Mannan_Expanding PNC Home Visits in Bangladesh, The MaMoni Experience

7/31/2019 Mannan_Expanding PNC Home Visits in Bangladesh, The MaMoni Experience

1/18

Expanding PNC home

visits in Bangladesh:

the MaMoni experience

Imteaz Mannan

MaMoni Integrated Safe Motherhood,Newborn Care, Family Planning Project


2/18

The Graph that launched a thousand ships

Source: DGFP MIS data, Habiganj

Postnatal Care in Habiganj 2011


3/18

WHO/UNICEF Joint Statement 2009Home visits for the newborn child: A strategy to

improve child survival

"Studies have shown thathome-based newborn careinterventions can prevent 3060% of newborn deaths in highmortality settings undercontrolled conditions.

Therefore, WHO and UNICEF

now recommend home visits inthe babys first week of life toimprove newborn survival."


4/18

Chronology of Home Based Postnatal Care inBangladesh

03 04 05 06 07 08 09 10 11 12

SNLBRACCAREBPHC

UNICEF MNCS

Joint UN MNH

Projahnmo

BRAC HP/MNCH

SMPP SMPP-2

CB-PNC OR/SNL

BRAC MANASHI

ACCESS ISMNC

DFID Char Livelihoods Project

UNICEF/BRAC MNCH

MaMoni

NNHSap

proved


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Postnatal Care in Bangladesh

NNHS 2009 defines and provides clinicalguidelines for PNC

Transition from policy to action taking longer thanexpected

HPNSDP 2011-16 prioritizes MNH and PNC

PNC traditionally recorded at MIS as carewithin 42 days

Trainedvs. medically trainedprovider


6/18

MaMoni ISMNC-FP Project

One of the models of USAIDsGHIs upazila health systemstrengthening

MOH&FW key service provider

Partner NGOs - supportive andfacilitative role

An integrated package

District wide approach

Integration and linkage of Nonhealth sectors community, LG

with MOH health careproviders


7/18

Habiganj Public Service Delivery System

1.8 mill pop 8 sub-district, 3 in haor

6 municipalities

29.6% staff vacancy 27% SP vacancy

5% pop in tea garden

3% pop in urban slums


8/18

The WHY" and the WHATPNC Prescribed by MaMoni

Activity Maternal Newborn

Counseling andSupport

LAM, PPFP, dangersigns, nutrition

positioning/attachment, EBF,danger signs, delayed bathing,thermal management

Referral forroutine services

PP Vit-A, PP-IFA, BCG, EPI

Check for

complication

Nipples/breastfeeding,

sepsis, other problems

Infection, LBW, hypothermia

Mgmt/Referralof complications

Identify appropriatecenter, notify serviceprovider

Same +S2S Contact,

Program Mgmt Misoprostol use

validation

Birth registration (MOLGRD)

Why? To prevent mortality and morbidity of mother and newborn,

ensure growth and development* PNC begins at ANC, if mothers are not identified and counseled, PNC may not happen


9/18

The Who", The When, The Where"

HA FWA/CHW FWV CHCP

WHO

0-2 days 4-7 14 days

WHEN

Home, satelliteclinics

Community Clinic UH&FWC Secondary

Facilities

WHERE

Visit encouraged but not counted as care Volunteers TBAs/Village Doctors

Home Tea Garden

Outreach Clinics Clinic


10/18

Civil Surgeon,Deputy CS, MO

Deputy Director ofFamily Planning

UH&FPO,RMO, MA, EPITechnician, HI

DistrictHospital (100

beded)

UpazillaHealthComplex(31 beded)

Health SubCentreMO, MA, AHI,Pharmacist

UH&FWCFWV, SACMO,FPI

MCWC

CommunityClinic(For 6000people)

UFPO MO(MCH),SFWV

EPI CentreHealth Assistant

HA

Satellite ClinicFWV, FWA

FWA

FewMCWC

District

Upazilla

Union

Ward/Outreach

HouseholdMO

H&FWST

RUCTURED

istrict&Below


11/18

The How MaMoni Strategy to Expand PNC

ActivitiesHabiganj

Training (FWA, HA, FWV, SACMO)

Volunteers /300 pop.

Community groups /900 pop. or /village

Satellite clinic strengthening - history Community -planning involving FWA, HA,volunteers to update MIS data

TBA orientation (delivery notification)

PNC register revision FWA - 48h, 7d

Supportive Supervision (JSV)

Facility strengthening for delivery, PNC

Referral chain setup, transport


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PNC Coverage Jul 2011-Mar 2012

Source: DGFP MIS


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Wait a Minute! Isnt it

Supposed to be a percentage?

too low?

showing no trend?


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Issues MIS & Reporting

No single report Facility delivery often doublecounted

HAs report not processed

No record of continuum of care ofARH-FP-MNCH, some mothersnot recorded at all

No single denominator

Live births vs. BCG: The 22-50issue

Identification system different forH&FP, not updated

Delivery notification a challenge


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Issues Service Delivery at Home

Less time: Move away from domiciliaryservices, promoting one-stop services(Community Clinics)

PNC/OPD confusion

More people: HH-CHW ratio doubled sincelast HR planning, even triple in some areas

1 FWA/6,000 population in 1995

More work: 18 items in the JD includingpromoting VAW, homestead gardening, etc.


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MaMoni approach to solve these problems

Community micro-planning (396/mnth)

Birth notification by TBA,link to FWV/A

UP registration

GR support in oneupazila

Poil study Single MIS for

ANC/Delivery/PNC

Validation of data(BCG/Live birth)


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Take Away Message

Operationalizing policy takes time andpatience

Need some transition activities before it can bescaled up

For high mortality districts, home based PNCis needed, lessons from Habiganj should beconsidered


18/18

Thank You

"Childrens lives should be counted in years and decades,not in minutes, hours and days

Mannan_Expanding PNC Home Visits in Bangladesh, The MaMoni Experience

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