Mannan_Expanding PNC Home Visits in Bangladesh, The MaMoni Experience
Transcript of Mannan_Expanding PNC Home Visits in Bangladesh, The MaMoni Experience
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Expanding PNC home
visits in Bangladesh:
the MaMoni experience
Imteaz Mannan
MaMoni Integrated Safe Motherhood,Newborn Care, Family Planning Project
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The Graph that launched a thousand ships
Source: DGFP MIS data, Habiganj
Postnatal Care in Habiganj 2011
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WHO/UNICEF Joint Statement 2009Home visits for the newborn child: A strategy to
improve child survival
"Studies have shown thathome-based newborn careinterventions can prevent 3060% of newborn deaths in highmortality settings undercontrolled conditions.
Therefore, WHO and UNICEF
now recommend home visits inthe babys first week of life toimprove newborn survival."
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Chronology of Home Based Postnatal Care inBangladesh
03 04 05 06 07 08 09 10 11 12
SNLBRACCAREBPHC
UNICEF MNCS
Joint UN MNH
Projahnmo
BRAC HP/MNCH
SMPP SMPP-2
CB-PNC OR/SNL
BRAC MANASHI
ACCESS ISMNC
DFID Char Livelihoods Project
UNICEF/BRAC MNCH
MaMoni
NNHSap
proved
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Postnatal Care in Bangladesh
NNHS 2009 defines and provides clinicalguidelines for PNC
Transition from policy to action taking longer thanexpected
HPNSDP 2011-16 prioritizes MNH and PNC
PNC traditionally recorded at MIS as carewithin 42 days
Trainedvs. medically trainedprovider
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MaMoni ISMNC-FP Project
One of the models of USAIDsGHIs upazila health systemstrengthening
MOH&FW key service provider
Partner NGOs - supportive andfacilitative role
An integrated package
District wide approach
Integration and linkage of Nonhealth sectors community, LG
with MOH health careproviders
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Habiganj Public Service Delivery System
1.8 mill pop 8 sub-district, 3 in haor
6 municipalities
29.6% staff vacancy 27% SP vacancy
5% pop in tea garden
3% pop in urban slums
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The WHY" and the WHATPNC Prescribed by MaMoni
Activity Maternal Newborn
Counseling andSupport
LAM, PPFP, dangersigns, nutrition
positioning/attachment, EBF,danger signs, delayed bathing,thermal management
Referral forroutine services
PP Vit-A, PP-IFA, BCG, EPI
Check for
complication
Nipples/breastfeeding,
sepsis, other problems
Infection, LBW, hypothermia
Mgmt/Referralof complications
Identify appropriatecenter, notify serviceprovider
Same +S2S Contact,
Program Mgmt Misoprostol use
validation
Birth registration (MOLGRD)
Why? To prevent mortality and morbidity of mother and newborn,
ensure growth and development* PNC begins at ANC, if mothers are not identified and counseled, PNC may not happen
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The Who", The When, The Where"
HA FWA/CHW FWV CHCP
WHO
0-2 days 4-7 14 days
WHEN
Home, satelliteclinics
Community Clinic UH&FWC Secondary
Facilities
WHERE
Visit encouraged but not counted as care Volunteers TBAs/Village Doctors
Home Tea Garden
Outreach Clinics Clinic
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Civil Surgeon,Deputy CS, MO
Deputy Director ofFamily Planning
UH&FPO,RMO, MA, EPITechnician, HI
DistrictHospital (100
beded)
UpazillaHealthComplex(31 beded)
Health SubCentreMO, MA, AHI,Pharmacist
UH&FWCFWV, SACMO,FPI
MCWC
CommunityClinic(For 6000people)
UFPO MO(MCH),SFWV
EPI CentreHealth Assistant
HA
Satellite ClinicFWV, FWA
FWA
FewMCWC
District
Upazilla
Union
Ward/Outreach
HouseholdMO
H&FWST
RUCTURED
istrict&Below
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The How MaMoni Strategy to Expand PNC
ActivitiesHabiganj
Training (FWA, HA, FWV, SACMO)
Volunteers /300 pop.
Community groups /900 pop. or /village
Satellite clinic strengthening - history Community -planning involving FWA, HA,volunteers to update MIS data
TBA orientation (delivery notification)
PNC register revision FWA - 48h, 7d
Supportive Supervision (JSV)
Facility strengthening for delivery, PNC
Referral chain setup, transport
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PNC Coverage Jul 2011-Mar 2012
Source: DGFP MIS
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Wait a Minute! Isnt it
Supposed to be a percentage?
too low?
showing no trend?
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Issues MIS & Reporting
No single report Facility delivery often doublecounted
HAs report not processed
No record of continuum of care ofARH-FP-MNCH, some mothersnot recorded at all
No single denominator
Live births vs. BCG: The 22-50issue
Identification system different forH&FP, not updated
Delivery notification a challenge
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Issues Service Delivery at Home
Less time: Move away from domiciliaryservices, promoting one-stop services(Community Clinics)
PNC/OPD confusion
More people: HH-CHW ratio doubled sincelast HR planning, even triple in some areas
1 FWA/6,000 population in 1995
More work: 18 items in the JD includingpromoting VAW, homestead gardening, etc.
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MaMoni approach to solve these problems
Community micro-planning (396/mnth)
Birth notification by TBA,link to FWV/A
UP registration
GR support in oneupazila
Poil study Single MIS for
ANC/Delivery/PNC
Validation of data(BCG/Live birth)
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Take Away Message
Operationalizing policy takes time andpatience
Need some transition activities before it can bescaled up
For high mortality districts, home based PNCis needed, lessons from Habiganj should beconsidered
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Thank You
"Childrens lives should be counted in years and decades,not in minutes, hours and days