Bangladesh Association for Maternal and Neonatal Health (BAMANEH)

Concept Paper of MCH Project

Background of BAMANEH

In a developing country like Bangladesh, maternal and child health problems pose serious threat to the improvement of overall health status of the country & thereby negatively affect the socio-economic development. Maternal mortality rate (MMR) in Bangladesh is still very high with prevalence rate at 4.4 per 1.000 births in 1997. Infant mortality rate (IMR) is still unacceptably high. with prevalence rate at 77 per 1.000 births in 1997 Majority of the mothers and children are also exposed to severe malnutrition. The situation is worse in rural areas.

To curb the increased rate of maternal & infant mortality, especially in rural areas, Bangladesh Association for Maternal and Neonatal Health (BAMANEH), a national NGO, as well as an affiliated body of International Associational for Maternal and Neonatal Health (IAMANEH),came into being in the year 1979 with untiring efforts of its founder President, Late Prof.(Dr.)Syeda Firoza Begum ; an eminent Gynaecologist and Obstetrician of the country along with some of her peers with the prime objectives to address mothers and children health. Since its inception, BAMANEH has been contributing significantly in the arena of Family Planning, Traditional Birth Attendants (TBAs) training, Reproductive and Child Health Care, Action Research on health related issues. BAMANEH has also the creditability in contributing a lot with Govt. initiatives in various studies, the designing and planning activities of the health sector.

Organisational profile & its activities (Past & Present)

BAMANEH is run by a nine members Executive Committee. Dr. Akhter Iqbal Begum, Retd. govt. health policy maker, a MCH specialist and ex-consultant of UNICEF & World Bank is the current president of BAMANEH. The programes are implemented by a group of personnel under direct supervision and guidance of the executive committee.

In the early stage of the organization it was recognized that the very objective of maternal and child mortality reduction could be achieved to a great extent by TBA training, if safe deliveries of babies could be assured. Accordingly initiatives were taken and positive results were obtained. Later on, it was realized that the service of those village based TBAs could as well be utilized for family planning motivation and health care awareness Accordingly, in 1982, the activities of TBA’s towards incorporating the service of Family Planning motivation and Health Care was introduced in 5 areas with the financial support. from The Asia Foundation.

BAMANEH perceived that services like M.C.H. care are essential to reduce the mother and child mortality and morbidity Accordingly, M.C.H delivery services were started in the year 1986 to serve the poor and under privileged. section of the community with the financial and technical support from Swiss Red Cross (SRC) in the name of “COMMUNITY BASED MOTHER AND CHILD HEALTH CARE PROJECT” ,.first at Chandina in Comilla district in the year 1986 and then in the year 1988 at Gabtoli in Bogra district. Later, another two projects were developed in sadar upazila of B.Baria district and in Alfadanga upazila of Faridpur district in the year 1992 & 1993 respectively. Another similar project was started at sadar upazila of Munshigonj District in the year 1998 with the financial support of IAMANEH. These five geographically distinct but similar in project components are covering a total population of about 104,662 in 61 villages.These projects are offering MCH care focusing on ANC/PNC,General Treatment, BCC activities, EPI for women & children ,Growth Monitoring to 0-3 years children & Mobilization of community people through formation of Mothers club & Health committees to have an increased participation of community people for the implementation of the programme. Due to changes in the policies of funding, SRC could not continuing the support to BAMANEH’s MCH Projects since Jan.2001. Presently, IAMANEH is supporting these Projects for the period up to December 2001.

BAMANEH in the year 1991 undertook a special project titled “CONTINUING EDUCATION OF TBA’S” with the financial and technical support from W.H.O.which showed that the continuing education program for TBA’s is effective in reducing the maternal as well as infant mortality quite significantly
BAMANEH’s long experience and keen interest with mothers & children health programme was recognised by the Government and was involved with the Government in various planning activities of the health sector. In the year 1993, BAMANEH completed a study on “STANDARDIZATION OF FP, MCH & MIDWIFERY KITS”. In November 1994 BAMANEH in cooperation with IAMANEH organised an “International Conference on Maternal and Neonatal Health” in Dhaka. More than one hundred world reputed professional and experts attended the conference. Focussing the global situation ,the issue of maternal & child health care with special emphasis on situations in Bangladesh. was also given importance
In November 1999, BAMANEH also organised another International Conference titled as “FIRST SOUTH ASIAN CONFERENCE ON REPRODUCTIVE AND CHILD HEALTH” in Dhaka with the cooperation of IAMANEH , Indian College of Maternal and Child Health (ICMCH), & Obstetrics and Gynecological Society of Bangladesh (OGSB), where delegates from India, Pakistan, Nepal, Bhutan attended the conference and made valuable recommendations to improve the Reproductive and Child Health Status of South Asian countries including Bangladesh.
Thus, BAMANEH is trying to play an active role in the field of maternal & child health and family planning with special emphasis on the MCH care of the rural mothers.

Goal of the community based MCH Project

The goal or mission of the project is to improve the quality of life with special emphasis on reproductive health of rural women & child so that maternal and neonatal and infant mortality could substantially be reduced in the command area and in the long run to develop a sustainable health care program through the active participation of community people.

Specific Objectives

to reduce the maternal and neonatal mortality as well as morbidity
to ensure safe delivery of the mothers
to raise awareness about the importance of ORT and ways of preparing them at home
to raise awareness about the hazards of improper hygienic practices, environmental contamination, drinking and using surface water
to educate about appropriate food nutritional needs for mothers & children
to educate & motivate pregnant mothers to attend health center for antenatal and postnatal care & to bring children for immunization
to make aware of the immunizable diseases and their prevention
to establish a growth monitoring system with participation of the community in order to improve the nutritional status of children
to ensure rational use of drugs
to motivate women to mobilize local resources and organise themselves in their villages
to organise rural poor women of reproductive ages as cohesive group for health development
to ensure community participation through Mother’s club & health committees formed on para/village wise

Present status of the project

BAMANEH’s Community Based Mother & Child Health Care Project has created a sense of inspiration and enthusiasm among the community to improve their health.. The better and sincere services rendered by BAMANEH has earned goodwill from the beneficiaries.. Selection of TBA’s to work in their own community voluntarily have resulted in a positive impact. Empowerment of TBA’s in the project areas with continued training have enhanced their credibility. Their regular visits to mothers and timely intervention for intranatal care with more confidence and skill has brought a significant reduction in maternal & infant mortality in the working areas.,which is almost less than half of the national average. Thus, it shows that overall reproductive health care scenario has changed to a great extent.. At present more than 60% of the households are availing these services. They call for trained TBA’s at the time of delivery. Two-third of the deliveries are now conducted by these trained TBAs.

With the co-operation from Govt’s EPI programme, the workers of BAMANEH have succeeded to bring a positive changes on the situation. Immunisation coverage to a high level has been recognised by Govt. on several occasions , this shows BAMANEH’s contribution in preventive health care. Strong and effective health care motivation has raised the life expectancy, standard of living, child survival rate etc. Rate of maternal & infant mortality has also reduced to a great extent, which is almost half of the national average. Mothers and children have got easy access for general treatment at a very nominal cost. Patients with water-borne diseases are gradually declining. Consciousness about hazards of indiscriminate discharge of excreta, drinking contaminated water, unhygienic environment and unhygienic practices have significantly changed among the community. Community people are coming forward with participatory tools for the promotion of latrines and other identified health subjects.

Growth monitoring programme has brought a positive impact on nutritional status. About 30% of the children within the age group of 0-3 years are in the growth monitoring programme. Growth monitoring as well as health education on nutrition accompanied with increased kitchen gardening have brought a noticeable change in the overall situation. It has been found that malnutrition in the project areas is almost less than 50% as compared to the other parts of the country.

Mothers Club-a package intervention on income, education and health which aimed to improve economic, social and health condition of landless and under privileged section of women to improve their position in society through self-reliance, skill development, awareness building, utilization of local resources etc. have ushered new hopes and aspirations among these section of mothers. Their regular meetings which focus on diverse subjects including family planning, MCH, nutrition, sanitation, hygiene, savings and credit management etc. have increased their self- confidence and awareness. Through their collective entrepreneurial endeavors, they are currently earning a regular flow of income with their small savings, with which they can subsidize their children’s education and help their husbands in maintaining families. Now these woman folk has proved themselves for rendering more effective services to their family and society in respect to the family and social development. These clubs have fostered solidarity and cohesion among their members, thereby, strengthening the organisations. Recently, they have marched one step ahead through formation of confederation to work unitedly for further development They have set a rare example of developing their organisation with the spirit of Self-help approach. Gradual phase-out of Mother’s club have also started so that they can independently run all the club affairs by themselves.

Formation of para/village wise health committee has opened up a new vista to organise & mobilise community people in a smaller form to identify their felt-needs of different health issues and how to utilize their participatory efforts to ameliorate those problems. Achievement of one committee is providing impetus to others for forming similar committees realising the very fact that improvement of their health depends on them, not on some others. In all, community members including Para/Village health committees, Mothers Club Members and local self-help groups are in the state of coming forward with the zeal of leadership to organise various actions for making the projects beneficial and sustainable one.

From local donation & revenue generation BAMANEH has been successful in procuring 0,30 acre of land including construction of two storied building at chandina Project and 0,33 acre land for construction of its of own clinic at B.Baria Project. We expect to have our own clinic building on donated land gradually in all the projects.

Relevance/Justification for further continuation

To continue the journey towards desired sustainablity & to materialize the felt needs of the community the project would like to address the following issues.

Delivery of mothers at BAMANEH clinic rather than home is the persistent demand of community. Implementation of this will ensure safe delivery of mothers as well as will generate revenues. BAMANEH therefore plans to introduce delivery facilities gradually in all the centres.

It is observed that the extent of high risk pregnancies can be reduced substantially if proper screening could be done through proper counseling , requisite laboratory support & referral of mothers right place in right time with the involvement of community. BAMANEH aims to take a joint initiatives in this regard with participation of the community

Tube-wells for safe drinking water across the country are now delivering micro amounts of poison resulting in Arsenicosis. The epidemiology of Arsenicosis is poorly understood . It is estimated that 20 million people are at risk of arsenic contamination. BAMANEH plans to intensify its campaign of in the awareness building

HIV/AIDS emerged as a serious problem with estimate of 21,000 individuals being effected, there is a concern about the potential threat, especially in the context of favourable environment, inadequate surveillance and reporting as well as inadequate control measures .BAMANEH plans to intensify its campaign on awareness raising & preventive measures through wide dissemination of messages on prevention at the community level.

Women are the main victims of malnutrition. The additional biological demands during menstruation, pregnancy and lactation have made nutritional deficiencies the most widespread and disabling health problem among the women. The women folk therefore deserve to be addressed with wide interventions. BAMANEH plans to implement certain programmes in this respect involving the community.

It has been observed that lack of access to food is not only the cause of malnutrition, poor feeding practices and infection or combination of the two are major factors for malnutrition of children. Infection, particularly persistent diarrhoea, pneumonia and measles undermines nutritional status. Poor feeding practices -inadequate breast feeding, offering of wrong foods in insufficient quantities etc. contribute to malnutrition. Such conditions require concerted efforts the good nutrition. The organisation envisages to take effective measures in this regard to combat the malnutrition.

Adolescents between 10 and 19 years of age deserve to be addressed as a separate component as rapid physical, emotional and social changes take place at that time.. Adolescent find themselves exposed to a number of factors which can adversely effect their physical and mental health. In most cases, early marriage and early pregnancy can set into motion a cycle of ill health and growth failure. Interventions like organising & mobilizing of adolescents on increased awareness, and dissemination of messages including counseling are necessary for their wellbeing.

It has been observed that lack of adequate literacy among the Mother’s club members are impediment in the progress of mother’s club activity as well as the formation of mother’s Thus, intervention on adult literacy is needed. To increase empowerment of Mothers club members it is necessary to make them aware about their rights & legal issues that are required and organise some training on poultry farming & cattle rearing, tailoring, nursery of plants, food processing of locally produced items etc This will enhance their income and will ultimately be helpful to raise their standard of living as well as health. BAMANEH plans to design a set of activities for their income generation..

Our experience reveals that the behavioural changes of people need time. Healthy practice are still lagging behind.. Strong drives are required to change the long standing cultural and values to bring a sustainable changes in health behaviours. BAMANEH has a plan to gear up the activities on Behavioral Change Communication(BCC) like Interpersonal Communication, Health Education at schools & community level, Target group meetings & Use of audiovisuals in the community.

Formation of Para/Village health committees is proceeding at a slow rate as people do not give sufficient time for discussion and interaction with them due to their preoccupation in the household activities. It takes several sittings to form a health committee involving the people.. Hence, further input is required to raise the number of Para/Village health committees.

To involve the community in participatory process (Planning, Implementation, Monitoring, Evaluation & situation analysis for next course of action) of Project development needs sufficient time & enough facilitating role is needed. During the previous years of project development BAMANEH initiated the process, but now it deserves more attention in the form of facilitation .To continue the facilitating role with the ultimate aim of participatory project development & sustainability, further intervention in this regard is needed.

Conclusion

In order to address the needs/constraints experienced during the last couple of years and to raise the extent of service coverage of different components along with improved quality ,the project deserve to be continued for a period of another three years. We are optimistic that we would sure be able to develop a participatory form of self-sustained health delivery system for rural community, which will set a model of self-financing and to be replicated in other parts of the country.

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Edited by Aldo Campana,