Skilled Birth Attendant (SBA) Training Program in Bangladesh

1. Skilled Birth Attendant (SBA) Training Program in Bangladesh Prof. A B Bhuiyan President , OGSB and Focal point SBA Training Program

2. Bangladesh Situation • 26,00,000 delivery per year • High Maternal Mortality Ratio 3.2/1000 live births in spite of decades of TBA training • 90% delivery occurs at home attended by TBAs and relatives • 80% deaths occur at home mostly during and immediately after child birth. • For each maternal death another 40 suffer from morbidity • Delivery by skilled attendants only 13% • Neonatal mortality 45 /1000 live birth All this deaths are preventable

3. Need Assessment of SBA Initiated by WHO, OGSB conducted the Need assessment Study to assess the feasibility of training of FWA and FeHA as skilled attendants (2001) Findings were positive • Family Welfare Visitors (FWAs) and Female Health Assistant (FeHA) are ready to become SBA on being trained for 6 months • Majority faced a demand from the community to conduct home delivery • FWA and FeHA are already exposed or involved to community health services

4. Need Assessment of SBA • Need assessment findings were presented to Hon’ble Minister, Ministry of Health & Family Welfare • Approval for Piloting of the SBA training was obtained • WHO and UNFPA agreed to provide support • OGSB provided the technical support

5. A Memorandum of Understandingwas signed between MOHFW, WHO and UNFPA • Implementing Organizations are: • Obstetrical & Gynaeclogical Society of • Bangladesh (OGSB) • Institute of Child & Mother Health, • Dhaka (ICMH) • Maternal & Child Health Training • Institute (MCHTI), Dhaka

6. A Curriculum is developed based on Job description analysis and based on the level of health infrastructure they work Findings of need assessment Reviewing existing literature & curriculum Formation of Curriculum task force Technical appropriateness by Experts National Curriculum Steering Committee approved Trainee’s Curriculum on Oct. 2002

7. Overview • 90 District Trainers were selected by personal interview and TOT was given (15 trainers per district) • MOHFW implemented SBA Training Pilot program in 6 districts started from 1st March 2003 to 31st August 2003. • Comilla, Tangail, Barisal (supported by WHO) • Joypurhat, Jessore, Habiganj (by UNFPA)

8. Criteria of SBA Trainees • Family Welfare Assistant (FWA) and Female Health Assistant (FeHA) • Education : Minimum SSC (standard X) • Age : 35-45 Years • with positive aptitude • Willingness to participate 6 month training at district level • Should reside in their place of posting • Committed to serve the local community

9. SBA Training Course It is a Competency Based Training Training Period : 6 months Post training evaluation : After 6 months Total 26 Weeks (6 Months) Training • 4 Weeks-Class Room Lecture, Demonstration • 13 Weeks-Clinical Practice in Hospital • 8 Weeks-Community Practice • 1 Week- Final Evaluation

10. 90 FWA & FeHA completed the SBA Training • Final examination was conducted & Certificate was provided by Bangladesh Nursing Council (BNC) • Registration was given by BNC as SBA • Quality Assurance (QA) of the training by QA Team, National Consultants & National team • Supervision & Monitoring is being provided by DGHS, DGFP, MCHTI, ICMH, NIPORT, OGSB, WHO, UNFPA……

11. Final Evaluation Bangladesh Nursing Council conducted Final Examination at district level • Written Test - Paper I 26th August 2003 - Paper 2 27th August 2003 • Practical and Oral 28th August 2003 • Total mark for written examination 200(100+100) • Total mark for oral and practical 100(50+50) • Pass mark for both Written & oral Practical was 50%

12. Registration and Certification • The Honorable Minister, MOHFW, distributed certificates on 4th September, 2003 in a program at Hotel Sonargaon, Dhaka • Registration was given by Bangladesh Nursing Council (BNC)

13. Visible Changes in SBAs after Piloting (result of evaluation) • SBAs are well accepted by the community • They look more confident • Community people are satisfied and happy with their services • Referral has increased in the Referral Centre

14. Achievement in Piloting • Strong Commitment from GOB • Strong partnership at all level • Registration and Certification through BNC as special category: SBA • Approval of Accreditation Guidelines

15. Accreditation of SBA Training To ensure quality of all the SBA Training components, “Accreditation guidelines” has been prepared and approved by the Government.

16. Conclusion • After completing the training, SBAs conducting 2-7 deliveries per month in their community • Other FWA and FeHA wanted to become Skilled Birth Attendant at community level as early as possible. • FWAs and FeHAs are the most suitable candidates in GOB and equivalent paramedics in NGO for SBA training. • NGO worker shown interest in this type of training • Continuous and intensive monitoring and supervision of training & services is required for the success of the program.

17. New Development • UNFPA is supporting SBA training in 19 Districts taking 33 Upazillas • It is expected that 18 more upazilla will be taken soon. A total of 850 SBAs will be in the field after training by the end of the year 2004.

18. Thank you