Engaging Communities to Help Mothers and Newborns: MaMoni Experience from Bangladesh

Rowshon Jahan

Presentation outline

• MaMoni overview and strategies • Community mobilization approach • Results • Challenges and lessons learnt • Steps towards sustainability and scale up

Context

       Home delivery is the norm Weak health systems:   vacancy of health workers quality of care at health care facilities Traditional healers/practitioners have a strong role Social inequity prevails – deaths are more in lower strata Geographically difficult terrain Successful vertical programs like – EPI, Family Planning Stronger GO-NGO collaboration

Why MaMoni in Sylhet ..

Indicators (BDHS 2007) Neonatal mortality rate Total fertility rate CPR Unmet need for family planning National 37/1000 41/1000 ( 2004) 2.7

56% 18% At least one ANC attendance with trained provider 60% Place of delivery Home: 85% Skilled attendance at birth 18% Sylhet 53/1000 63/1000 (2004) 3.7

32% 26% 47% Home: 91% 11%

MaMoni overview and strategies

    MaMoni is an Integrated Safe Motherhood, Newborn Care and Family Planning Project (ISMNC-FP) under the leader award, Maternal and Child Health Integrated Program (MCHIP). 3.3 million pop. coverage in 2 districts Follow on project of ACCESS (2006-2009) The prime is JHPIEGO and local partners are –  MOH&FW    Save the children, USA FIVDB Shimantik

MaMoni results framework

National goal Improved maternal and neonatal health outcomes

•Practice high impact MNH behaviors •Use high impact services

Project purposes Increase knowledge, skill, practice at home Increase utilization of services Increase family planning acceptance and understanding Systems strengthening Mobilize community to support demand Stakeholder leadership, commitment and action

MaMoni package: Integrated Package 1 Pregnancy identification 2 ANC1 3 PP maternal care, Vit A and management of Management of newborn complications complications Essential newborn care/KMC Clean delivery and immediate newborn care Misoprostol Birth preparedness HW counseling IFA Supplementation TT ANC2 TT ANC3 ANC4 4 5 6 7 8 AMTSL & referral for EmOC 9 D Supply of PoP, transition to modern method, Supply of FP methods and referral for LAPM Postnatal session promoting LAM, spacing, PoP, FP, transition Immunization p1 p2 p3 p4 Exclusive breastfeeding and promotion of LAM/PPFP p5 p6

Highlights of MaMoni approach

      MOH&FW key service provider Partner NGOs play a supportive and facilitative role Active role of the community An integrated package District-wide approach MOH&FW and community capacity enhanced to ensure sustainability

CM helps in adoption of healthy practices & increase utilization of services Health systems Linkage/ interface COMMUNITY

Enabling Environment, Collective actions

Reinforce demand HOME/FAMILY

Supportive decision making

Linkage/ interface Reinforce demand WOMEN, NEWBORNS

Healthy Behaviors

Health systems

Disseminate health messages Support behavior change Engage community leaders

Community mobilization approach:

Community Action Cycle (CAC)

Explore MNH situation and set priorities Plan together Prepare to mobilize Prepare to scale-up Organize the community for action Evaluate together Act together

Community mobilization activities

     Selection of villages Resource mapping Orient the community and invite for participation Formation of CAGs Capacity building for community resource persons (CRPs)

Results: gender balance in CAGs

   Each village has two separate groups: male and female Membership of male groups slightly higher than female groups (18317 [51%] versus 17455 [49%]) 3820 CRPs – equal membership (1909 females and 1911 males) – 60% demonstrated ability to conduct CAC independently

Results: emergency fund & transport

• 56.9% of the groups arranged emergency transportation system • 43.4% of the groups developed emergency fund.

• 396 mothers and newborns used the system to get to the health facility

Results: linkage/interfacing with health systems

   12 Satellite clinics and 2 EPI center newly opened by the group initiatives CAGs worked with govt. & NGOs to regularize 69 inactive/irregular clinics/EPI centers 56% CAGs has participation of MOH field service providers

Lessons learnt and challenges

• Unavailability of services and/or poor quality of care • Male CAG members available mostly in the evening • Some communities need time to get prepared • Difficult to ensuring participation of all segments especially the vulnerable groups • Some female community members not permitted to attend meetings by their mother-in-laws • Program disruption by natural disaster including floods

Lessons learnt and challenges

• Appropriate community entry essential for successful community interventions • Sharing real stories/results increase community engagement • Men and women can work together to mobilize their communities in conservative communities • Engagement of men in the CAC increase their involvement in MNH activities • Communities can be mobilized without any material or financial incentives • Formation of CAG with existing group is more effective and sustainable • Community Resource Persons demonstrated potential of sustain these initiatives

Steps towards sustainability and scale-up

• Community action cycles are being done by community

resource persons/ volunteers

• Selection of volunteers from existing functionaries • Role of volunteers as extended hands of the health workers • Stronger linkage with local governments and health systems • •

Community clinic management groups Elected union parishad (local government)

• Combining female and male groups • Integrating family planning • Involvement in source for local MNH-FP commodities • Component of a number of large MNH programs

Mothers and newborns lives are saved through community initiatives . . .