illness-Nutrition IP Infection Prevention IPC Infection Prevention and Control IPD Inpatient Department IR Intermediate Result ISQua International Society for Quality in Health Care IUCD Intra Uterine Contraceptive Device JHU Johns Hopkins University JSV Joint Supervisory Visit KII Key Informant Interview KMC Kangaroo Mother Care KSH Khulna Shishu Hospital LARC Long-Acting Reversible Contraceptive LARC&PM Long-Acting Reversible Contraceptive and Permanent Method M&E Monitoring and Evaluation MAM Moderate Acute Malnutrition MCHTI Maternal and Child Health Training Institute MCRAH Maternal, Child, Reproductive and Adolescent Health MCWC Maternal and Child Welfare Center MEC Medical Eligibility Criteria MFSTC Mohammadpur Fertility Services and Training Centre MgSO4 Magnesium Sulfate MIS Management Information System MNCH/FP/N Maternal, Newborn and Child Health, Family Planning, and Nutrition MO Medical Officer MOHFW Ministry of Health and Family Welfare MO-MCH/FP Medical Officer-Maternal, Child Health and Family Planning MP Member of Parliament MPDSR Maternal and Perinatal Death Surveillance and Response MSH Management Sciences for Health NGO Nongovernmental Organization NIPORT National Institute of Population Research and Training NIPSOM National Institute of Preventive and Social Medicine NNHP National Newborn Health Program NNS National Nutrition Services NHSDP NGO Health Service Delivery Project NSU Newborn Stabilization Unit OBGYN Obstetrics and Gynecology OGSB Obstetrical and Gynecological Society of Bangladesh MaMoni Health Systems Strengthening Activity: FY18 Q1 Quarterly Report 5 OP Operational Plan OPD Outpatient Department OPHNE Office of Population, Health, Nutrition, and Education ORT Oral Rehydration Therapy OT Operation Theatre pCSBA Private Community-Skilled Birth Attendant PDCA Plan-Do-Check-Act PE/E Pre-eclampsia/Eclampsia PHC Primary Health Care PHD Partners in Health and Development PM Program Manager PPFP Postpartum Family Planning PPH Postpartum Hemorrhage PPIUCD Postpartum Intra-Uterine