By Naimul Haq
DHAKA (IDN) – Twenty-year-old Aklima Khatun gave birth to her first child on August 27 at a small clinic run by the government. The clinic, known as community clinic (CC), offers affordable but reliable maternal health services. Unlike the widely adopted traditional home deliveries, Aklima chose safer delivery in the hands of skilled birth attendants and in a hygienic environment.
All this was possible because Aklima had attended a safe motherhood programme, which promotes maternal healthcare and health education needed for mostly the poor and illiterate mothers. It is part of a Japan International Cooperation Agency (JICA) funded project. The project aims at improving a maternal healthcare programme by revitalizing and enhancing effective care and monitoring.
Healthcare facilities, including essential drugs and individual care are some of the main attractions of the state-run CCs, which are mostly located within walking distance for the local population.
Besides social awareness programmes, the project has also promoted referral of institutional deliveries at the state run ‘mini hospitals’ known as Thana Health Complex (THC), Upazila Health Family Welfare Centre UHFWC) and Maternal and Child Welfare Centre (MCWC) where trained nurses and doctors as well as basic medical equipment are available.
The community clinics mostly act as a referral point although many are capable of performing normal childbirth where skilled birth attendants are available.
“About seven months ago, I was approached by a healthcare provider who had registered my pregnancy and had explained the risks associated with pregnancies. In the successive consultations at the nearest CC, I learnt what it needs to have a safe childbirth,” Aklima told this correspondent sitting at the courtyard of her thatched home in Abhaynagar sub-district of Jessore district, about 230km from the capital Dhaka.
A shy Aklima explained how she got involved in the antenatal programme pursued by community support group (CSG), originated in the JICA funded project in Narshigdi district, for a safe childbirth. “I paid six visits to the community clinic where the Community Healthcare Provider (CHCP) individually advised me on the care during and after pregnancy which I believe was very important.”
Aklima, who was married two years ago, said: “After every counseling session on food hygiene, nutrition and safe eating in pregnancy, I was handed free drugs like iron, calcium tablets and vitamins. Separate counseling sessions were held for breast feeding and exercises and also to identify risk factors during pregnancy.”
Sathi Khatun, a CHCP who mostly examined and advised Aklima, told IDN, “The Safe Motherhood Promotion Project (SMPP) was designed to improve care giving and so we observed that a blend of much needed friendly advice and devoted healthcare intervention like, physical examination, prescribing drugs, monitoring weight is very encouraging.”
Dr Putul Roy, Civil Surgeon of Narsingdi district where SMPP was first implemented as a pilot project in 2006, said: “It is very obvious that women would prefer a women friendly hospital for childbirth. After all, women are still conservative in many instances. So, taking lessons from previous similar maternal health programmes, SMPP was designed to promote maternal healthcare services at the root level,” she told IDN.
Dr Depandranath Atarja, Civil Surgeon of Jessore district told IDN, “We greatly benefitted from the ‘Narshingdi Model’, which is regarded as an effective system. People are now more sensitized and safe deliveries at clinics in my district have substantially increased since the start of SMPP.”
One of the main strategies of SMPP was recognizing and adopting active roles of CSG, Community Group (CG) and the Union Parishad (UP) or the local government. The entire programme is aimed at encouraging institutional childbirth. The local government and the local community are sensitized so that they are capable of identifying the pregnancies and create a demand-based public healthcare system.
The active roles played by the 17-member CSG and CG are unique as they promote social mobilization on the services clinics (CCs, THCs, UHFWCs, MCWCs) offer. The groups play significant roles in the community. They are very influential because teachers, local government officials, businessmen, religious leaders, student leaders, the voiceless poor and NGO officials represent them.
“We believe that healthcare is a human right and so people requiring healthcare must have informed choices and that is what we are aiming to ensure for all those who need quality care,” said Mofizuddin Ahmed, a leader of community support group of Kenduabo village in Narshingdi.
“We create pressure on the health providers for the services they are supposed to provide. As a result, there is a sense of accountability and transparency, with the local government constantly monitoring. This is a remarkable achievement and the increase in deliveries from almost zero to an average ten deliveries a month now is certainly a proof of the success,” Saber-Ul-Hye, Danga Union Parishad Chairman of Narshingdi district, told IDN.
Mehedi Hasan, community healthcare provider of Char Shindur village in Palash sub-district of Narshingdi district told IDN, “An increasing trend in delivery cases in greater Narshingdi district is a testimony of how the programme has proved to be a success. We have noticed tremendous enthusiasm among the families of our ‘clients’. Even mother-in-laws who traditionally had refused institutional delivery are now showing interest in childbirth in CCs.”
Shafiqur Rahman, a member of Kenduabo CSG in Narshingdi, told IDN, “Each pregnancy is closely monitored. There is no scope of denying any clients the services.”
Families are often forced to buy medicines during deliveries as the community clinics run out of the quarterly supplies received from the central government. Fewer ‘clients’ spend on average between USD10 and 15 or buy necessary drugs but there is still a sense of satisfaction as the amount is far too less compared to the cost of private deliveries.
SMPP in collaboration with Community Clinic Project of the government developed the Core Team Strategy, which enhances the monitoring of CCs by teams of government supervisors. It has been introduced in five districts and has shown significant improvement in CC performance and activation of CG and CSG.
Yukie Yoshimura, Chief Advisor of SMPP representing JICA, told IDN, “The project tried to utilize the government system and mobilize existing resources. I believe this approach resulted in success. We supported a partnership among the health service providers, community people, and Union Parishads to realize better health in the community. Their bondage is based on the trust.”
Yoshimura added: “What SMPP did was to identify a good practice, facilitate to develop a policy related to the good practice (institutionalization), and support its expansion and effective and continuous functioning of the expanded good practice. We focused on this entire process of scaling up of good practices run by the government.”
The ‘Narshingdi Model,’ widely known in Bangladesh as an ideal maternal healthcare programme, is another of JICA’s many contributions for the development of the country. It has helped improve the percentage of institutional delivery from 33.4 to 51.7 percent in Southwestern Satkhira district.
The maternal mortality rate fell from 322 deaths per 100 000 live-births in 1998–2001 to 194 deaths per 100 000 live-births in 2007–2010, an annual rate of decrease of 5·6 percent.
One of the key contributions to this decrease was the replication of the effective model, which has been recognized as a sustainable programme. Unlike in many cases where such foreign aided promising projects gradually die with the completion of the project, SMPP has flourished and stands on a strong footing. [IDN-InDepthNews – 31 August 2016]
Photo: Member of a community support group shares lessons on maternal health in a courtyard discussion with young women. Credit: Naimul Haq | IDN-INPS