Transcript Country Team Action Plan - ESD Project: Reaching Further

Country Team Action Plan
Bangladesh
Goal
Reduce Fertility, Maternal and Neonatal Mortality
through an integrated Post Partum Care Package
Package components
Component
Family Planning
ENC
Best Practices
Post partum contraceptive,
LAM, PP sterilization
C-ENC, F-ENC
Prevention of PPH AMTSL, C-Misoprostol
PAC
PAC and FP
Nutrition
Maternal and Newborn (Exclusive
BF) Nutrition, Vit. A, IFA
Where are we now?
– Current levels of accomplishment/Progress and
challenges since Bangkok 2007
Six Divisional workshop organized by DGHS, DGFP and
NGOs on Best practices (Participants: Div. and District level H
& FP Managers, Specialist, MO, Nurses, FWV, MA, SACMO,
Paramedics, HA, FWA and NGO worker etc.)
AMTSL Training – Doctors, Nurses, FWV, C-SBA
Key programs:
EOC, DSF, C-SBA, Midwifery, MNH, MNCH, MNCS,
Prevention & management of Fistula, Blood Transfusion,
Prevention of HIV transmission, Com SS for EOC.
Problems/challenges
1. Lack of adequate EOC trained HR at all levels
2. Retention of HR at rural, remote and hard to reach
areas
3. Transfer of EOC trained manpower to non-EOC
facilities (Retention)
4. Generating demand in the community
5. Lack of Community support system (aware, support)
6. Private practitioner is not aware to address PPH
Where do we want to be?
Major Objectives
• Best Practice Chosen for Scale-Up and Its
Components:
Integrated PP Care Package focusing PPH
• Desired levels of accomplishment
By 2015 Maternal Mortality due to PPH will be
reduced by 40% through implementation of
Integrated PP Care Package
What are the gaps?
List gap between current status and desired levels of
accomplishment
• PNC coverage is 22% and SBA is 18% desired level
of Management of PPH is 40%
List reasons for the gap
• Lack of adequate skill HR
(C-SBA is 5000, Target-13,000. EOC trained Doctors -700,
Target-1000, Nurses-700, Target-1000)
• Lack Integrated activities, supportive supervision,
monitoring and MIS
What interventions
can we use to close the gap?
Increase coverage AMTSL, Assisted delivery
Intervention will be implemented in Integrated
way through DGHS, DGFP, NGO and PPP both
at Facility and Community level
Intra and inter Ministerial and sectoral collaboration
with community involvement
List activities to carry out the
interventions
• Fill up vacant post
• Training and Refresher training
• Motivation of service providers (incentive
career plan) and clients
• Supportive supervision
• Monitoring & Evaluation
What are the possible challenges
to the intervention?
1. To increase adequate Skill Service Providers
2. Retention of skill HR
3. Motivation of service providers and Com. Support
Group
4. Sustainable supply of logistic
5. Coordinated activities of DGHS and DGFP
6. Leadership, Monitoring, MIS and PPP
7. Effective Referral mechanism and BCC
Who are the possible partners,
allies, and stakeholders?
• Executive agency: MOHFW
• Implementing agency: DGHS and DGFP
• Supportive organization: Professional bodies like –
BMA, OGSB, Bangladesh Peri-natal Society, Nursing
Council
• Partners: Dev. Partners, Private Providers and NGOs
What is the evidence to support this best
practice?
Global: Nepal, Ghana, Indonesia, Tanzania, Ethiopia,
Ecuador, Dominica Republic
National evidence (AMTSL practice at facilities and
use of Misoprostol at Community level)
What actions are needed to provide additional evidence?
Periodic evaluation (process and impact), Maternal
Mortality Survey 2010 is going on
Is better documentation of the evidence needed? Yes.
What are the modifications needed to
improve the intervention’s scalability?
• After final/periodic evaluation modification
will be considered
• Improve capacity of Govt. to lead the process
• Coordinated activities of DGHS, DGFP,
NNP, Dev. Partners, Private Practitioner
and NGOs
Who will be involved in scaling-up?
• Organizations responsible for scaling-up:
MOHFW, DGHS and DGFP.
NGOs, DPs, Professional bodies and Private Practitioners
• Capacity of the organizations to scale-up and what
implications this has for scaling-up. Good infrastructure,
Needs assessment (Training, supply, monitoring,
leadership, MIS, advocacy)
• Who will be part of the team to support the process of
scaling-up? National PPH Task force. (Evaluation will be
done and placed to national authority - MOHFW)
What are the opportunities
and constraints of scaling-up?
Opportunities: Commitment of Ministry, DGHS, DGFP
Support from Dev. Partners, NGOs, Professional bodies,
Revitalization of Community Clinic Project
Constraints of scaling-up and how they will be avoided
Constraints: Scale-up country wide, skill HR, supply of
logistic, Monitoring and MIS
Avoid by: Govt. leadership, Partnership with DPs,
NGOs
Program for Reproductive Health & Safe Motherhood
Strengthening EmOC services
- MNH, MNCH,
MNCS, SMPP
Community
based
Skilled
Birth
Attendant
(SBA)
Programme
Reduce
Maternal
Mortality &
Morbidity
- National Fistula
Program,
- Women Friendly
Hospital Initiatives,
- Adolescent
Reproductive Health
Programme
- Others
Demand Side Financing (DSF):
Maternal Health Voucher Scheme
What policy, regulatory, budgetary, or other
institutional steps are needed?
• Needs national guidelines on Post partum care
package and develop monitoring indicators.
• Coordinated action plan of Govt., DPs, NGOs and
Private Sectors lead by MOHFW
• Inclusion in next SWAp with budgetary allocation
• Up dating training curriculum (pre and in-service)
• Ensure uninterrupted supply and logistic
Who will advocate for these? When?
How?
Who? DGHS and DGFP
Others – White Ribbon Alliance (WRA), Bangladesh
and EngenderHealth
How? Series of consultation, policy dialogue, workshop
and media support
When? Immediately the Team will report to MOHFW
Where, when and how will the best practice
be expanded?
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Expansion to new geographic sites or populations?
Refresher training to 32 districts within one year
Expansion (facility level) in rest 32 district within two years
Expansion (community level) 25 districts
How will the best practice be disseminated to new areas or
populations?
By developing an action plan for the expansion (Training,
budgetary allocation, logistic, develop capacity of the
facilities and training institution, increase community
support system)
What will be the costs of expansion and
how will needed resources be mobilized?
• The cost will be calculated based on the
current demonstration
Estimated: Tk. 200 m (30 m u$), mobilized
from SWAp (HNPSP)
How will the process, outcomes and impacts
be monitored? How will results be fed into
decision-making?
• Through monitoring checklist
• Periodic evaluation
How will results be fed into decision-making?
During revision of ADP and OP
Thank you very much