Improving the quality of family planning and reproductive tract infection services for urban slum populations: Demand-based reproductive health commodity project

Quality of care has been a neglected dimension of family planning (FP) services for a long time in Bangladesh. Furthermore, effective programs are yet to be implemented to address the imbalance in contraceptive method mix. As outlined in this report, efforts were made through an operations research project to improve the quality of FP and reproductive tract infection (RTI) services provided by NGO clinics in selected slums in Bangladesh. The capacity of these NGO clinics to offer high-quality services to slum neighborhoods was strengthened by training service providers, strengthening service delivery points, and improving counseling services to ensure client satisfaction. Service providers were trained to follow standard screening criteria and informed counseling so that clients can select an appropriate contraceptive method. They were also sensitized to counsel clients by using the “life cycle approach” with emphasis on long-term and permanent methods for women who have completed their family size. The aim of this study was to test a service delivery model for client-centered FP and RTI services to improve the reproductive health of couples living in urban slums

Health systems and maternal mortality, neonatal mortality and child health: Review of selected service delivery models

Effective maternal and child health services at the community level in developing countries are rarely available. In many developing countries the health systems cannot provide quality maternal and child health care services due to lack of adequate human resources; shortages of equipment, drugs, and supplies; and absence of proper referral mechanisms. Strengthening health systems is central to improving maternal and child health. A variety of targeted interventions have been implemented in the health systems of developing countries. This study was conducted to identify the health service delivery models that have contributed to the reduction of maternal, infant, and child mortality in five selected developing countries, and to identify the strengths and limitations of these models. The countries studied, Bangladesh, Cambodia, Ghana, Tanzania, and Pakistan, were selected according to level of maternal and infant mortality, initiatives undertaken in the health sector to improve maternal and child health, and level of progress toward achieving the health-related Millennium Development Goals. Based on a set of selection criteria, several successful service delivery models implemented in the selected countries have been identified

Strengthening health and family planning services in low performing and hard-to-reach areas of Bangladesh: Workshop report

Although Bangladesh has established a comprehensive physical infrastructure to deliver health and family planning services with a network of primary health care facilities in rural areas, the impact of this health service network has been much less than expected because services do not reach all regions effectively. Two divisions, Sylhet and Chittagong, remain the most disadvantaged in terms of health and population outcomes and access to services, compounded by poor utilization of facilities in these areas. Moreover, the current health and population sector programs are beset with human resources and infrastructural problems. The Population Council organized a workshop to find answers to a key question: how can service delivery be improved in low-performing and hard-to-reach areas. This report shows that the workshop’s objectives were to: review current and emerging health and family planning issues particularly in low-performing and hard-to-reach areas; identify areas of deficiency in service delivery; and develop strategies for improving the performance of the health and population sectors in low-performing and hard-to-reach areas. Discussions were centered on human resources and infrastructure; behavior change communication and advocacy; and supplies and logistics

Strengthening union level facility for providing normal delivery and newborn care services: Workshop report

In Bangladesh, a network of government health facilities providing maternal and child health services has been established. In rural areas, first-level fixed-facility service is provided at the union level through Health and Family Welfare Centers (HFWCs). These facilities are designed to improve maternal and child health by making services available to the people in rural areas, however a full range of reproductive health services for women is not available in those facilities. At present, no evidence exists to support whether or not HFWCs can safely and cost-effectively provide normal deliveries. There is a need for a policy research initiative that can draw upon concrete evidence to support the policy changes necessary for strengthening HFWCs so they can provide normal delivery and newborn care services. With financial support from the UK Department for International Development (DFID), the Population Council has undertaken a policy and systems study aimed at identifying possible mechanisms for strengthening HFWCs so that they can provide normal delivery and newborn care services. A workshop was organized at the onset of this study, and findings from that workshop are presented in this report

Innovative financing through pay-for-performance for providers to improve quality of care in Bangladesh: Transforming research into action

To improve access to and use of facility-based obstetric and newborn care, the Government of Bangladesh is implementing two innovative performance-based financing programs, namely demand-side financing (DSF) and pay-for-performance (P4P). With the purpose of identifying the lessons learned, limitations of the P4P and DSF models, and scopes for cross learning, a two-day workshop was organized in Dhaka. This workshop report, prepared by the Population Council, resulted in several recommendations to modify DSF and P4P schemes. In Bangladesh, the need for continuing performance-based financing programs to meet MDGs and other health indicators is beyond argument, but it is urgently required to decide in what capacity the performance-based financing program should continue. The government needs to prepare itself to continue performance-based incentive programs in pursuance of achieving the MDGs of reducing maternal and neonatal mortality

Innovative financing through pay-for-performance for providers to improve quality of care in Bangladesh: Transforming research into action

To improve access to, and use of, facility-based obstetric and newborn care services in rural areas, the Government of Bangladesh is implementing two innovative performance-based financing programs: demand-side financing (DSF) and pay-for-performance (P4P). Both programs have contributed to the increase in institutional deliveries, yet not enough women receive the recommended care during pregnancy and delivery. DSF and P4P are implemented in parallel and have their own merits and limitations. As described in this brief, a two-day workshop was organized in 2011 in Dhaka to identify the lessons learned and limitations of P4P and DSF models and scopes for cross-learning. Both DSF and P4P were found to have the same goal but differ in approaches and outcomes. The main difference is that P4P implements a “quality of care”-based incentive mechanism for maternal, newborn, and child health (MNCH) care, which has the potential to improve monitoring of health-service delivery in rural areas of Bangladesh. The workshop resulted in several recommendations for modifying DSF and P4P schemes

Future of family planning program in Bangladesh: Issues and challenges

Bangladesh experienced large population growth in the past, but due to a successful family planning program, the total fertility rate (TFR) declined rapidly until the mid-nineties. Over the last decade, the country experienced a slow pace in fertility decline with a small increase in the contraceptive prevalence rate (CPR). This slow pace in fertility decline is causing serious concern for reaching replacement level fertility by 2015. CPR increased seven-fold from 1975 to 2000, but there was no significant increase from 2000-09, demonstrating the weakness of present program efforts. This raises concern among researchers, policymakers, and program managers about the prospect of further fertility reduction in the near future. Strengthening the national family planning program remains a critical challenge. The Population Council organized a workshop to find answers to a key question: What opportunities and challenges lie ahead for the family planning program to address future needs. Recommendations made at the workshop are described in this workshop report

Identifying opportunities and challenges to strengthen union level facility for providing normal delivery and newborn care services: Findings from policy advocacy activities

The Population Council/Bangladesh, with assistance from the UK Department for International Development (DFID), organized a series of advocacy meetings and workshops that were carried out as part of a policy and systems research study titled “Strengthening Union Level Facility for Providing Normal Delivery and Newborn Care Services.” The Council held one consultative meeting, one stakeholders’ meeting, two experience-sharing workshops in Jamalpur and Thakurgaon, two local-level advocacy workshops in Kurigram and Habiganj, and two roundtable dialogues with journalists from Bengali and English newspapers. This document includes five reports: Strengthening HFWCs (Health and Family Welfare Centers) for Normal Delivery and Newborn Care Services: Findings from Consultative Meeting; Stakeholders’ Views and Experiences on Strengthening Union Level Facility for Providing Normal Delivery and Newborn Care Services; Strengthening HFWCs for Normal Delivery and Newborn Care Services: Findings from Local Level Advocacy Workshops; Lessons from Strengthened HFWCs for Providing Normal Delivery and Newborn Care Services; and Strengthening HFWCs for Normal Delivery and Newborn Care Services: Findings from Roundtable Dialogues with Journalists

Understanding factors influencing adverse sex ratios at birth in Bangladesh

Nationally, the sex ratio at birth has persisted at its natural level of 105 male per 100 female newborns for the past half century in Bangladesh. However, at the regional level, Bangladesh is characterized by an east-west divide in sex ratios at birth. While the western region shows normal sex ratios at birth, the eastern region displays distorted sex ratios. To understand the factors that contribute to regional variations, a household survey was conducted among married women aged 18–49 years who had at least two living children. Views of health-care providers on gender-biased sex selection and of program implementers on the impact of gender-focused programs on the importance of having a daughter in the family were also gathered. The study was located in Comilla district which had an adverse sex ratio at birth, and Rangpur district having a normal sex ratio. Caution should be exercised in interpreting the findings, as the sample size of women interviewed was not adequate to reach a definitive conclusion. Future studies are needed that work with a larger sample

A P4P model for increased utilization of maternal, newborn and child health services in Bangladesh

In Bangladesh, maternal health programs are not yet reaching the desired level of facility-based obstetric care service. Most deliveries are conducted by untrained persons at home, demonstrating inequity in access to recommended maternal health care services and underutilization of existing obstetric and newborn care services. Suboptimal performance by providers is a key barrier to improving availability and quality of maternal, newborn, and child health (MNCH) services. To increase use of facility-based services, an operations research study of “pay-for-performance” (P4P) incentives for providers and subsidization of consumer costs was initiated in 2010. The study, part of the Government of Bangladesh–United Nations MNCH and maternal and newborn health projects, has been included as a human resource innovation project under the operational plan of the Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of Bangladesh. The Population Council provided technical assistance in implementing the study, with collaboration from James P. Grant School of Public Health of BRAC University. This policy brief describes the implementation of the P4P operations research study and its consequent implications for policymakers