A joint project by GOB, UNFPA, UNICEF and WHO

1. Accelerating Progress Towards Maternal and Neonatal Mortality Reduction Using a Rights-based approach A joint project by GOB, UNFPA, UNICEF and WHO

2. Goal To contribute to the HNPSP objectives of reduction of maternal and neonatal mortality and morbidity, with emphasis on equity issues to achieve MDGs 4 and 5

3. Rationale • To work for reduction of maternal and neonatal mortality and morbidity - a priority both for Govt,civil soceity and DPs ,part of HNPSP . • Greater participation of citizen and decentralized approach with local level planning increasing health system accountability - addressing prevailing voicelessness and social exclusion of the poor.

4. Purpose Purpose 1: • To contribute to increased utilization of maternal and newborn health (MNH) services by enhancing the capacity of MNH teams at district and below, to ensure quality and continuum of maternal and newborn care, that is inclusive and equitable Purpose 2: • To contribute to women, families and communities practising key behaviours for improving maternal and newborn health and exercising their right to care

5. Outputs and Interventions • Output 1.1:Enhanced capacity of district and sub-district health and family planning management teams in participatory planning, implementation, monitoring and evaluation • Interventions • 1.1.a: Capacity-building of the district and sub-district health and family planning management teams in participatory planning and the plan endorsement process, implementation, monitoring, supervision and evaluation. • 1.1.b: Instituting a functional MNH QA system, including an HMIS, for facilities at upazila and district levels.

6. Outputs and Interventions • Output 1.2:Increased availability of a quality continuum of MNH care and services • Interventions • 1.2.a: Ensuring availability of quality continuum of MNH care and services at all service levels (including specific piloted services in selected facilities) and strengthening the MNH referral system. • 1.2.b: Ensuring availability of quality EMONC services 24 hours a day, 7 days a week . • 1.2.c: Ensuring availability of quality FP services • 1.2.d: Establishing partnerships /alliances /networking with NGOs, CBOs, other civil society groups and private sector service providers to ensure increased availability and access to quality MNH care and services for communities

7. Outputs and Interventions • Output 1.3:Increased availability and quality MNH HR for assured delivery of MNH services through capacity-building and planning • Interventions • 1:3:a: Improving availability and quality of MNH HR, including implementation of innovative strategies for deployment recruitment and retention of staff. • 1.3.b: Increasing the number of community-based SBAs. • 1.3.c:Strengthening the competencies of the staff at EMONC facilities. • 1.3.d: Piloting creation of midwifery cadres.

8. Outputs and Interventions • Output 2.1:Developed capacity of women, family decision makers and communities to practice selected MNH behaviours, most importantly in obtaining skilled care at birth and responding to obstetric and neonatal emergencies • Interventions • 2.1.a: Developing an evidence-based strategic BCC plan – for women, families and communities - for providing and acting on information, and for supportive interpersonal communications and counseling on healthy MNH practices. • 2.1.b: Building capacity of the GOB, NGOs, CBOs and social networks to implement all types of BCC activities. • 2.1.c: Promoting birth planning interventions to women, key family decision-makers (husbands, mothers-in-law, others) and community level service providers.

9. Outputs and Interventions • Output 2.2:Enabling environment created to support women to increase their rights to MNH care, by working with women, families and communities • Interventions • 2.2: Developing and implementing strategies to encourage informed and dignified demand for services, especially by the poor, vulnerable and marginalized groups.

10. Outputs and Interventions • Output 2.3:Developed community support systems that strengthen linkages among women, families and communities, as well as between them and the health system • Interventions • 2.3: Establishing new or strengthening existing consumer and community support groups to sponsor dialogues and design and implement effective linkages

11. Outputs and Interventions • Output 2.4:Strengthened participation of community groups to improve quality of care and provider accountability • Interventions • 2.4.a: Developing and implementing a community participation plan that includes specific routine or emergency support activities to improve quality of MHN care and services at household and community level • 2.4.b: Increasing dialogue between community groups and providers for mutual examination of provider accountability issues and development of strategies to improve provider accountability.

12. Added Values • Decentralized and local level planning with an equitable, inclusive, and rights-based approach • A quick start to reduction of Maternal and Neonatal Mortality Reduction – in line with the HNPSP • Transparancy of the district plan including fund transactions • Acknowledging demand and supply sidefactors • Diversification of service provision by partnering with NGOs and Private sector • Building capacity of service providers and clients (women, families and communities) • Effective monitoring and supervision along with the stakeholders and Health Watch Groups • Synergies of 3 UN Agencies working together

13. DfID National Steering committee PCC Unicef, UNFPA, WHO & PC Line Directors District MNH Committee Project team PC, Programme Officers, MO, FO Task Force UN Working group with FP & PC Upazila MNH Committee NGOs, CBOs, CSO Task Force UN Field Unit Union level Coordination Structure DfID DfID National Steering committee National Steering committee PCC UNFPA, UNICEF, WHO and PC Line Directors Line Directors District MNH Committee District MNH Committee Project team PC, Programme Officers, MO, FO Task Force Task Force UN Working group with FP & PC Upazila MNH Committee Upazila MNH Committee NGOs, CBOs, CSO Task Force Task Force UN Field Unit UN Field Unit Union level Union level

14. Appraised & approved District MNH Plan Technical Appraisal Committee Technical Appraisal Committee Funds Managementone UN Agency Funds Management UNICEF & UNFPA Technical Appraisal Committee Overseas Procurement Activities at National Levels Endorsed District MNH Plan District/Upazila cost centres UpazilaMNH Committee District MNH Committee Upazila MNH Plan NGOs CBOs CSOs Community NGOs CBOs CSOs Community District MNH Plan Upazila MNH Task Force Endorsed Upazila MNH plan District MNH Task Force Union Principal UN Agency Principal UN Agency Field Office staff of Unicef & UNFPA, WHO Operation and Fund Management Plan

15. District Selection Criteria • Human Poverty Index • IMR • TFR • CPR • ANC coverage during last pregnancy • Last delivery assisted by Skilled Persons • Female Literacy Rate

16. Planning of Programme Phase 1 Phase 2 6 months 18 months 2 years Startup and prep phase Full implementation4 districts Scale up period18 districts Total 22 districts to be covered in 4 years

17. Activities at District / Upazilla • MNH and EMO NC • 22 districts = 44 ”cost centers” • Development of Plans • Facility and Provider Improvements • Training • Service Upgrades to Facilities (avaiability, quality) • Improving linkages with community, including transport • Improving retention of staff and addressing other HR issues • Equipment/Supplies • Improving facility ”culture” = bbetter/quicker service for incoming patients/clients (reduction in waiting time) • Other facility-related improvements to services

18. Activities at District / Upazilla • NGOsCSOs • Involving them in: • Community mobilization • Consumer-related ”watch groups=accountability • Service delivery improvements • Private Providers • Selected improvements to services as per national standards • Community level support • To increase knowledge/awareness • To change behaviours – increase demand • To strengthen links with facilities (including community transport schemes and other support for woman/family) • To strengthen confidence of women and key family decisio-makers • To enable women and communities to monitor services

19. Proposed Budget • Total Budget : $M 28 for 4 Years • Duration: July 2006 – June 2010 • Year-wise Budget: $M 1.0 for 2006 (jul-dec), $M 7.2 for 2007, $M 7.7 for 2008, $M 7.6 for 2009, $M 4.5 for 2010 (jan-may)

20. Thank You