The End of Magical Thinking:

1. The End of Magical Thinking: Sustainability Evaluation of the Saidpur and Parbatipur Municipal Health Partnership Model in Bangladesh Dr. Eric Sarriot – Eric.G.Sarriot@MacroInternational.com7 November 2009

2. Why Municipal Health? • Urban poor have highest under-five mortality rate (138/1,000 LB) compared to national rate of 118 (BDHS, 2004) • 36 million urban dwellers; by 2010 over 1/3 of the population will reside in urban areas • Over 300 municipalities, and the number is growing exponentially • Policy implementation gap for urban health promotion and coordination: the poor fall between the cracks

3. History • 1999 – CSP ‘entry phase’ • 2000 – CSP implementation in Saipur and Parbatipur (S&P) • 2004 – End of CSP • Expansion into 7 new municipalities (MHPP) • Minimum involvement in S&P as ‘Learning Centers’ (LC)_ • 2007 – First post-project assessment • 2009 – 5-Year post-project assessment

4. Post-Intervention Assessments Methodology: October 2005 & July 2009 • 12 person team: Evidence + Participation • KPC surveys with 953 mothers with children <2 years • WHC capacity assessments (n=24) • Municipality Institutional Capacity Assessments • Additional data query; interviews; group discussions; case studies... • Each phase = 4-days field work • Synthesis with municipal stakeholders

6. Core Elements of the Municipal Health Partnernship Model • Local government leadership • Coordination of public and private service providers • Networks of existing local resource persons • Best practices in maternal and child health • Community organizing and health promotion in each Ward • Social protection for the poorest • Facilitation with extremely limited additional financial inputs

7. How It WorksMunicipal Health Partnership Model Municipality Cabinet, Other Departments, Health Staffs Health Platform (MEPSCC) Govt , NGO & Private Health Facilities Civil Society Social & religious leaders Ward Health Committee Private pharmacists Community organizations Youth volunteers Teachers Traditional health providers

8. Achievements CSP phase

9. Sustainability of Health Outcomes • child health indicators

10. Other elements in the evaluation • WHC institutionalized, but… • Decreasing self-efficacy • Have funds • Expenditures lag • Power & Accountability • Municipal Health Department Role • Health budgets: 1-1.5% of Municipal • Gap in expenditure

11. Conclusions on the Model • Effective? Yes! • Sustained? Partially • Still sustainable? Yes! • Sustaining community health progress? Not enough!