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Community-based Obstetric emergence care for pregnant women especially poor and marginalised women

Pooling together community resources to overcome barriers for poor and marginalised pregnant women to access timely the health facilities

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In spite of Maternal mortality ratio in Bangladesh being declined significantly since 1990 toward attaining Millennium Development Goal target by 2015 ,still in 2006 Bangladesh Government experienced a very high Maternal mortality of about  32 per 1000 live births.Seventy-five percent of women who died from pregnancy-related complications did so at home, without ever having received professional medical attention. In an effort to improve maternal and newborn health (MNH) services, the country’s Ministry of Health and Family Welfare (MOHFW), with a technical and financial support from the Japan International Cooperation Agency (JICA), launched the Safe Motherhood Promotion Project (SMPP) in Narsingi district. The overall aim of SMPP was to improve the maternal and neonatal health situation of the district through establishment of a functional service delivery system for accessing quality obstetric care services by women during pregnancy, childbirth and postpartum period supported by a Community Support System (CmSS). Moreover, CARE Bangladesh as a partner of JICA facilitated community mobilization in two of the project’s six sub-districts.

The project had both public hospital and community-based interventions.

Under the hospital interventions; two upazila (sub-district) level hospitals (Raipura and Palash) were strengthened to provide quality comprehensive Emergency Obstetric Care (EmOC) services, while other upazila and district level hospitals were supported to improve quality of EmOC services. The main hospital level activities include; supply of necessary equipment, minor renovation of delivery room, operation theatre and female ward, staff (doctors and nurses) training on midwifery, active management of third stage of labor, essential newborn care and neonatal resuscitation, infection prevention practices, and management information system.

On the other hand, under the community-based intervention, had two interventions

  • First was the development of a Community Support System (CmSS), at two upazilas (Raipura and Monohardi) of the district. CmSS is a mechanism for establishing a system at the community level through collective efforts of the people which aims at providing support to women during obstetric emergencies. Under the community support system, Community Support Groups (CSGs) were formed to support the poor pregnant women for accessing health services during obstetric complications. Formation of CSG is a self-driven process that was facilitated by CARE-Bangladesh, as a partner of JICA. Each CSG covers 150-300 households in the community.

 Activities of the CSG include; household mapping, identification and registration of pregnant women, conducting birth planning sessions with the pregnant women and their family members, educating them on the danger signs of pregnancy and neonates, and providing information on and encouragement for utilization of available maternal and neonatal health care services. The CSGs comprised of 15-22 members (unpaid volunteers), about 50% of whom were female. The female members are commonly the Traditional Birth Attendants (TBAs) , female member of the Union Parishad (Local Government), non-government organization staff, housewives and students.

  • Second intervention under community-based intervention was the “Model Union” for ensuring safe delivery through the Model Union Approach

The Model Union (sub-sub district or minimum unit of local administration) Approach is intended to demonstrate a simple, effective and atractive model to reduce maternal and neonatal deaths through introduction of a comprehensive intervention package in the union level.

Included development of union level plans and a safe delivery team, strengthening of union level health facilities (Health and Family Welfare Centre; or H&FWC), promoting awareness on birth planning and the danger signs of pregnancy and newborns, and involving the local government in healthcare activities. All the Family Welfare Visitors (FWVs) and CSBAs of the model unions received training on ANC, PNC and a refresher on normal delivery. They also received training on active management of third stage of labor, immediate newborn care and resuscitation, and infection prevention practices. The FWVs (paramedic) are the service providers at H&FWCs, while the CSBAs are the health (female Health Assistant) and family planning (Family Welfare Assistant) field staff trained for 18 months to provide ANC, PNC and normal delivery services at home.

Project's Impact

  • An impact study of the Safe Motherhood Promotion Project (in which CmSS was implemented) in 2010 showed that CmSS is associated with reduced wealth disparities for key maternal health outcomes.
  • CmSS resulted in 71% antenatal care access among women in the lowest wealth quintile, compared to 30% in the non-CmSS area.
  • Increased maternal health knowledge and practices was also evident as a result of CmSS. Women in the project area had 5 times the odds of having a birth plan as those in the comparison area.

Therefore, regardless of the current situation that is experienced in Tanzania whereby most Tanzanians have access to basic health care services, but they still struggle to access specialised or emergency care services. This scenario is very worse in rural communities – where pregnant women – face a lot of difficulties to get health support, mostly find health facilities are very far from their households, other lack money support to pay for treatment, some women do not want to go alone to hospital and in some circumstances they need to get permission from spouses to go for treatment. Hence, if this Model is adopted and being replicated as well as being scaled in Tanzania would reinvent the wheel at large extent

What is a provocation or insight that might inspire others during this challenge?

Community empowerment and mobilization has been a critical strategy for changing health care seeking norms and behaviors. Always an empowered and mobilized community can provide a deeper understanding of individual and social barriers to services, and being the best advocates for high quality, affordable and culturally appropriate care and make local government responsible for that care

How does this research relate to our use cases and personas?

This inspiration has covered the challenge's cases and persona in the sense that the aforesaid Community Support System (CmSS) will form a committee– a Community Support Group (CSG)— and establishes linkages with the health system and local government for tracking all pregnant women, and provides need-based support for making their pregnancy safer, including timely use of lifesaving emergency obstetric care services.

Tell us about yourself:

An Economist working with Ministry of Education,Science and Technology under Policy and planning department responsible in writing, designing, analyzing and implementing various ministerial Project

Are you currently an employee of Sutter Health or UCB Pharmaceuticals?

  • No

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Photo of Kate

Hi marco mihambo !

There is 1 week left to submit ideas to the New Life Challenge. It would be great to see you and your ideas there.

The deadline for idea submission is Sunday at 3 pm PST on September 24.

Please email me if you have any questions - krushton@ideo.com