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

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

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

3. 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 Context

4. Why MaMoni in Sylhet ..

5. 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

6. National goal Improved maternal and neonatal health outcomes • Practice high impact MNH behaviors • Use high impact services Increase utilization of services Systems strengthening Mobilize community to support demand Increase knowledge, skill, practice at home Increase family planning acceptance and understanding Stakeholder leadership, commitment and action MaMoni results framework Project purposes

7. MaMoni package: Integrated Package PP maternal care, Vit A and management of complications Supply of PoP, transition to modern method, Supply of FP methods and referral for LAPM Management of newborn complications Essential newborn care/KMC Clean delivery and immediate newborn care Postnatal session promoting LAM, spacing, PoP, FP, transition Misoprostol Pregnancy identification Birth preparedness HW counseling Immunization IFA Supplementation TT ANC2 TT ANC3 ANC1 ANC4 1 2 3 4 5 8 9 p2 p3 p4 p5 p6 6 7 p1 D Exclusive breastfeeding and promotion of LAM/PPFP AMTSL & referral for EmOC

8. 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 Highlights of MaMoni approach

9. CM helps in adoption of healthy practices & increase utilization of services COMMUNITY Enabling Environment, Collective actions HOME/FAMILY Supportive decision making WOMEN, NEWBORNS Healthy Behaviors Linkage/ interface Linkage/ interface Health systems Health systems Reinforce demand Reinforce demand

10. Disseminate health messages Support behavior change Engage community leaders

11. Community mobilization approach:Community Action Cycle (CAC) Prepare to mobilize Prepare to scale-up

12. 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)

13. 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

14. 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

15. 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 Results: linkage/interfacing with health systems

16. 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

17. 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 Lessons learnt and challenges

18. 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 Steps towards sustainability and scale-up

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