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Engaging Communities to Help Mothers and Newborns: MaMoni Experience from Bangladesh Rowshon Jahan


Presentation outline • MaMoni overview and strategies • Community mobilization approach • Results • Challenges and lessons learnt • Steps towards sustainability and scale up


Context  Home delivery is the norm  Weak health systems:  vacancy of health workers  quality of care at health care facilities

 Traditional healers/practitioners have a strong role  Social inequity prevails – deaths are more in lower strata  Geographically difficult terrain  Successful vertical programs like – EPI, Family Planning  Stronger GO-NGO collaboration


Why MaMoni in Sylhet .. Indicators (BDHS 2007)

National

Sylhet

Neonatal mortality rate

37/1000 41/1000 ( 2004)

53/1000 63/1000 (2004)

Total fertility rate

2.7

3.7

CPR

56%

32%

Unmet need for family planning

18%

26%

At least one ANC attendance with trained provider

60%

47%

Place of delivery

Home: 85%

Home: 91%

Skilled attendance at birth

18%

11%


MaMoni overview and strategies  MaMoni is an Integrated Safe Motherhood, Newborn Care and Family Planning Project (ISMNC-FP) under the leader award, Maternal and Child Health Integrated Program (MCHIP).  3.3 million pop. coverage in 2 districts  Follow on project of ACCESS (2006-2009)  The prime is JHPIEGO and local partners are –  MOH&FW  Save the children, USA  FIVDB  Shimantik


MaMoni results framework National goal Improved maternal and neonatal health outcomes •Practice high impact MNH behaviors •Use high impact services

Increase utilization of services Increase knowledge, skill, practice at home

Increase family planning acceptance and understanding

Project purposes

Systems strengthening Mobilize community to support demand

Stakeholder leadership, commitment and action


MaMoni package: Integrated Package PP maternal care, Vit A and management of complications Management of newborn complications Essential newborn care/KMC Clean delivery and immediate newborn care Misoprostol

Pregnancy identification

Supply of PoP, transition to modern method, Supply of FP methods and referral for LAPM

Postnatal session promoting LAM, spacing, PoP, FP, transition

Birth preparedness HW counseling

Immunization

IFA Supplementation TT ANC1

1

2

3

TT ANC3 ANC4

ANC2

4

5

6

7

8

9

p1

p2

p3

p4

D AMTSL & referral for EmOC

Exclusive breastfeeding and promotion of LAM/PPFP

p5

p6


Highlights of MaMoni approach  MOH&FW key service provider  Partner NGOs play a supportive and facilitative role  Active role of the community  An integrated package  District-wide approach  MOH&FW and community capacity enhanced to ensure sustainability


CM helps in adoption of healthy practices & increase utilization of services

Health systems

Linkage/ interface

COMMUNITY Enabling Environment, Collective actions

Reinforce demand

HOME/FAMILY Supportive decision making

WOMEN, NEWBORNS Healthy Behaviors

Linkage/ interface

Reinforce demand

Health systems


Disseminate health messages

Support behavior change Engage community leaders


Community mobilization approach: Community Action Cycle (CAC)

Explore MNH situation and set priorities

Prepare to mobilize

Prepare to scale-up

Organize the community for action

Plan together

Act together

Evaluate together


Community mobilization activities   

 

Selection of villages Resource mapping Orient the community and invite for participation Formation of CAGs Capacity building for community resource persons (CRPs)


Results: gender balance in CAGs  Each village has two separate groups: male and female  Membership of male groups slightly higher than female groups (18317 [51%] versus 17455 [49%])  3820 CRPs – equal membership (1909 females and 1911 males) – 60% demonstrated ability to conduct CAC independently


Results: emergency fund & transport • 56.9% of the groups arranged emergency transportation system • 43.4% of the groups developed emergency fund. • 396 mothers and newborns used the system to get to the health facility


Results: linkage/interfacing with health systems 

12 Satellite clinics and 2 EPI center newly opened by the group initiatives CAGs worked with govt. & NGOs to regularize 69 inactive/irregular clinics/EPI centers 56% CAGs has participation of MOH field service providers


Lessons learnt and challenges • Unavailability of services and/or poor quality of care • Male CAG members available mostly in the evening • Some communities need time to get prepared • Difficult to ensuring participation of all segments especially the vulnerable groups • Some female community members not permitted to attend meetings by their mother-in-laws • Program disruption by natural disaster including floods


Lessons learnt and challenges • Appropriate community entry essential for successful community interventions • Sharing real stories/results increase community engagement • Men and women can work together to mobilize their communities in conservative communities • Engagement of men in the CAC increase their involvement in MNH activities • Communities can be mobilized without any material or financial incentives • Formation of CAG with existing group is more effective and sustainable • Community Resource Persons demonstrated potential of sustain these initiatives


Steps towards sustainability and scale-up • Community action cycles are being done by community resource persons/ volunteers • Selection of volunteers from existing functionaries • Role of volunteers as extended hands of the health workers • Stronger linkage with local governments and health systems • Community clinic management groups • Elected union parishad (local government)

• Combining female and male groups • Integrating family planning • Involvement in source for local MNH-FP commodities • Component of a number of large MNH programs


Mothers and newborns lives are saved through community initiatives . . .

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