Suchergebnisse

Through the initiative of the Family Planning Fortnight: Meeting the Future Challenges, held in December 1993, the Government of Bangladesh made a policy statement about the critical importance of dealing with the nation's population problem. The Fortnight provided the strategic framework for developing actions to strengthen the National Family Planning Program that would meet the country's population challenges. To initiate rapid action, the Family Planning Fortnight Steering Committee, under the chairmanship of the Secretary, Ministry of Health and Family Welfare, formed a working group to prepare a report that would capitalize on all earlier efforts and lay out a plan of action. The working group identified a number of priority areas requiring immediate action to regain the momentum of the National Family Planning Program, and to ensure success in meeting the government's demographic, social, and economic goals. The working group recognized that there are a number of long-term, strategic policy issues that also require quick attention. As noted in this report, efforts to increase the dissemination and utilization of research results for policy formulation have been productive in Bangladesh from the perspective of the government, NG0s, and donors.

Background: Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed "Demand-Side Financing" or "Output-Based Aid", includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services. Methods/Design: Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to address the lack of evidence around the pros and cons of 'voucher and accreditation' approaches to improving the reproductive health of low income women in five developing countries. In Bangladesh, the activities will be conducted in 11 accredited health facilities where Demand Side Financing program is being implemented and compared with populations drawn from areas served by similar non-accredited facilities. Facility inventories, client exit interviews and service provider interviews will be used to collect comparable data across each facility for assessing readiness and quality of care. In-depth interviews with key stakeholders will be conducted to gain a deeper understanding about the program. A population-based survey will also be carried out in two types of locations: areas where vouchers are distributed and similar locations where vouchers are not distributed. Discussion: This is a quasi-experimental study which will investigate the impact of the voucher approach on improving maternal health behaviors and status and reducing inequities at the ...

Family planning (FP) and maternal and child health (MCH) in Bangladesh have achieved commendable success in the recent past, mostly through a large-scale government service-delivery system supported by donors and nongovernmental organizations. Although encouraged by this success, there was concern about programmatic, financial, and social sustainability of the program, including quality of services. It is now believed that most of these concerns will be taken care of if effective community participation can be ensured. A pilot project was initiated in 1997 in Anowara, a low-FP-performing area in rural Chittagong, with assistance from the Population Council. The main objective of the project was to develop a strategy to ensure community participation in the FP-MCH program and to document the process. This report notes that community members became more aware of the population problem and came to know about existing service facilities and the role of various stakeholders, including themselves. As a result of the intervention, the demand for services increased and most of the service providers were responding positively to the growing demand.

Background: Most births in rural Bangladesh are done at home because of barriers to access to facility-based services. To address this issue, the Bangladeshi Government piloted a demand-side financing scheme (the maternal health voucher programme) at subdistrict public health facilities in rural areas. We assessed the effect of this intervention on use of delivery care services and out-of-pocket expenses. Methods: We did a non-randomised, controlled study. We selected 22 subdistricts in Bangladesh with a probability proportional to their size: 11 intervention subdistricts took part in the demand-side financing programme and 11 control subdistricts did not. We selected 150 women from each subdistrict. From each subdistrict, three of nine unions and three villages from each union were selected through probability proportional to size and from each selected village we drew the required numbers of respondents through simple random sampling. We included women aged 18–49 years who had given birth in the previous 12 months. A baseline survey was done in 2010, and a follow-up survey was done in 2012, recording socioeconomic and demographic characteristics as well as service use and cost of services, collected with a structured questionnaire. Findings: 3300 women were surveyed (1650 in each group). Use of delivery services was 8% (126/1650) in 2010 versus 16% (263/1663) in 2012 in the intervention subdistricts and 8% (129/1650) versus 11% (178/1671) in control areas. Delivery at a public health facility in the intervention areas increased significantly compared with the control areas (p < 0·0001) and the intervention contributed to some of the change (difference in differences 5·1%). Average out-of-pocket cost in intervention areas fell for both normal births (from US$40 to $22) and caesarean births (from $115 to $80). In control areas, average out-of-pocket cost decreased slightly for normal births (from $33 to $29), but increased for caesarean births (from $118 to $125). Interpretation: To sustain the trend of use, ...

The project "Involving Private Medical Practitioners (PMPs) in Family Planning Services" is an innovative initiative to involve PMPs in protecting the reproductive health (RH) of couples, attract private investment in the family planning (FP) sector, and eventually reduce the increasing financial pressure on the government. The project was implemented in two phases. In phase I, qualified PMPs from urban areas were given training on FP. In phase II, nonqualified PMPs were given training on FP. PIACT Bangladesh, a local NGO, conducted two pilot projects to involve the PMPs in FP. The first one was to involve qualified PMPs in urban areas (Dhaka) and the second one was to involve nonqualified PMPs in rural areas (Komalganj Thana of Moulvibazar District). Qualified PMPs are medical graduates and nonqualified PMPs are rural medical practitioners (RMPs) who are not medical graduates. The overall objective of the pilot projects was to explore the feasibility of involving PMPs and RMPs in providing selected FP services on a commercial basis with emphasis on counseling and side-effect management. The findings of both projects are presented in this report.

The family planning (FP)/maternal and child health (MCH) program in Bangladesh has achieved success in the recent past, mostly through a large-scale government service-delivery system with support and cooperation from donors and nongovernmental organizations. There is concern about the financial and social sustainability of the program. Other issues include achievement of replacement-level fertility within a stipulated period and improvement of MCH-FP service quality. It is widely believed that most of the concerns will be taken care of with effective community participation. Before activating community initiatives, it is worth carrying out action research. A literature review was completed from July to October 1996 to identify a range of models used for increasing community participation and experiences in terms of implementation, management, financing, monitoring and evaluation, and sustainability in both rural and urban areas. Attempts were also made to identify a set of indicators to assess the level of community participation in these programs. This report documents the results of the review.

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.

Extremely inadequate government primary health care (PHC) structure exists in cities in Bangladesh. Nongovernmental organizations (NGOs) play an important role in providing basic health and family planning services to a limited proportion of the urban population. However, NGO programs are time-bound and subject to the availability of development assistance. Bangladesh has one of the highest rates of growth of urban populations among developing countries. For this teeming urban population, there is no structured family planning service. To ensure continuous family planning services in urban areas it is critical to develop a sustainable primary health care structure with the thrust on family planning services. However, there are several challenges, including the absence of a strategy for providing primary health care and family planning services to the urban population. This report provides the details of a workshop organized to identify issues and challenges to family planning service delivery in the urban area and to develop the future course of the urban health and family planning program.

To test a statistically significant change in delivery by medically trained providers following introduction of a demand-side financing voucher, a population-based quasi-experimental study was undertaken, with 3,300 mothers in 2010 and 3,334 mothers at follow-up in 2012 in government-implemented voucher program and control areas. Results found that voucher program was significantly associated with increased public health facility use (difference-in-differences (DID) 13.9) and significantly increased delivery complication management care (DID 13.2) at facility although a null effect was found in facility-based delivery increase. A subset analysis of the five well-functioning facilities showed that facility deliveries increased DID 5.3 percentage points. Quintile-based analysis of all facilities showed that facility delivery increased more than threefold in lower quintile households comparing to twofold in control sites. The program needs better targeting to the beneficiaries, ensuring available gynecologist–anesthetist pair and midwives, effective monitoring, and timely fund reimbursements to facilities.

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation's Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country's policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders to implement the UN Commission's recommendations in conjunction with this assessment's findings. This assessment validated the availability of the 13 commodities in three districts at district, subdistrict, and community levels, and within drug stores, in 15 government facilities and 27 private drug stores. Key stakeholders were consulted. A national workshop stimulated discussion, identified national priorities and information gaps, and identified areas requiring policy review. This stakeholder engagement helped identify opportunities for organizations' contributions to implementing the recommendations.

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.

Sexual and reproductive health education is not yet formally introduced in Bangladesh without which the International Conference on Population and Development (ICPD) in Cairo's goal to ensure young people's right to access to such information and services will remain unfulfilled. The Population Council provided technical assistance to a governmental department to pilot youth reproductive health education. Study findings from, the pre- and posttests of 379 matched respondents revealed significant changes in knowledge, attitudes, and life-skills. Knowledge about long-term contraceptives and skills on negotiating safe sex improved significantly by 63% and 26%, respectively. Youths who do not consider menstruation as a disease nearly doubled, and misunderstandings about the mother's role in sex determination of a child were significantly dispelled. Decisions not to accompany friends in visiting sex workers and to use condoms, ignoring friends' disapproval, were increased over 18%. Over 98% of students reported that teachers discussed condoms, while only 12% alleged unfriendly behavior. Findings motivated the department to scale up the reproductive health curriculum.

Bangladesh has a successful family planning (FP) program and has succeeded in bringing about a demographic transition at a much faster rate than many of its neighboring countries. The contraceptive prevalence rate in Bangladesh increased from 3 percent in 1971 to 45 percent in 1993, and the fertility rate decreased from 7.0 to 3.4 births per woman during the same period. This reflects the effort that the Government of Bangladesh, with the help of international agencies, has made to educate couples about FP and increase access and choice of contraceptive methods, even in remote areas. Another predominantly Muslim country that has achieved remarkable success in FP is Indonesia which has had unprecedented economic growth in recent years. A visit to these countries to study their FP programs provided opportunities to closely observe activities that have contributed to this success. The Population Council, under the Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) project funded by USAID, organized a study tour of Bangladesh and Indonesia for Indian officials, and results are provided in this report.