Second Regional Training Session for LRH II II Final Report.pdfSecond Regional Training Session for...

Second Regional Training Session for LRH II

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Faculty Profiles

Dr Zafarullah Chowdry

Zafarullah Chowdhury is a Bangladeshi public health activist. He is the founder of

Gonoshasthaya Kendra (People's Health Center), a rural healthcare organization. Dr.

Chowdhury is known more for his work in formulating the Bangladesh National Drug Policy

in 1982. In 1972, Zafarullah Chowdhury took on the challenge of developing an effective

rural health care delivery system. Building on his experience of running a field hospital with

young women and men without previous medical training, Gonoshasthaya Kendra (GK) was

set up.

Gonoshasthaya Kendra is a multi-faceted community and development programme

encompassing activities ranging from agricultural cooperatives, community schools, primary

health care centres to women’s vocational training by GK Trust. Apart from these,

Gonoshasthaya Pharmaceuticals, Gonoshasthaya Intra-venous Fluid Units, Gonoshasthaya

Basic Antibiotics Production Units, Gono Mudran (Gonoshasthaya Printing Press),

Gonoshasthaya Foods Limited, Gonoshasthaya Tath Limited (Handloom weaving) are some

of the income generating units owned by the Gonoshasthaya Public Charitable Trust.

Gonoshasthaya Kendra has for the last 30 years worked on community health services. It

has successfully introduced innovative community health care services in Bangladesh,

especially in the field of paramedical training and domiciliary services achieving low

maternal mortality (MMR) and infant mortality rates (IMR). In most GK’s operational areas,

MMR and IMR is between 1/3 to 1/2 of the national average. Family planning in GK’s field

practice area is well accepted and the growth rate is 1.5 %, while the national rate is above

2%. GK had introduced a Rural Health Insurance System in 1973 in GK operated Primary

Health Care Centres and hospitals. Poor and low income groups are charged lower rates of

Health Insurance Premium while rich and middle class pay much higher rates. Nonetheless

all groups receive equal quality health care.

Dr Koasar Afsana

Dr. Kaosar Afsana is the Associate Director of Health Programme at BRAC and has been with

BRAC for over 18 years. She is an MD with MPH from Harvard and PhD from Edith Cowan

University, Australia. Currently, she is heading two significant projects of BRAC on maternal,

newborn and child health in urban slums and rural districts of Bangladesh. She is also

involved in many different activities with BRAC including strategic directions, policy-making and programmatic decisions.

Dr. Afsana authored two books on childbirth practices – “Discoursing Birthing Care.

Experiences from BRAC, Bangladesh,” and “Disciplining Birth & Power, Knowledge and

Childbirth Practices in Bangladesh”. She has published research papers in journals, books

and monographs. She has been awarded with many prestigious awards including Asian

Studies Association of Australia's Presidents' Prize for the best thesis on Asian topic and the 2003 University Research Medal and the 2003 Faculty Research Medal for her PhD thesis.

http://en.wikipedia.org/wiki/Bangladesh

http://en.wikipedia.org/wiki/Bangladesh

http://en.wikipedia.org/wiki/1982


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Dr. Afsana is the Board member of The Partnership for Maternal, Newborn and Child Health

and Advisor to Maternal Health Task Force and represents many national and international

organizations as a member. She also teaches reproductive health at James P Grant School

of Public Health, BRAC University. Currently, Dr. Afsana has been involved in many national

and international research projects, namely, mobile health, post-partum package

development, prolonged labor and birth asphyxia, maternal depression, and sexual and

reproductive health rights.

Dr Nazr ul Haque

Dr. Nazrul Haque holds a Masters in Public Health (MPH) from Dhaka University,

Bangladesh and a Diploma in Tropical Medicine & Hygiene from Liverpool School of Tropical

Medicine, University of Liverpool, U.K. He is also a Medical Graduate (MBBS) from Rajshahi

University, Bangladesh.

He has more than 20 years of experience in designing and implementing strategy for

behavior change communication and capacity building. Dr. Haque is an accomplished

facilitator and a specialist in developing training curricula.

Since 2008, he is working as the Deputy Director at Bangladesh Centre for Communications

Program. He is involved in design and development of policy engagement, advocacy and

communication programs. BCCP is a local program by John Hopkins University in Dhaka.

He has undertaken nationwide campaign focusing on health issues and on issues on other

sectors. As focal person, he implemented two social communication campaigns to promote

youth unity to combat terrorism and radicalization; and to promote family values as a tool

to protect youth involvement from terrorist activities.

As a team leader of the Advocacy and Communication Component (ACC) of HIV/AIDS

Prevention Program (HAPP) of the National AIDS/STD Program (NASP), Government of

Bangladesh, he provided guidance to the team for advocacy, program communication,

partnership building, social mobilization, and NGO networking. He has also designed and

implemented a Nationwide Campaign for Prevention of Human trafficking of Women &

Children in Bangladesh and worked extensively with International Organization for Migration

(IOM) in promoting Safe Migration and pre-departure health orientation for Migrant workers

in Bangladesh.

Tawfique Jehan

Mr. Tawfique Jahan is a communication specialist, a public health communication expert and

a human resource and management consultant. He is also an accomplished facilitator and a

curriculum development specialist.

His areas of interest are communication, advocacy, campaign design and community

mobilization.

He has more than 16 years of experience in senior management positions implementing

health service delivery projects, conceptualizing, designing and implementing large scale

communication programs, in particular launching mass media campaigns.


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Currently, he is working as the Senior Program Specialist at Bangladesh Center for

Communication Programs. Under his guidance, many prime communication materials have

been conceived, developed and distributed.

He is also a consultant in one of the largest health projects in Bangladesh funded by the

European Union (EU), working with the Functional Improvement Team (FIT) where he was

closely involved in project management that provided technical assistance to the health care

providers at the district and upazila levels.

Dr Muhammad Abdus Sabur

Dr. Muhammad Abdus Sabur has a Post-Graduate Diploma in Personnel Management from

1992 Bangladesh Management Development Centre, Dhaka and master degree in

community health from Liverpool School of Tropical Health Medicine, England.

He has more than 25 years experience in field of reproductive health policy planning,

strategic implementation, monitoring and health service delivery. Recently he worked in the

capacity of Team Leader at the Programme Support Office in the Ministry of Health and

Family Welfare of Government of Bangladesh, which dealt with policy formulation about

national health, population, poverty reduction, five year plan, ten years’ perspective plan

and programme implementation and monitoring.

He has worked in reputable organizations as the Country Representative at Water Aid -

Bangladesh, as Health and Population Sector Manager at UK’s Department for International

Development (DFID) - Bangladesh , as Sector Coordinator for Health and Population-

CARE Bangladesh, as Head of Programme, Health at Save the Children – UK (SC-UK) -

Bangladesh , as Management Adviser in the Management Development Unit (MDU), United

Nations Fund for Population Activities (UNFPA) and has worked at various positions at the

Ministry of Health and Family Welfare, Government of Bangladesh.

Dr Zia ul Islam

Dr. Zia ul Islam has a Masters Degree in Health Services Management from London School

of Hygiene & Tropical Medicine, University of London, UK and public health administration

from National Institute of Preventive & Social Medicine, University of Dhaka.

His areas of interest are health systems research and economic evaluation of health

programs He has twenty five years of job experience in the public sector health care

delivery system and is involved in research in the International Centre for Diarrheal Disease

Research, Bangladesh (ICDDR,B ) 1999 to date. Since March 1999, he has been working in

the area of operations research, health systems research and economic evaluations of

health programs as Principal Investigator, Co-Principal Investigator and Co-Investigator.

He has held several posts; under the Directorate General of Health Services at different

tiers; including Sub-district (upazila) Health Complexes, Urban Primary Health Care Clinics

and Primary Health Care and Disease Control sections of the Directorate of Health Services.


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Table of Contents

Executive Summary .................................................................................................... 7 Training Agenda for RTS II .......................................................................................... 8 DAY 1 Inaugural Session & Opening Dinner ................................................................ 10 DAY 2 Session 1 (Group A): Understanding Health Policy ............................................. 14

Session 2 (Group A): Health System Financing .................................................. 15 Session 1 (Group B): Engaging Decision Makers on Health Policy ......................... 16 Session 2 (Group B): Livelihood and Reproductive Health .................................... 18

Day 3 ..................................................................................................................... 19 Day 4: Field Visit to BRAC Health Division .................................................................. 20 Day 5: Field Visit to Gonashasthaya Kendra Nagar Hospital .......................................... 24

Closing Ceremony .......................................................................................... 26 Faculty Evaluation .................................................................................................... 27 Field Visit Evaluation................................................................................................. 28 Overall Training Evaluation ........................................................................................ 29 Annexure 1: Presentation by Key Note Speaker ........................................................... 30

Annexure 2: Presentation on Understanding Health Policy ............................................ 30

Annexure 3: Presentation on Health System Financing .................................................. 44

Annexure 4: Presentation on Engaging Policy Makers .................................................. 51

Annexure 5: Presentation on Livlihood and Reproductive Health ..................................... 61

Annexure 6: Pre /Post Training Test ........................................................................... 65


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Executive Summary

The training was the second in a series of two workshops being organized by LEAD Pakistan

in collaboration with The David and Lucile Packard Foundation. Titled “Engaging Decision

Makers on Health Policy”, it was conducted for a Cohort of 32 mid career professionals

belonging to diverse backgrounds and areas of expertise from District Khairpur. The

workshop aimed to facilitate participants in acquiring knowledge, skills and attitudes vital for

engaging with Health Sector decision makers at policy level.

LEAD Pakistan successfully built on existing linkages and formalized a landmark

relationship-building Memorandum of Understanding (MoU) with Institute of Governance

Studies (IGS), BRAC University. Under this MoU, both organizations will facilitate each other

in the fields of research and training and will have joint ventures in South Asian region to

promote sustainable development.

The participants were divided in to two groups, A and B. The first module aimed at enabling

participants to view basic concepts of health policy and its relation with the term

reproductive health. The second module addressed key financial concepts associated with

Health Policy Making while the third focused on engaging stakeholders in health policy

making at district and federal levels.

The cohort visited urban slum areas of BRAC Health division. Group A visited Manoshi Mirpur

and group B visited Manoshi Uttara. Both groups had an elaborate presentation of the

Health system set up by BRAC Health and were later taken to the birthing huts, the

antenatal and post natal care centers. The trainees also had a visit to Gonasashthaya

Kendra Nagar Hospital where they had an orientation session of the NGO and the projects of

education, health and empowerment being run by them. Afterwards, Dr. Zafarullah

Chowdry, the renowned public health activist and the founder of Gonasashthaya Kendra,

met the group and had a very informed discussion with them regarding the progress made

by their country in the field of reproductive health.

The workshop had a specific emphasis on Bangladesh-related Reproductive Health success

stories. Women empowerment through education and employment was focused upon

among other initiatives taken by BRAC while agricultural loans and vocational trainings by

Gonasashthaya Kendra were explored with the aim to implement the same back in Pakistan.

The participants were inquisitive, participatory and open to new ideas and concepts,

particularly in the field visit. A glance at the pre and post training evaluation statistics reveal

that there has been a significant improvement in the participants’ basic concepts and beliefs

of reproductive health and all other issues associated with it.


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Training Agenda for RTS II

Date Time Activities Facilitator

27-12-2010,

Monday

0400 hrs Arrival at Karachi airport. LEAD Pakistan

0600 hrs Distribution of passports, training folders and

training identification cards.

LEAD Pakistan

0630 hrs Brief Orientation about training and rules,

regulations.

LEAD Pakistan

0900 hrs PIA - PK 266 Departure from Karachi airport LEAD Pakistan

1315 hrs Arrival at Dhaka airport LEAD Pakistan

1400 hrs Departure from Dhaka airport Institute of Governance

Studies

1500 hrs Arrival at BRAC-CDM, Savar Institute of Governance

Studies

1530 hrs Check in into rooms at BRAC-CDM, Savar BRAC-CDM, Savar

1830 hrs Inaugural Session/Key Note Speaker Institute of Governance

Studies

2000 hrs Formal opening dinner BRAC-CDM, Savar

28-12-

2010,Tuesday

0730 hrs Breakfast BRAC-CDM, Savar

0800 hrs Morning Registration LEAD Pakistan

0830 hrs Understanding Health Policy: Session I – Group A Dr. Suleman Qazi, LP

Health Policy Engagement for RH: Session I –

Group B

Mr. Taufeeq Jehan &

Dr. Nazar ul Haque

1000 hrs Tea Break BRAC-CDM, Savar

1015 hrs Understanding Health Policy: Session II – Group A Dr. Suleman Qazi, LP

Health Policy Engagement for RH: Session II–

Group B

Mr. Taufeeq Jehan &

Dr. Nazar ul Haque

1145 hrs Understanding Health Policy: Session III –

Group A

Dr. Suleman Qazi, LP

Health Policy Engagement for RH: Session III–

Group B

Mr. Taufeeq Jehan &

Dr. Nazar ul Haque

1300 hrs Lunch and Prayer Break BRAC-CDM, Savar

1345 hrs Evening Registration LEAD Pakistan

1400 hrs Health System Financing : Session I – Group A Dr. Zia ul Islam

Livelihood & RH: Session I - Group B Dr. Abdus Sabur


1530 hrs Health System Financing : Session II – Group A Dr. Zia ul Islam

Livelihood & RH: Session II - Group B Dr. Abdus Sabur

1645 hrs Evaluation LEAD Pakistan

2000 hrs Dinner BRAC-CDM, Savar

29-12-2010,

Wednesday



0830 hrs Health Policy Engagement: Session I – Group A Mr. Taufeeq Jehan &

Dr. Nazar ul Haque

Understanding Health Policy : Session I – Group B Dr. Suleman Qazi, LP


1015 hrs Health Policy Engagement: Session II – Group A Mr. Taufeeq Jehan &

Dr. Nazar ul Haque

Understanding Health Policy : Session II –Group B Dr. Suleman Qazi, LP


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1145 hrs Health Policy Engagement: Session III – Group A Mr. Taufeeq Jehan &

Dr. Nazar ul Haque

Understanding Health Policy: Session III –Group B Dr. Suleman Qazi, LP


1345 hrs Evening Registration LEAD Pakistan

1400 hrs Livelihood & RH: Session I – Group A Dr. Abdus Sabur

Health System Financing: Session I - Group B Dr. Zia ul Islam


1530 hrs Livelihood & RH: Session II – Group A Dr. Abdus Sabur

Health System Financing: Session II- Group B Dr. Zia ul Islam

1645 hrs Evaluation LEAD Pakistan


30-12-2010,

Thursday


0800 hrs Departure for field visit to BRAC Health division Institute of Governance

Studies

1000 hrs Presentation at Manoshi Mirpur and Uttara BRAC Health Division

1100 hrs Tea Break BRAC Health Division

1130 hrs Visit to birthing hut, antenatal and post natal care

centers

BRAC Health Division

1430 hrs Arrival at BRAC-CDM, Savar Institute of Governance

Studies


1900 hrs Certificate Awarding Ceremony LEAD Pakistan


31-12-2010,

Friday


0800 hrs Morning Registration and Check out LEAD Pakistan/BRAC-

CDM, Savar

0830 hrs Departure for Gonashasthaya Kendra Hospital Institute of Governance

Studies

1000 hrs Arrival at Gonashasthaya Kendra Hospital Institute of Governance

Studies

1000 hrs Presentation by GK Nagar Hospital Staff GK Nagar Hospital

1030 hrs Tea Break GK Nagar Hospital

1100 hrs Meeting and Discussion with Dr Zafarullah

Chowdry

GK Nagar Hospital

1400 hrs Arrival at Dhaka airport Institute of Governance

Studies

1630 hrs Departure from Dhaka for Karachi by PIA LEAD Pakistan

1900 hrs Arrival at Karachi airport LEAD Pakistan 1930 hrs Dinner in Karachi LEAD Pakistan 2000 hrs Departure of LRH II cohort for Khairpur LEAD Pakistan, PO


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Acknowledgements

The 5 days’ Regional Training Session in BRAC-CDM, Bangladesh was actually a result of

three months’ effort of a number of people. LEAD Pakistan (LP) is highly indebted to the

whole team involved in this process and making it a success.

The training would not have been possible were it not for collaboration from David Lucile

and Packard Foundation. First of all, LP deeply acknowledges approval for training and the

financial support provided by the Packard foundation to enhance the knowledge and

exposure of LRH II cohort leading to improved RH status of district Khairpur.

LP extends their sincere gratitude to the facilitation and guidance provided by Institute of

Governmental Studies (IGS), BRAC University, Bangladesh. The LP-IGS relationship will

prove to be instrumental for sustainable development.

LP is grateful to the Pakistani High Commissioner in Bangladesh, Mr. Ashraf Qureshi, for

sparing time from his busy schedule for the closing ceremony of the Training in Bangladesh.

LP would like to thank Bangladesh Centre for Communications Programs (BCCP),

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) and

Gonoshasthaya Kendra Hospital for their part in the participation and facilitation of this

training.

LP is really grateful to Dr. Kaosar Afsana, Associate Director, BRAC Health Program and Dr.

Zafarullah Chowdry, founder of Gonoshasthaya Kendra Centre for being our keynote

speakers and adding value to our sessions.

LP acknowledges BRAC, Centre for Development Management (CDM) for their hospitality

and services for a wonderful stay of the trainees and LEAD Team. Also we are extremely

obliged to BRAC Health Division for arranging a learning exercise in the field visit for the

trainees.

We are also grateful for the intellectual input and guidance from Dr. Suleman Qazi, Chief

Technical Advisor for LEAD Pakistan. Last but not the least LP would like to appreciate the

efforts of CEO for his prompt guidance and advice and PMD, CSD and Admin departments

who were involved in making this event possible. Without their hard work and determination

this event would not be a reality.

We would like to extend sincere apologies if there are errors, omissions or

misrepresentations.

Regards

Training Unit

Core Services Department (CSD)

LEAD Pakistan


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LRH II Objectives

The broader objectives of this project are:

1) Community sensitization and mobilization – while reaching out to all community

members, especially the disadvantaged, the project will identify and work closely with

the most vulnerable sections. For RH, this is primarily teenage girls who are not enrolled

in schools;

2) Local and community leadership development;

3) Policy engagement, focusing on strategic direction, district health budgeting, and

synergies between population and health departments;

4) Development of partnerships and networks of multi-sectoral stakeholders nation-wide,

for the improvement of RH in Khairpur;

5) Documenting and disseminating a local model for RH.

The training modules designed for this project are aimed to train mid-to-senior level

professionals from Khairpur and Lodhran districts on reproductive health as a broader issue

so that they can play an effective role in improving the reproductive health indicators in

their respective districts. Two national training sessions and one international training

session are to be conducted for Khairpur cohort. The first Regional Training Session held in

Islamabad in September 2010 specifically addressed the community mobilization aspect of

the project. The engagement of decision makers on Health policy making and Livelihood are

covered in the second Regional Training Session.


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Dr Koasar Afsana and Dr Suleman Qazi sharing views

DAY 1 Inaugural Session & Opening Dinner

Dr Koasar Afsana was the keynote

speaker for the inaugural session of

RTS II. Dr Suleman Qazi welcomed

the participants of both groups to

LEAD Pakistan and introduced them

to the trainers and other staff

members.

This session aimed at giving the

participants a brief introduction of the

Bangladesh health portfolio, their

national policies and its revisions.

They were briefed about the Health,

Population and Food & Nutrition

Policies of Bangladesh. Also the maternal Health strategy, the neo-natal health strategy and

poverty reduction strategy papers were discussed. Dr Afsana mentioned the Millennium

Development Goals (MDGs) and particularly elaborated MDG 4 (Reduce Child Mortality) and

MDG 5 (Improving Maternal Health). She referred to the National level programmes

regarding newborn and maternal health in order to accomplish the above mentioned MDGs.

The National level initiatives taken for improving maternal health include EmOC/EmONC,

Community Skilled Birth attendants, Maternal Voucher Scheme and Family Planning tools.

The steps taken by the Govt for the new born and child health include EPI, IMCI (Facility &

Community based), Vit A suppl/deworming, National Nutrition programme and

Breastfeeding practices. Overall the National programs deal with accelerating MNH, MNCH &

SMPP Programmes, National Fistula programme, Women Friendly Hospital Initiatives, PPH &

AMTSL programmes and particularly the Adolescent Reproductive Health Programme.

The Bangladesh Family Planning Program aims at slowing down the population growth and

ensuring the accessibility of family planning to all so as to achieve the replacement fertility

level by 2016. The reduction of fertility can be attributed to several reasons as pointed by

the keynote speaker: Access to IMR, Women’s education, empowerment and employment,

Improved socio economic conditions and communications, better access to EmOC,

Reduction in selected causes of death (abortion, obstructed labour, infection and PPH), EPI

especially measles and provision of Vitamin A.

She provided possible explanations for the success of Family Planning Program in

Bangladesh: Sustained commitment of Government, Dedication of field workers, Govt and

NGO collaborations, Cafeteria approach for Family Planning, Involvement of Community,

Stakeholders and Civil Society and Increased cooperation of development partners. The


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challenges ahead for the maternal and neonatal health are: Malnutrition and Poverty, Poor

water and Sanitation, Injury prevention and a dysfunctional Health System.

Dr Suleman Qazi, Chief Technical Advisor also spoke to the participants and exhorted them

to strive for excellence. He informed them about the eligibility criteria for their graduation.

The criteria included their daily attendance and punctuality, demonstration of adequate

interest and participation in group discussions and other network activities.

(See Annexure 1 for Presentation by Dr. Koasar Afsana)

Pre-Training Assessment

The main focus of this session was to assess the basic know-how of the participants with

regard to policy making in reproductive health issues. This exercise was done to facilitate a

review of the success of the workshop by determining the extent of knowledge gained by

the participants at the end of the workshop. They were asked a few questions about RH

success stories in Bangladesh, Health System Financing, Health Policy Understanding and

Engagement of Decision Makers in Policy Making and Livelihood.

The pre-test assessment was based on existing understanding, basic knowledge, concepts

on the four training modules so that the trainer would understand the level of knowledge of

the participants and the extent of training needed to be delivered to build participants’

capacities.


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Dr Suleman Qazi taking the session of “Understanding Health Policy”

DAY 2 Session 1 (Group A): Understanding Health Policy

Dr Suleman Qazi initiated the session

with the session objectives as 1)

Understanding the concept of health

policy, 2) Understanding how policy

decisions are made, and 3)

Understanding challenges to RH Policy

in Pakistan.

Discussing various definitions of policy,

he differentiated what is policy from

what is not policy. He talked at length

about public policy and health policy.

He made the participants understand

how an 8 step policy cycle works. There

was a thorough discussion on the

intended and unintended impacts of a

policy. Dr Suleman also elaborated different health care models and made the trainees

understand which model is applicable to Pakistani Health System. He emphasized that

universal health care requires government intervention and oversight.

Regarding the Reproductive Health Policy of Pakistan, he mentioned that health is a

provincial matter now. He discussed in detail some of the primary functions of Ministry and

Departments of Health in Pakistan. He made a comparison in the roles of public and private

sector health care systems. He particularly informed the trainees of the 18th amendment for

the Health Sector followed by dissolved Ministries and their impact. Regarding the health

system of the country, Dr Suleman talked about types of equity and types of efficiency

which are actually mutually compatible goals. He finally concluded the module by initiating

the discussion on Health Financing.

(See Annexure 2 for Presentations by Dr. Qazi on Understanding Health Policy)


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Dr Zia ul Islam interacting with the trainees

Session 2 (Group A): Health System Financing

After formal introduction with the

participants, Dr Zia ul Islam started the

module by discussing the difference

between Financing, Budgeting and

Accounting. Then he talked at length about

performance audit, medical audit and

financial audit. Regarding Health financing,

he mentioned the cost analysis, cost

effective analysis cost utility analysis and

cost benefit analysis. Dr Zia defined Health

system as all the activities whose primary

purpose is to promote, restore and

maintain health. It includes all actors,

institutions and resources that undertake

health actions. While talking about

Bangladesh health care delivery system, he

told that the key health care providers are private and public sector, as well as the NGOs.

However, the Ministry of Health and Family Welfare (MOHFW) of Bangladesh has multi

tiered service delivery system. Like Pakistan, a large majority of the Bangladesh population

goes to private sector to seek medical advice. He introduced the concepts of Revenue and

Development Budgets.

An important program by the Government of Bangladesh is the introduction of the Financial

Management Unit (FMU) in the MOHFW. This unit is responsible for financial audit in the

government health sector. Also there is an external audit by a private audit team hired by

World Bank.

(See Annexure 3 for Presentations by Dr. Zia on Health System Financing)


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Mr. Tawfique Jahan in an interesting discussion with a cohort member

Session 1 (Group B): Engaging Decision Makers on Health Policy

Two resource persons from Bangladesh Centre

for Communication Program (BCCP), Mr

Tawfique Jehan and Dr Nazar ul Haque took the

session. After explaining the concept of sexual

and reproductive health, they gauged the

attention of audience by generating a discussion

on these definitions. They stressed that the

right concepts of reproductive and sexual rights

are to be provided for every individual and they

are to be safeguarded by the government. As

there is a gap between the real definition of

reproductive health and the associated rights,

the right one has to be campaigned through

effective communication. The trainers

emphasized the need to understand the process of engaging the stakeholders to do so.

There are three levels of engagement: institutional, community and personal.

On the topic of health Policy, the vital part is to to influence policy makers’ behavior through

persuasive communication. The people involved in policy engagement are: Believers,

Satisfied Users, Media, Interested Parties, Experts, Chosen Representatives and all of us.

One very important aspect of policy engagement is to encourage people for persuasive

communication. He discussed the A frame of policy engagement. He also highlighted the

importance of message development and credible, feasible, relevant, high priority and

urgent means to do so.

Dr Nazr ul Haque explained with the example of Reduction in Maternal Mortality (RMM) in

Bangladesh, a campaign of BCCP. As the first step, they first understood the problem that is

high maternal mortality. As the second step, they identified the channels of access to

decision makers, which are Government of Bangladesh and UNICEF. Then come strategy, a

focus on goals which in the case of RMM is to create danger signs and birth preparedness

signs for women in form of pictorial posters and graphics. As the mobilization part, the

stakeholders were contacted for the approval of logo and pictorial cards. Then there was

launching of National communication campaign through consultative workshops and mass

media. In the Action plan, there is use of credible messages and materials consistently.

Finally, the Evaluation part determines the achievements you have made. The most

important part is the continuity in spreading these messages again and again to maintain

the impact.

The BCCP had also designed Family Planning Program by engaging relevant decision makers

(religious leaders, civil society members etc). Policy engagement is the effort to sustain or

change public policy through various forms of persuasive communication. The stake holders


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and the policy maker are brought into contact. At first they have differing opinions, solved

through negotiations, finally turning into the policy dialogues. Team building is done and

finally they develop integrated programs. (See Annexure 4 for Presentations on Health

Policy)


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Dr. Sabur presenting Livelihood and

Reproductive Health areas in his session

Session 2 (Group B): Livelihood and Reproductive Health

Dr Sabur initiated the session by simply defining the Livelihood as “ways and means of

living”. He established the relation between the livelihood and reproductive health. He

stressed upon the fact that all aspects of reproductive health: Family Planning, Safe

Motherhood, Child Health, Women’s Health, Adolescent Health, Abortion and Fertility are all

integral components of Livelihood of a person and a family.

The livelihood capabilities are acquired

through education; the livelihood’s assets

are reflected through wealth. The work on

Livelihood in Bangladesh includes educating

and employing women thus improving their

living conditions. It is an established fact that

in the process of educating a girl, her

marriage age is considerably

delayed and so is the first pregnancy age.

Similarly employing women also delays

their marriage and first pregnancy in the

same manner. Also an employed married

woman cannot afford more pregnancies in total, increased knowledge level, better health

care seeking behaviors, better health outcomes and ultimately better livelihoods.

In this way, Grameen Bank, Gonoshasthaya Kendra and BRAC provided employment

opportunities to women folk and improved their livelihood statuses. Moreover, apart from

poverty alleviation, the women employment experience in Bangladesh involves women not

only in income generation but also engages them in the decision making in the house. This

ultimately affects their decision making in the reproductive health issues.

(See Annexure 5 for Presentations by Dr. Sabur on Livelihood and Reproductive Health)


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Day 3

On the third training day, the trainers were switched for both groups. The sessions were

planned in a manner that on the second day the trainers take the alternative groups with

the same module. The session plan for both days is as follows:

Dates Group A Group B

Training Day 2 Understanding Health Policy Engaging Decision makers on Health

Policy

Health System Financing Livelihood and RH

Training Day 3 Engaging Decision makers on

Health Policy

Understanding Health Policy

Livelihood and RH Health System Financing

In this way, on the third day of training, the same modules were repeated by different

trainers for both groups.


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The cohort and LEAD Team meeting

Community members at Manoshi

Mirpur

BRAC Manoshi Uttara (Manoshi

meaningMother, neonatal and Child

in Bangla)

Day 4: Field Visit to BRAC Health Division

The field visit was organized by BRAC Health division in two areas Mirpur and Uttara.

Group A went to Uttara and Group B visited Mirpur. Both were identical projects of BRAC

Health Program initiated in urban slums. Their MNCH centers, under a project called

Manoshi (Urban Maternal, Neonatal & Child Health Project), provide community health

solutions in urban Bangladesh.

Bangladesh, a nation of 150 million people, has a high urban population growth rate of 6%.

Almost a quarter of Bangladeshis now live in urban settlements – a third of them in slums.

Most slum dwellers are involved in low-paid jobs in informal sectors and their capacity to

seek health care is limited. The urban slums, thus present a much greater challenge to

improving health care than other areas of the country. Despite Bangladesh’s significant

improvement in maternal and child health status over the past few decades, the situation

remains unacceptably poor in urban slums.

BRAC has adapted its Essential Health Care model to a project, called Manoshi, aimed

at improving the health status of vulnerable mothers and children in urban slums. Manoshi

is addressing challenges of MNCH in urban slums. Manoshi emphasizes on capacity

development of community health workers and birth attendants; providing health services

to pregnant and lactating women, neonates and under five children, timely referral to

quality health facilities; community empowerment through development of women’s groups;

and linkage with local government, community people and other non government

organizations.


21

Birthing Huts

Birthing huts, locally known as “BRAC delivery centers”, provide women centric, culturally

accepted clean and safe delivery services. The delivery centers maintain utmost privacy and

dignity of pregnant women, and facilitate prompt diagnosis and referral of maternal and

newborn complications to the hospital.

Each simple, clean birthing hut is run by two trained urban birth attendants supported and

supervised by Manoshi midwives around the clock, providing services to 10,000 slum

people. Currently, 425 delivery centers are being run in 6 city corporations.

Essential Service Package at Manoshi:

Trained community health workers provide key

preventive and curative services at the household

level.

Community health workers provide basic, community

based maternal, neonatal and child health care

services.

Timely referral systems to triage obstetric

emergencies and other severe acute illnesses in

women, newborns and children at qualified health

facilities.

Education and empowerment of women to organize

urban slum communities around key health and

nutrition issues affecting newborns, mothers and

children.

Linkage to existing municipal, nongovernmental and

other local health services, including hospitals and

clinics operating in the community.

The Birthing Hut is a simple and clean place at Manoshi


22

The trainees meeting the SS (Shastika Sabeeka, the midwife) and pregnant

mothers with BRAC Health Officer, Ms Taskeen Chowdry

Street theatre performance by Manoshi

In urban slums of Dhaka

Referral Linkage

BRAC has developed a referral linkage system

between the community and health facilities.

BRAC Staff, with the help of community health

workers and other stake holders, select referral

facilities based on the availability of required

services and easy access from slums. MNCH

complications are referred as soon as they are

diagnosed. Health workers help organize

transport for referred patients and

communicate with BRAC program organizers

posted at referral facilities. They ensure that

each case gets appropriate treatment at the

hospital or clinic by communicating with

doctors and nurses. The use of cell phones

ensures timely referral for cases with

complications.

The health system is fashioned in a way that

for every 10,000 people there exists a MNCH

Centre. A voluntary woman acts as midwife

(SS, Shashtika Sabeeka), responsible for 200 people. She visits them regularly and

collects data on newlyweds, new pregnancies and guides about family planning methods

etc. Since she belongs to the community, so she is considered a trust worthy person. This

midwife SS works under a Health Worker (Shastika Kormi, SK), who is a BRAC employee

and a matriculate. One SK supervises 10 midwives (SS). Alongwith the SS and SK are Urban

Birth Attendants (UBAs). When a complication is identified and hospital referral is made for

a pregnant woman, SKs contact UBAs in the nearby hospitals (posted by BRAC Manoshi) where

they receive the patient and facilitate her treatment.

Interactive Communications

Manoshi has introduced street

theatre and folk music performances

to raise awareness about maternal

and child health issues among slum

populations in catchments areas of

BRAC delivery centers.

Performances are organized

regularly to inform the community

about neonatal danger signs.

Billboards and television spots


23

The cohort members meeting a religious leader,

A member of MNCHcommittee at Manoshi Mirpur

The cohort discussing RH with MNCH committee

(religious leader, school teacher and civil Society member)

informing about maternal issues, TV dramas on maternal health and documentaries on

Manoshi activities are among the innovative means of communication adopted by BRAC.

Community Support Groups

MNCH committees and Women support groups are formed with influential slum dwellers

who meet regularly. These committees have proven to be extremely successful in

encouraging pregnant women to go to delivery centers for safe and hygienic birth and

referring complicated patients as needed. The MNCH committee comprises a religious

leader, a school teacher and a civil society member.

LEAD Team and LRH II cohort visited all these facilities, met the Health workers, the

midwives and the MNCH committee members. They explained their respective roles in the

community and the ways and means they use for persuasive communication. The team also

visited the Ante natal and Post natal care services being provided at homes in the urban

slums.


24

The trainees being presented the activities ofGonasashthaya Kendra Nagar Hospital

Day 5:

Field Visit to Gonashasthaya Kendra Nagar Hospital

On March 25, 1971, a group of expatriate doctors working in London got together to

organize the Bangladesh Medical Association. Two of the doctors, Dr. Zafarullah Chowdhury

and Dr. M.A. Mobin established a field hospital on the eastern border of Bangladesh, near

the Tripura and Comilla districts. The lessons learned in treating the poor people and

refugees proved invaluable in developing the character of today’s Gonoshasthaya Kendra

(GK).

Gonoshasthaya Kendra strongly believes that in order to develop health care, services must

be integrated with other development activities. Therefore, GK works to gradually

incorporate the following programs into the activities of each health center:

1. To develop people-oriented health

management, and to make people aware of

different health issues. 2. To provide basic education, particularly to

women and children of poor families. 3. To organize women, particularly from land-

less populations, and to provide financial

assistance to alleviate poverty. 4. To make women aware and self-conscious of

their rights and to encourage them to reach

their full potential. 5. To promote the mother language of Bangla,

and establishing its importance in national life. 6. To play an advocacy role for the well-being of

poor people in Bangladesh and internationally. 7. To create social awareness about

fundamentalist and communal violence, and

to protect the interests of minority

communities. 8. To undertake natural and man-made disaster-mitigation relief and rehabilitation

programs and to conduct disaster preparedness programs. 9. To be a self-reliant organization.

During the last three decades, GK has made significant improvements in its coverage of

health services, especially with regards to reproductive health services and child health. In

particular, GK has made noteworthy progress in achieving some of the Millennium

Development Goals that are related to maternal and child health.

Women living in rural areas are much more oppressed by religious fundamentalists than

women living in urban areas. Gonoshasthaya Kendra discovered that it was considered a

social crime for women to consult doctors. Therefore, it became Gonoshasthaya Kendra's


25

primary task to train women health workers, so that they could provide health care services

in the rural areas.

Gonoshasthaya Kendra has provided employment opportunities for women, inspiring them

to have confidence and courage, and to establish themselves as self-reliant and dignified

professionals in a male-dominated, fundamentalist society. In 1974, a group of women

health workers from Gonoshasthaya Kendra rode bicycles from the GK campus in Savar to

the Shaheed Miner martyr shrine located in central Dhaka. That day, health workers worked

together to break a major social barrier. They became confident in establishing their own rights through action, without compromising their traditional culture.

Gonoshasthaya Kendra launched the Poverty Alleviation Program in 1976 at Savar and 1996

at Cox’s Bazar. The program includes social forestry, fisheries, livestock rearing, health

care, disaster management, water and sanitation, small assistance for post cyclone house

repair etc. program through skill training and distribution of micro credit amongst target beneficiaries at Cox’s Bazar areas.

The LRH II cohort visited Gonashasthaya Kendra Nagar Hospital in Dhaka and the staff

presented them with the accomplishments by GK in the last three decades. They were

familiarized with the projects GK is undertaking and the difference it has made in the MDGs

of maternal and child mortality in Bangladesh.

Then the group met Dr Zafarullah Chowdry, the renowned public health activist and the

founder of GK. He shared his insight on the health, reproductive health and awareness

issues in his country along with the role played by poverty alleviation and empowerment of

women by education and employment. He talked at length about his organization’s

innovative programs and how they accomplished their aims and contributed to the society at large.

A vigorous discussion with Dr. Zafarullah Chowdry


26

Closing Ceremony

A certificate award ceremony was held to conclude the training. The High Commissioner of

Pakistan in Bangladesh, Mr. Ashraf Qureshi was the chief guest for this occasion. Dr Rizwan

Khair, Academic Coordinator, IGS was also one of the guests.

The worthy audience was briefly apprised of the project and kearnings from 2nd Regional

Training Session held in BRAC-CDM, Savar, in collaboration with Institute of Governance

Studies, IGS, BRAC University.

A cohort member receiving her certificate from Dr

Rizwan Khair

Pakistani High Commissioner in Bangladesh, Mr.

Ashraf Qureshi addressing the trainees


27

Faculty Evaluation

Modules & Trainers

Question 1:

Trainer’s

knowledge

on the

subject

matter

Question 2:

Trainer’s

presentation

skills

Question 3:

Ability to

achieve group

participation

Question 4:

Ability to

maintain

interest

Understanding

Health Policy

(Dr Suleman Qazi)

93%

96% 92% 93%

Engaging Decision

Makers on Health

Policy

(Tawfique Jehan &

Dr Nazrul Haque)

93% 88% 82% 83%

Health System

Financing

(Dr Zia ul Islam)

84%

76%

69% 66%

Livelihood and

Reproductive

Health

(Dr Abdus Sabur)

83% 80% 71% 74%

The trainees have rated the faculty of RTS II quite satisfactorily. Dr Suleman Qazi turned

out to be the best trainer in their opinion, followed by Mr. Tawfique Jehan and Dr. Nazar ul

Haque from BCCP. These two sessions elicited more interest and generated healthy

discussions. Dr Zia ul Islam, the trainer for Health System Financing, was not rated as

highly as the other two. Dr Sabur was also rated satisfactorily. Trainees expressed their

interest in receiving training from aforementioned trainers again.


28

Field Visit Evaluation

Training Groups Question 1:

Relevance

Question 2:

Organization

Question 3:

Time

Management

Question 4:

Overall field

visit

Group A : BRAC

Health Division

(Manoshi, Uttara)

89%

96%

92%

94%

Group B : BRAC

Health Division

(Manoshi, Mirpur)

82%

85%

77%

81%

The field visit was generally liked by the trainees. They found it to be a learning exercise.

They were guided through a group exercise and a field visit checklist of questions was

prepared for them. This enabled the trainees to participate fully in the field and to make use

of the opportunity to see the Bangladesh RH model.


29

Overall Training Evaluation

Quality of Workshop Facilitation 75%

Quality of Training Folder 73%

Administrative Support by facilitators 80%

Meals 92%

Transport 84%

Accommodation 88%

Staff Support 86%

Overall Average 88%

Feedback for the overall training shows positive results. It can be seen from the above table

that the trainees were generally satisfied with the structure of the training workshop, it was

a learning experience for the group, the trainers and core faculty effectively managed the

training, the folder content was well organized and the accommodation and food

arrangements were satisfactory. The participants have rated the overall training

considerably high and their verbal comments and feedback also revealed their level of

satisfaction from RTS II.


30

Post-Training Assessment This exercise was conducted to evaluate the difference in knowledge base of participants

and consequently assess the success of the training and to find out whether the objectives

of the training have been achieved or not. The same pre test questionnaire was used in the

post test so that the exact change in the responses can be noticed

The post training analysis clearly shows better comprehension about the concepts and

process amongst the participants. (See Annexure 6 for Pre Test/Post Test Questions)

0

5

10

15

20

25

30

35

1 3 5 7 9 11 13 15 17 19 21 23 25

Pre

Post


31

Annexure 1: Presentation by Key note Speaker - Dr. Koasar Afsana


32


33


34


35

Annexure 2: Presentation on Understanding Health Policy by Dr. Qazi


36


37


38


39


40


41


42


43


44


45


46


47


48


49


50


51

Annexure 3: Presentation on Health System Financing by Dr. Zia-ul-Islam


52


53


54


55


56


57


58

Annexure 4 - Presentation on “Engaging Policy Makers on Reproductive Health”


59


60


61


62


63


64


65


66


67


68

Annexure 5: Presentation on Livelihood and Reproductive Health by Dr. Sabur


69


70


71


72

Annexure 6 – Pre Training & Post Training Test Format

2nd Regional Training Session on Engaging Decision Makers on Health Policy

Training Evaluation

Pretest /Post Test

1. Double burden of disease is a Policy challenge to Pakistan. Double burden of disease

implies:

a. Every year the number of diseased cases doubles

b. Presence of diseases both among men and women folk

c. Presence of both the communicable and chronic diseases

2. The model of health care delivery where government is both the provider and financer

of the health care is known as:

a. Bismarck Model

b. Beveridge Model

c. National Health Insurance Model

3. In Pakistan if we look at the health expenditures by source of funding we learn that

donors contributions are:

a. A major source of health care financing

b. Equal to public sector financing

c. Only a small portion of the total health expenditures.

4. If a company has increased its outputs with the same inputs it is an example of:

a. Allocative Efficiency

b. Technical Efficiency

c. Both

5. 18th Constitutional Amendment has:

a. Redefined the concurrent list

b. Introduced a concurrent list

c. Abolished the concurrent list

6. Financing is an activity of managing

a. Stores and inventories


73

b. Medicines and drugs

c. Funds and assets

7. Health Budgeting is a plan to spend money over a:

a. Specific period

b. A medical transaction

c. A health facility

8. Health System Accounting is an act of

a. Pay health bills

b. Recording and reporting financial transactions

c. Recording and reporting prescribed medicine

9. Health Budget in Bangladesh is:

a. 2.15% of national budget

b. 4.15% of national budget

c. 6.15% of national budget

10. A medical audit /clinical audit entails

a. Systematic analysis of book keeping

b. Systematic analysis of quality medical care

c. Systematic analysis of quality financial system

11. Livelihood comprises of

a. The material assets and collaterals

b. The individual and group capabilities to earn a living

c. The capabilities, assets and activities required for a means of living

12. Bangladesh’s Adolescent Fertility Rate according to BDHS 2006 is :

a. 37.2%

b. 32.7%

c. 23.6%

13. Percentage of deliveries at health facilities in Bangladesh is:

a. 13.9%

b. 12.7%

c. 14.6%


74

14. Following statements on impact of microfinance are true except:

a. Women empowerment

b. Decrease in population growth

c. Decrease in literacy level

15. ‘Assets’ in the concept of livelihood comprises of following:

a. Material and social resources

b. Manpower and education

c. Wealth

16. Broadly speaking the levels of advocacy include

a. Institutional, Community, Personal

b. Policy makers, Government, donors, media

c. Family, friends, partner

17. Advocacy is:

a. Communicating with other people to gain support for an issue and influence their

behavior in a specified way

b. Strategic use of communication to promote positive health outcomes

c. Process of bringing together all feasible and practical inter-sectoral allies to raise people’

s knowledge of and demand for a good quality health care.

18. Advocates include:

a. Believers, Satisfied users, Media, experts

b. Non believers, unsatisfied customers and uninterested parties

c. Both the policy makers and lay men

19. Advocacy Works Best if

a. Research, views, interests, goals

b. Recruit others – win allies, friends, can’t advocate alone

c. Frame your issue – urgent, feasible, credible, priority

d. Present your case – give clear cues to gatekeepers

e. Follow through – focused participation of gatekeepers

20. Step of “Mobilization” in the A- Process includes the following except:

a. Delegate tasks,

b. Establish indicators

c. Work with the media


75

21. Which one of the following is not a reason for RH success story in Bangladesh

Advocacy?

a. A Women’s Education

b. Improved Socio Economic conditions

c. Excellent Coordination between Health wing and Population Welfare wing

22. The women in Bangladesh who are not eligible for micro financing were helped through

the following initiative:

a. Working with Religious Imams

b. Program for ultra poor

c. Change in Family Planning Methods

23. The most common method of family planning in Bangladesh is:

a. Surgical Contraceptives

b. Birth Control Pills

c. Menstrual Regulation

24. Bangladesh health policy has been revised after every:

a. 5 years

b. 3 years

c. 7 years

25. The objective of micro-financing program for Bangladeshi women is:

a. To educate women

b. To employ women

c. To raise awareness

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