Engaging Communities to Help Mothers Engaging Communities to Help Mothers and Newborns: and Newborns:

MaMoni Experience from BangladeshMaMoni Experience from Bangladesh

Rowshon Jahan

Presentation outlinePresentation outline

• MaMoni overview and strategies

• Community mobilization approach

• Results

• Challenges and lessons learnt

• Steps towards sustainability and scale up

ContextContext

Home delivery is the norm Weak health systems:

vacancy of health workers quality of care at health care facilities

Traditional healers/practitioners have a strong role Social inequity prevails – deaths are more in lower

strata Geographically difficult terrain Successful vertical programs like – EPI, Family

Planning Stronger GO-NGO collaboration

Why MaMoni in Sylhet ..Why MaMoni in Sylhet ..

Indicators (BDHS 2007) National Sylhet

Neonatal mortality rate 37/100041/1000 ( 2004)

53/100063/1000 (2004)

Total fertility rate 2.7 3.7

CPR 56% 32%

Unmet need for family planning 18% 26%

At least one ANC attendance with trained provider 60% 47%

Place of delivery Home: 85% Home: 91%

Skilled attendance at birth 18% 11%

MaMoni overview and strategiesMaMoni overview and strategies

MaMoni is an Integrated Safe Motherhood, Newborn Care and Family Planning Project (ISMNC-FP) under the leader award, Maternal and Child Health Integrated Program (MCHIP).

3.3 million pop. coverage in 2 districts Follow on project of ACCESS (2006-2009) The prime is JHPIEGO and local partners are –

MOH&FW Save the children, USA FIVDB Shimantik

MaMoni results framework

Improved maternal and neonatal health outcomes

•Practice high impact MNH behaviors

•Use high impact services

Increase knowledge, skill, practice at home

Increase utilization of services

Increase family planning acceptance and understanding

Systems strengthening

Mobilize community to support demand

Stakeholder leadership, commitment and action

National goal

Project purposes

1 2 3 4 5 6 7 8 9 p1 p2 p3 p4 p5 p6D

IFA Supplementation

ANC1TT

ANC2 ANC4TT

ANC3

Pregnancy identification

Misoprostol

Clean delivery and immediate

newborn care

PP maternal care, Vit A and management of

complications

Essential newborn care/KMC

Management of newborn

complications

Immunization

Postnatal session promoting LAM, spacing, PoP, FP, transition

Supply of PoP, transition to modern method, Supply of FP methods and referral for

LAPM

MaMoni package: Integrated PackageMaMoni package: Integrated Package

Birth preparedness

HW counseling

AMTSL &

referral for

EmOC

Exclusive breastfeeding and

promotion of LAM/PPFP

Highlights of MaMoni approachHighlights of MaMoni approach

MOH&FW key service provider Partner NGOs play a supportive and facilitative

role Active role of the community An integrated package District-wide approach MOH&FW and community capacity enhanced to

ensure sustainability

CM helps in adoption of healthy practices & increase utilization of services

COMMUNITYEnabling Environment,

Collective actions

WOMEN, NEWBORNS

Healthy Behaviors

HOME/FAMILYSupportive

decision making

Health systems

Health systems

Linkage/ interface

Linkage/ interface

Reinforce demand Reinforce

demand

Support behavior change

Disseminate health messages

Engage community leaders

Explore MNH Explore MNH situation situation

and set prioritiesand set priorities

OrganizeOrganizethe communitythe community

for actionfor action

PlanPlantogethertogether

Act Act togethertogether

Evaluate Evaluate togethertogether

Prepare to mobilize

Prepare to scale-up

Community mobilization approach:Community Action Cycle (CAC)

Community mobilization activitiesCommunity mobilization activities

Selection of villages Resource mapping Orient the community

and invite for participation

Formation of CAGs Capacity building for

community resource persons (CRPs)

Results: gender balance in CAGsResults: gender balance in CAGs

Each village has two separate groups: male and female

Membership of male groups slightly higher than female groups (18317 [51%] versus 17455 [49%])

3820 CRPs – equal membership (1909 females and 1911 males) – 60% demonstrated ability to conduct CAC independently

Results: emergency fund & transport Results: emergency fund & transport

• 56.9% of the groups arranged emergency transportation system

• 43.4% of the groups developed emergency fund.

• 396 mothers and newborns used the system to get to the health facility

12 Satellite clinics and 2 EPI center newly opened by the group initiatives

CAGs worked with govt. & NGOs to regularize 69 inactive/irregular clinics/EPI centers

56% CAGs has participation of MOH field service providers

Results: linkage/interfacing with health systems

• Unavailability of services and/or poor quality of care• Male CAG members available mostly in the

evening• Some communities need time to get prepared• Difficult to ensuring participation of all segments

especially the vulnerable groups• Some female community members not permitted to

attend meetings by their mother-in-laws• Program disruption by natural disaster including

floods

Lessons learnt and challengesLessons learnt and challenges

• Appropriate community entry essential for successful community interventions

• Sharing real stories/results increase community engagement• Men and women can work together to mobilize their

communities in conservative communities• Engagement of men in the CAC increase their involvement in

MNH activities• Communities can be mobilized without any material or financial

incentives• Formation of CAG with existing group is more effective and

sustainable• Community Resource Persons demonstrated potential of

sustain these initiatives

Lessons learnt and challengesLessons learnt and challenges

• Community action cycles are being done by community resource persons/ volunteers

• Selection of volunteers from existing functionaries

• Role of volunteers as extended hands of the health workers • Stronger linkage with local governments and health systems

• Community clinic management groups• Elected union parishad (local government)

• Combining female and male groups• Integrating family planning• Involvement in source for local MNH-FP commodities• Component of a number of large MNH programs

Steps towards sustainability and scale-up Steps towards sustainability and scale-up

Mothers and newborns lives are saved through Mothers and newborns lives are saved through community initiatives . . .community initiatives . . .