Bangladesh: Health: Maternal and child health

Manoshi Project- Maternal, Neonatal and Child Health Initiative (Urban)
BRAC’s Manoshi Project uses a unique model, linking slum residents with both traditional birth attendants in slum birthing huts and referral facilities for birth complications. These resources build on slum health volunteers, health workers who visit households, traditional birth attendants, and referral advocates (programme organisers) located in hospitals. The system has rapidly increased access to clean delivery at birthing centers (by 44 %) and emergency obstetric care at hospitals/clinics (by 26 %) in urban slums in Dhaka. Now, the project is providing preventive and curative services to about 5.6 million inhabitants of six 6 city corporations in Bangladesh.

A special feature is the establishment of delivery centres to provide clean and private birthing places for slum women who usually live in small shacks with a large number of family members. The centres also offer quick diagnosis and referral in case of birth emergencies. Each delivery centre has two birth attendants who cover about 2,000 households (about 10,000 people). Community midwives are also on hand to provide skilled care during delivery.

Improving Maternal, Neonatal and Child Survival (IMNCS)- Rural
Started in 2005 as a pilot initiative in Nilphamari district, Improving Maternal, Neonatal and Child Survival (IMNCS) is now engaged to expand access to quality MNCH services to approximately 21 million populations of ten 10 rural districts of Bangladesh.  The intervention employs community health resources (health volunteers, health workers, new born health workers, and skilled birth attendants) to work with village health committees for addressing issues of pregnancy, newborn and child health, for motivating behaviour change in the community and also for facilitating access to obstetric and new born care at public and private facilities.  Currently the programme is promoting preventive and curative maternal and neonatal care practices through targeted household visits and community mobilisation, resulting in a sharp rise in pregnancy identification, antenatal care and skilled attendance during delivery as well as declining trends in neonatal and maternal complications and mortality in the intervention districts.  Since 2008, selected shasthya karmis from 10 IMNCS districts continue to receive 6 months training BRAC to acquire social and technical skills required to ensure safe and clean deliveries in rural communities. These community-based skilled birth attendants conduct normal deliveries and refer complications.

Alive and Thrive
Alive and Thrive is a nutritional intervention aimed to reduce under nutrition and nutrition induced mortality through effective implementation of twin strategies, e.g. exclusive breast-feeding and timely initiation of complementary feeding. The project promotes healthy nutrition practices among infant, young children below 2 years and their care givers through community level counseling, coaching and demonstration and is being duly supported by appropriate advocacy, social marketing, and mobilisation activities to ensure an enabling environment around the project.  After completion of one year long piloting in three rural upazillas and one urban slum in Dhaka; the project has expanded to 50 rural upazillas of Bangladesh in 2010.

Sprinkles Programme
The goal of the Sprinkles Programme is to significantly improve nutritional status and remedy Iron Deficiency Anemia amongst infants and children of the poor and ultra-poor throughout Bangladesh. The target groups for this programme are children from 7 (after completion of 6 months) to 60 months.

The objective is to:

• Reach approximately 3.33 million children (0.52 million children by year 1; 1.05 million children by year 2; and 1.76 million by year 3);
• Improve the vitamin and mineral status of the target population by 20% over baseline;
• Create an infrastructure demonstrably capable of generating the additional revenues needed to sustain the program past 3 years.

Intervention: Administration of Multiple Micronutrient Powder Sprinkles (15 micronutrient composition) to children of 7-24 months of age (60 sachets within 120 days). It is a tasteless dry powder that needs to be added in the complementary food of the child. Initially, we are using our door-to-door approach by the health volunteer along with strong social mobilisation through the community influencers (village doctors and community people). We recognise that social change will be of paramount importance and BRAC uses its proven orientation and mobilisation methods to work with the health volunteers, health workers, other field staff and community influencers in this regard.

Area coverage: All upazillas in Bangladesh except for Rangamati, Khagrachhori and Bandarban (as these three are malaria prone areas).

The project is funded by The Global Alliance for Improved Nutrition (GAIN) while the supporting partners of this project are Renata Ltd and Sprinkles Global Health Initiative (SGHI). The duration of the project is 3 years (March, 2010 -- February, 2013).

Acute Respiratory Infection (ARI) Control Programme
The community based ARI Control Programme started in 2007 and gradually expanded to 40 districts in 2009 with an aim to reduce deaths due to ARI among children under 5 years and thereby significantly reduce under-five mortality.