Synergies in Partnership for Maternal, Newborn, and Child Health

National Consultation Meeting Organized by the White Ribbon Alliance Bangladesh

With Support from the Partnership for Maternal, Newborn and Child Health

January 10, 2007

Summer Palace Hotel Dhaka, Bangladesh

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Background The Partnership for Maternal, Newborn, and Child Health (PMNCH) was launched in 2005. One of its main aims is to harmonize national efforts. Through a small grant from the PMNCH, the White Ribbon Alliance for Safe Motherhood in Bangladesh (WRA, B) held a national consultation meeting to bring together all stakeholders working in maternal, newborn and child health to share research, innovative programs, and new directions and opportunities for collaboration. This consultation strengthens the efforts of the WRA, B to act as a coordinating body and lead advocacy alliance for safe motherhood in Bangladesh, contributing to the goals and objectives of the PMNCH and guiding a collective way forward. When the consultation was launched in at the “Lives in the Balance” conference in New Delhi, the Delhi Declaration culminated the event. In effort to bring these global efforts to a Bangladeshi specific content, a modified version of the Delhi Declaration was introduced at the National Consultation, attended by more than 100 stakeholders. The attendees of the National Consultation reflected the diverse membership of the White Ribbon Alliance and its multi-sectoral approach: government officials, donors and development partners, international and local NGOs, researchers, the private sector, and committed individuals such as high profile stylist and a well-known Bangladeshi singer. The program for the day was build around three key themes: usage of maternal, newborn, and child health services, equity of MNCH services, and human resources issues and quality of care in MNCH services. The objectives of the consultation were:

• To share information about the landscape of current maternal, newborn and child health efforts in Bangladesh in relation to utilization of services, equity and human resources

• To identify opportunities for synergies between these priorities for possible partnership building

• To identify opportunities and mechanisms for public-private partnership • To reinforce commitment towards a united effort towards improving the maternal and

child health scenario in Bangladesh Copies of all presentations are available upon request from the White Ribbon Alliance Bangladesh.

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Introductory Session Dr. Shahjahan Biswas, Government of Bangladesh, Honorable Director General for Health Services Dr. Biswas thanked the 100 participants for their efforts “for a very honorable cause to ensure our women, newborns and children do not die any more from preventable diseases. We need to harmonize and intensify efforts to achieve the millennium goals.” He explained that there has been an appreciable drop in under-five death rates from 151 deaths per thousand live births in 1990 to 87 in 1999. This rate has since slowed considerably, with the figure standing at 82 in 2001. From this base, it will be necessary to maintain a pace of annually reducing under-five deaths by at least three deaths per thousand live births to achieve MDG 4 by 2015. Child mortality rate is a reflection of the care, health and nutrition status of children below the age of five years and also indicates the social, cultural, and economic progress in the country. While these findings are encouraging, they mask the fact that infants and children continue to consume diets that are grossly inadequate in Vitamin A, iron and other micro-nutrients. Anemia, which is largely due to iron deficiency, affects about 50 percent of under-five children, a prevalence level that denotes a severe public health problem. Breastfeeding is rarely exclusive for the first six months of life, and complementary foods are often introduced too early or too late and are of poor quality. There is urban-rural difference in under-five mortality rates. In 2001, the rate in urban areas was 52 percent while in rural areas it was 89 percent. Similarly, there is also difference in under-five mortality rate between boys and girls. In 2001, the under-five mortality rate for boys was 84 percent and for girls 81 percent. To achieve MDG 4 by 2015 this momentum has to be sustained by consolidating and strengthening achievements in on-going interventions that address fundamental causes of childhood mortality, accelerating the pace of reduction in neonatal mortality through ensuring antenatal care, skilled attendance at birth, and emergency obstetrics care for those in need, enhancing the effectiveness of interventions for reducing malnutrition among children and women, exploring interventions required to address the contemporary causes of mortality, i.e., accidents and injuries, specially drowning, strengthening partnerships between the Government, NGOs, specialized agencies and local government institutions, integrating vertical programmes for reduction of childhood mortality such as ARI and CDD, focusing on consumer awareness and communication strategies for promoting behavioral change, ensuring need-based-targeting of un-reached and un-served populations, especially for area-specific health and nutrition interventions in urban slums, the Chittagong Hill Tracts and coastal areas, strengthening the management information system through establishing a database for informed decision support, information gaps, consistency and veracity. In spite of the fact that maternal mortality has declined from nearly 574 per 100,000 live births in the 1990 to 320 in 2001, the maternal mortality ratio (MMR) in Bangladesh remains one of the highest in the world. It is estimated that 14% of maternal deaths are caused by violence against women, while 12,000 to 15,000 women die every year from maternal health complications. Some 45 percent of all mothers are malnourished. The chief causes of maternal deaths are hemorrhage, unsafe abortion, and the ‘three delays dynamics’. The first delay, arising mainly from poverty, is in seeking professional care, the second delay is logistical as most of the health centres and private clinics are located in district towns whereas 70 percent of the population are rural based, the third delay arises from the lack of adequate human recourses and trained personnel at the

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service centres. Several measures have been taken to address these problems. A holistic approach was adopted through the National Maternal Health Strategy 2001 which takes a rights-based approach to maternal health with Safe Motherhood as its central theme. The Strategy has been integrated into the Health and Population Sector Program, (HPSP 1998-2003) and into its follow-up the Health, Nutrition and Population Sector Program, (HNPSP 2004-2006). The White Ribbon Alliance for Safe Motherhood is a new approach in the maternal and neonatal health domain in Bangladesh. The White Ribbon Alliance works to ensure a Bangladesh, where safe motherhood for all women are achieved as a basic right, through a multi-sectoral approach and grassroots level movement involving all relevant stakeholders that will strengthen capacity, influence policies, harness resources and inspire appropriate actions. The Partnership for Maternal, Newborn & Child Health is a new global health partnership launched in September 2005 to accelerate efforts towards achieving Millennium Development Goals (MDGs) 4 and 5. It gives me great pleasure to be here today where these two global partnerships join forces, to create a forum through which members can combine their strengths and implement solutions that no one partner could achieve alone. I am very optimistic that we will have a lot of recommendations which would give us future directions for a truly synergistic partnership for maternal, newborn and child health. Following Dr. Biswas’ introduction, the White Ribbon Alliance for Safe Motherhood National Coordinator, Dr. Farhana Ahmad, announced the publication of a first newsletter and asked the Director General to cut the ribbon to inaugurate the inaugural issue.

Betsy McCallon, Global White Ribbon Alliance, Safe Motherhood Advisor Ms. McCallon added her greetings from the Global White Ribbon Alliance, acknowledging the Bangladeshi Core Group Members, thanking CONCERN for their support in this country. She acknowledged the importance of this national symposium’s focus on utilization of services, equity, and human resources issues. She gave a short PowerPoint presentation on the partnerships necessary for success • Convergence amongst maternal newborn and child health interventions • Governments to link existing initiatives • Appropriate involvement of civil society Ms. McCallon highlighted the purposeful work with Partnership for Maternal, Newborn and Child Health (PMNCH) for India and Bangladesh, implemented by Path and WRA that are in keeping with the consultation objectives of this meeting. She reviewed the history of the PMNCH: 1987 foundation of Safe Mother Initiative, 1999 Global White Ribbon Alliance founded, 2000 Healthy Newborn Partnership, 2004 Child Survival Partnership, 2005 convergence enabled with funding from Gates, UNFPA, DFID, and WHO in order to coordinate efforts toward achieving MDGs 4 & 5. Other goals include to intensify country support for accountability and to lobby for increased national support. Partnerships can offer greater visibility, raise awareness of the issues, reduce competition for resources and prevent unnecessary overlap. Ms. McCallon gave examples of similar partnership work in Cambodia before concluding with a series of questions to guide discussions related to the PMNCH in Bangladesh:

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• What is the role for civil society and NGOs in PMNCH? • How do we maximize synergies with out losing focus – particularly on maternal health? • What is the role of WRA in collaboration of the PMNCH?

Dr. Farhana Ahmad, National Coordinator, White Ribbon Alliance in Bangladesh The purpose of the White Ribbon Alliance for Safe Motherhood is to ensure that all women will receive the help they need through their pregnancy and childbirth. Maternal disabilities number 15-20 million each year worldwide. Perinatal and newborn mortality account for 40% of deaths of children under 5 years. Lack of access to quality maternal health services is often a key cause of death. The Alliance should generate political will, acknowledge social benefits of safe motherhood, and combine scarce resources. White Ribbon Alliance in Bangladesh (WRA,B) was founded in a March 2005 workshop involving government, donors, activists and NGOs. Members of WRA include professional bodies for OBGYN and Nursing, DFID, USAID, UN bodies, the private sector, NGOs, and individuals. Since its inception, the WRA has drafted an advocacy strategic paper, hosted the November 2005 formal launch, held a capacity building workshop, sought celebrity endorsement, developed advocacy materials, and participated in key events. Dr. Ahmad reviewed the accomplishments of the first year including a drama written and performed by members of faculty, ex and current students of department of drama and music from the University of Dhaka; International Women’ Day activities; supplements in National newspapers and programs on TV; and enlarging WRA membership to emphasize social responsibility.

Kieron Crawley, Country Director, Concern Bangladesh Concern is the institutional home and fund-manager for the White Ribbon Alliance. Mr. Crawley reviewed the health statistics card from conference bag to note the impact on women during his short talk. Concern was founded in Bangladesh in 1971-2 after the cyclone and Liberation War with initial aid into Salt Lake Camp of Bengali war refugees. CONCERN is currently engaged in numerous programs; the health and nutrition programs encompass the safe motherhood initiatives. 5 regional offices are in Bogra, Niphamari, Kurigram, Gaibandha, Joypurhat and Rangpur and have the first projects to reduce maternal and child mortality. Concern looks forward to sharing lessons within the Alliance. Care for underweight children, maternal services, newly married couples’ services, adolescent girls’ services, advocacy, and community based nutrition care are part of Concern’s programs. Mr. Crawley also highlighted the commitment of Concern to safe motherhood through their programmes and their commitment and support to White Ribbon Alliance as its host organization.

Ali Forder, Senior advisor, DFID Ms Forder acknowledged the commitment of those attending this meeting to MNCH. DFID’s work in Maternal and Child Health was reviewed in “Reducing Maternal Deaths” publication with inclusion of the goals of ICPD and Alma Mata. This publication shows the impact of DFID programmes: keeping maternal mortality high on policy level discussions, scaling up evidence based interventions, addressing wider social and economic barriers to maternal health (make certain that there are no delays), developing and applying new knowledge (especially the effects of education). DFID’s “Sexual Reproductive Health and Rights” paper was also shown. DFID is channeling more funding to the MDGs, especially for the poor, women and girls.

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DFID has a three track approach to channel HNPSP and UPHPC projects of the GoB. Urban Primary Health Care Project works with Marie Stopes. DFID encourages ring-fenced support for “hard to reach” MDGs by targeting the health needs of the extreme poor (livelihood components). DFID is currently finalizing partner programmes with UNICEF, UNFPA and WHO working at District level to involve NGOs for supplies and complementary support through other channels. Policy level efforts: DFID is chairing the HNP Consortium for 2007 with a review in April. One coordination mechanism is needed in working with government and successful programmes already effective in Bangladesh. Partnerships are key at every level, especially at the community level. She emphasizes the role for WRA,B in policy level efforts.

Dr. Sukumar Sarker and Krishnapada Chakrabarty of USAID Dr. Sarker explained that USAID programs are intended for “A healthier, better educated and more productive population.” His PowerPoint slides cited a dozen different MNCH programs supported by USAID in Bangladesh. He highlighted a few, including the NGO Service Delivery Program (NSDP) covering 30% of Bangladeshi population with maternal health services to 3.2 million women per year (clinics and home delivery). Dr. Sarker showed a pie chart accounting for key interventions for major causes of maternal mortality and highlighted the programs addressing these causes. Active management of the third stage of labor is part of the program coordinated through Engender Health. He also discussed major maternal disabilities and the work supported by USAID: fistula prevention and repair (Engender Health working at three NGO hospitals including Lamb, Kumudini, and another hospital) JiVitA is using global USAID funds for Vitamin A intervention; CRWC and Concern are also receiving USAID funds. Krishnapada Chakrabarty outlined in greater detail the ACCESS Program, a newer program in Bangladesh. Implementing partners in Sylhet area: JHPIEGO, Save the Children – USA, Shimantik, Friends in Village Development (FIVDB), ICDDR,B (technical partner). Objectives are to improve maternal and newborn health outcomes, to improve knowledge/practices in homes, to promote health services utilization, and to promote community participation in 7 Upazillas of Sylhet, 1.5 million population base with 375,000 women of reproductive age, and 45,000 annual births. The main strategies used are: • Behavior Change communication: counselor (1/5000) gives messages to mothers and family members in preparation for birth for ANC services, birth preparedness, nutrition, emergency plan, skilled birth attendants, recognition of complications. In four home visits, counselors use a doll to ensure clean delivery, drying/wrapping newborn demonstrations. Community mobilization • Create enabling environment and sustain project initiatives by identifying community leaders, form community groups to know dangers to pregnant mothers and newborns, build community capacity for transportation during complications, facilitate community action cycle, organize exchange visits Advocacy • at a National Level: liaise with GOB, donors, NGOs, workshops/seminars, produce newsletter • at local level to improve facilities

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Capacity building • Create a demand for improved facilities: training of service providers, minor renovations, quality of services, improving supervision, training of Trained Birth Attendants (TBAs)

Dr. Roushon Ara Begum, UNFPA Dr. Begum gave a brief update of UNFPA’s programme activities in Bangladesh. The 7 country UNFPA program began in 2006-2010. She pointed to challenges in Bangladesh with 90% home delivery with 50% of adolescents in marriage giving birth in first year. Maternal morbidity includes fistulas and cervical cancer, which are both key intervention areas for UNFPA. Anticipate 50% of births being attended by skilled birth attendants by 2010 (currently less than 10%). UNFPA advocates better midwifery training of nurses, family welfare visitors, and community-based Skilled Birth Attendants (SBAs). UNFPA Programmatic Focus is to improve EmOC services of OBs & Gynae and anesthesiology. Community based SBA 6 months’ training started in 2004 with collaboration by WHO, GoB, and UNFPA for 28 districts and was certified by Bangladesh Nursing Council. The Global Campaign to End Fistula is also focusing on Bangladesh.

Dr. Monira Parveen, Project Officer, Health and Nutrition Unit, UNICEF Dr. Parveen gave a brief update on the programmes and priority areas for UNICEF in Bangladesh. The UNICEF Project began in 2000 with a baseline survey of available services through OBGYN Society. The project included procurement of equipment and its maintenance for District Hospitals and Medical Schools now in 25 Upazila Health Complexes for safe blood transfusions. Established supervision and monitoring programme in government and are currently developing standard protocols in EmOC and prevention of infection-prevention. There was a special emphasis on Chittagong Hill Tracts includes the three District Hospitals for comprehensive maternal health care and beginning training for other hospitals with OT equipment. The project worked with headman and other community leaders for advocacy. In 2005, 212 facilities were providing comprehensive, essential EmOC services throughout Bangladesh as compared to 30 facilities in 1994. Statistics show that more women are accessing services over the past two years for emergency obstetrical care including 95% increase in births, 173% more treatment of EmOC and 131% increase in c-sections. Community support group activities focus in 6 Upazillas for increased referrals during obstetric emergencies are planned to include dramas to create awareness, training of doctors and nurses, NGOs capacity support training – these are implemented by CARE Bangladesh. MIS Health database is providing UN Process indicators. Best performing awards were given for facilities that have strengthened facilities for ANC and postpartum care. 2006-2010 targets discussed to maintain and equip 191 EmOC service facilities in Chittagong Hill Tracts and urban poor areas. Future plans include prevention of vertical transmission of HIV, decentralized planning for maternal and neonatal mortality and morbidity prevention.

Dr. Long Chhun, WHO Medical Officer in Reproductive Health When MCH coverage increased in Bangladesh, the maternal mortality declined. WHO primarily works with Government but does facilitate some funding of NGOs through special and rare memorandums of understanding. Technical reports are reviewed every 3 and 6

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months and sent to SEARO offices. 2006-7 plans aim at equitable access and use of quality maternal and newborn health care by: • Increasing availability and quality of maternal and newborn care at health facilities and community • Strengthening community support to empower women The are 16 objectives for WHO overall; #4 is a particular priority for MNCH: • reduce morbidity and mortality • improve sexual and reproductive health and promote active and healthy individuals • life-course orientation to health

Panel Discussion Chair of the Session, Ms. Karen Benbow Ross, Officer in Charge of UNFPA, summarized the introductory session saying that UNFPA are eager to form closer partnerships with all working in maternal, newborn, and child health. She recalled that the earlier emphasis for safe motherhood was on prevention. “We still need to help women not be pregnant when they do not desire further children. Let us not forget family planning as a pillar of safe motherhood.”

Second session: Presentations on Usage of Maternal, Newborn and Child Health Services

Iqbal Anwar, ICDDRB Dr. Anwar presented a study examining a decade of inequality in maternal health services in Bangladesh. Millennium Development Goal 5 is to reduce by the MMR by 75% by 2015 to be achieved by increasing trained or skilled birth attendants (SBA). He posed the question: what do statistics show about current practices? The study examined a decade of inequality in maternity services from 1991-2004. The London and ICDDR,B team of researchers analyzed 4 Bangladesh DHS report statistics gathered over 14 years to calculate poverty levels and status of maternal health (overall delivery by skilled birth attendant was 12.2%). The ANC rates have increased over time with no difference between rural and urban but C-sections increased in urban areas. Inequity in ANC – wealthiest sought more care than the poorest who had only 12% access for ANC. Graphs showed dramatically these disparities by economic quintiles, area of residence, and education. 26,000 mothers were surveyed. Delivery by skilled birth attendants did not increase over the 14 years of survey in the poorest areas. The mothers in upper quintiles are 4 times as likely to seek skilled birth attendance or 7 times as likely to deliver by C-section than the poorest quintile mothers. Services like EmOC did not reach the most disadvantaged groups. Demand side interventions are recommended to increase services to the ultra poor.

Dr. Jafar Ahmed Hakim, Line Director MC & RH Service Delivery of Deputy General Family Planning, Government of Bangladesh Dr. Hakim reviewed the current maternal, child and reproductive health service delivery programme in Bangladesh. His office receives field level reports in orientation of officers

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throughout Bangladesh. Maternal mortality remains at 320/100,000 live births. Total fertility rate is at 3 per women with annual births of 3 million with about 90% home deliveries. Safe motherhood involves ANC, safe delivery, family planning, postnatal care, C-sections (EmOC), prevention and treatment of unsafe abortion and newborn care. Dr. Hakim reviewed causes of maternal death and morbidity (focusing on national fistula program and injuries). Socio economic factors include inadequate community awareness of safe motherhood. By 2010 the government wants 50% deliveries by skilled birth attendants and to increase met need of Essential Obstetrical Care (EOC) from 27% to 70%. Dr. Hakim reviewed the RH-EOC services at 68 Mother Child Welfare Clinics (MCWCs) from 2003-2006. Initially a three year programme, it is now extended to 2010. Planning included training family welfare assistants to visit homes and to provide MCH-FP services from 8 satellite clinics per union per month. 6 months skill based training for the 5000 Family Welfare Visitors (FWVs) is offered as well as practical midwifery training. Out of 4000+ rural unions with 6000 FWCs, 1500 centres have been upgraded for performing routine deliveries. Azimpur MCH hospital has been expanded with UNDP supply of equipment (part of 1600 blood pressure machines and stethoscopes, labor tables to many hospitals) and drugs, training, introduction of emergency contraceptive pills. Now the medical officer and FWVs trained for MCH and screening of cervical cancer is being added to 6 more districts. 28 districts are receiving community-based SBAs, ECP training completed in 75% Districts. Computers are maintaining statistics. Increasing trends in ANC services, postnatal care, and family planning are seen in data collected. Although the government is faced with limited human resources and irregular supply of drugs, some successes are seen. These may relate to commitment of the doctors with strong team spirit as well as supplying the living residences of attending physicians to the clinics for on-call access as well as more regular supervision.

Dr. Umme Salma Meena, RH Advisor, NGO Service Delivery Programme Dr. Meena presented the safe motherhood activities of NSDP (NGOs Service Delivery Program). Through NSDP’s national network, 33 national NGOs run 317 static clinics throughout country, with 5000 trained staff and 7000 community workers to provide essential service packages to a catchment area of 20 million. The interventions include: antenatal care and counseling (weight, blood work, TT vaccination, recognizing complications), skilled delivery (now includes home delivery interventions), early referral for using EmOC services by promoting birth preparedness messages, est. community support systems and strengthening referral linkages by CARE. Postnatal care visits are to homes to ensure up to 3rd visit of mother and newborn.

Dr. Izaz Rasul, Senior Advisor, Health and Nutrition, Concern Dr. Rasul reviewed Concern’s community level initiatives for maternal and child survival in involving the community in seeking the health and nutrition services. The strategy includes measures of impact, innovation, and influence for the improvement of pro-poor policies at national level. Rajshahi Division in 2 cities of Saidpur and Parbatipur, urban slums, and 5 Upazillas of Dhaka District will be expanded to more remote areas (chars and urban areas). Civil society involvement includes social and religious leaders, community organizations, teachers, traditional health providers as well as government and private health facilities, private pharmacists and youth volunteers. The 1999-2004 Health outcomes indicators in Saidpur and Parbatipur were outlined in bringing full vaccination coverage from 45% up to 83%, dramatic Vitamin A coverage up to

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80%, ANC increased, Saidpur facility deliveries improved from 25% to 48%, increased breastfeeding after delivery, better diarrhea care and FPH methods also improved. All of these improvements are an indication of the community involvement in improving their own health! Capacity for improvement is compared from seed sowing to fruit bearing in design. Leadership and human resource development germinated and are maturing now under the municipality involvement. Rural area efforts in 5 Upazillas were undertaken by the Union Parishod who conducted the FP and health meetings with family welfare workers, school teachers, traditional birth attendants, imams, and mothers groups. Results included improved coverage and mothers’ knowledge of 3 pregnancy related danger signs, more TT vaccination coverage, safe delivery, detection of pneumonias. Community involvement and local government are essential in strengthening the existing support mechanisms and sustainability of the programmes.

Panel discussion

The panel was moderated by Nancy Tenborek, CRWC; she fielded a lively question and answer session. Question from Anneka Knutsson UNFPA: Anneka Knutsson expressed her concern regarding the definition of skilled birth attendants. “There is a very careful description by WHO, FIGO and ICM. We need to be more specific about what they can do if we want to be credible. The Bangladesh national programme has examined all the competencies but there are other categories of SBAs. Also, over utilization of C-sections in urban areas may give impression that C-section is recommended over normal vaginal deliveries.” Dr. Anwar replied: The DHS do categorize some categories of health providers (doctors, nurses, midwives, trained technicians) but we do not know who is being classified as SBAs and what their competencies are. Just in observing the training of nurses, I notice that the student nurses do not get the opportunity to participate fully in deliveries because of competition with the medical interns or small number of delivery cases. Many of the doctors do not have needed experience, in fact. C-section cannot be an indicator for safe delivery – 90% are conducted without sound reasons of maternal or newborn safety. Dr. Farhana Dewan responded to the issue of c-sections: At Dhaka Medical the C-section rate is 50% and is unacceptably high. We should be giving more emphasis on instrumental deliveries, such as vacuum extraction or forceps. Question: What training does NSDP give to their SBAs? Dr. Meena replied: We have three service providers’ categories: doctors, paramedics, and depot holders. We have developed a MoU with obstetricians for C-section. Paramedics do the home deliveries. Question from Subir Saha of Concern: Antenatal care visits increased significantly over the programme period but is it only the first visit? Dr. Anwar replied that the DHS study included only if they received any antenatal care, a single visit.

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Question by Dr. Jahanghir, CARE, Bangladesh: Concern’s data showed institutional delivery in intervention area is 38% but if home delivery by SBA included might reach 50% so this is a good case for achieving MDG. Concern speaker responded that the figures do look encouraging in as an increased number of women going to the health facilities for delivery. Multiple factors are responsibility, the most important being that TBAs accompanied the pregnant women to the clinics which were friendly to the women. Dr. Maloy Kanti Mridha from ICDDR,B asked Dr. Hakim about the neonatal care plans in the next government plans. He mentioned that Centres for Excellence elsewhere have certification. Dr. Hakim responded: The Training Centre’s for Excellence would provide IMCI, EOC as well as new generation services like cervical cancer screening. Dr. Motin, programme manager of IMCI asked: An IMCI module has been added to address the newborn care as part of safe motherhood. At Upazila level hospitals, have a limited number of doctors on their staff. The Medical Colleges are very busy but monthly statistics are not well documented. FWAs do not have space for deliveries. How will the MDG be reached for safe delivery in facilities? Dr. Hakim answered that the programme is supplementing training for FWAs. Limited manpower is giving a good performance with about 1000 C-sections and 5000 normal deliveries in District Hospitals. Gaibandha hospital has greatly improved. Dr. Anwar responded with the final comment that access must be increased in response to demand side.

Panel Session Mr. Kafil Muweed, Director of New Business, Grameen Phone Mr. Muweed explained that Grameen phone is involved in community social development through communication services. In order to reach the health MDGs there is a requirement that government and NGOs work closely together in leading the efforts. However, there are many private sector organizations, like Grameen phone, who are also interested in being partners in this and could lend funding and ideas, not only centrally based but all over the country. Dr. Farhana Dewan, Associate Professor, Dept. of OB/GYN, Dhaka Medical College Member OGSB:: Dr. Dewan shared that the Obstetrical and Gynecology Society of Bangladesh has been working closely by training doctors and nurses in medical college hospitals, especially in supervision and monitoring. Hearing the positive reports was very encouraging, especially in improving EmOC services into more comprehensive services. They trained doctors from some of the rural hospitals. The medical officers are using phones to communicate problems in delivery rooms to supervisor and to seek assistance. Partograms are being filled out by the FWAs. Refresher training is being given as continuing medical education to government doctors.

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Dr. Masudur Rahman, freelance writer, physician, Journal Editor Stethoscope, The Independent Dr. Rahman commented that perhaps we have cultural problems with nutrition and hygienic habits which can be overcome by community participatory strategic planning in order to achieve the MDGs in health by 2015. ECD, early childhood development message is a very apt one: If you want healthy newborn, mother, and child start caring from the pregnancy.”

Session 3: Presentation on Equity of Maternal, Neonatal and Child Health Services

Dr. Jahangir Hossain, Health Advisor, CARE Dr. Jahangir shared his statistics and program experiences to address inequities in Maternal and Newborn Health. Bangladesh has a HDI index of 130 out of 177 (UNDP Human Development Report 2005), life expectancy is up to 62; there is a total fertility drop; and maternal mortality decreased from 5.74 to 3.22 from 1986 to 2000, and under five child mortality decreased. Despite this positive impression, did the health benefits reach all sections of the population equally? Traditional service delivery and BCC approaches are not always effective in reaching unserved or underserved populations. ANC services are rare for women with no education, and the poorest 66% have no ANC access at all. Postnatal care (PNC) services are much higher for secondary school educated mothers (57.8%) according to the Bangladesh DHS 2004. Maps of delivery assisted by skilled birth attendant show areas where less than 10% use SBA. Geographical variation in childhood mortality was shown on another map. His presentation posed these questions: Does the HNP program address this MN health inequity? Why, where are gaps, what can we do? Demand side financing needs to involve local community resources. Remote areas need transport for field workers. Often women with obstetrical emergencies lack access to cash for transportation or unexpected hospital costs and decision-making men do not have access to accurate information such as danger signs and pregnancy issues. CARE’s goal is to reduce maternal mortality and morbidity through identifying and removing the barriers. One comparison area only upgraded its facility with usual health activities and another had no upgrading of facility or staff. CARE did birth planning promotion, Community Service System, Stakeholder information program. USAID did mass communication. To reduce maternal mortality and morbidity, the program needed to increase use of EOC services up to 50% and to reduce violence against women. Key components included: • Promote birth planning including emergency preparedness by involving woman’s husband and in-laws. • Establish community support system to help with financing, including blood grouping campaigns • Improve capacity of services and quality of care (death review/case studies motivated staff, stakeholders committee very important to bridge between community and facilities) • Support victims of violence. Key interventions addressed the three delays in seeking care, finding transport, and establishing women friendly services at facilities. Birth planning pictorial card was developed and used for discussions of danger signs and advanced planning, including savings schemes. Community meetings were led by a woman elected by that area to ask for local solutions; other meetings were conducted with males. A van gari was purchased by one community to transport women in labor to the facility.

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Results: Increased knowledge of 5 danger signs. Knowledge of birth preparedness showed improvements in intervention area in savings and transport plans. Utilization of EOC increased from 16% to 40%.

Dr. Abdul Barkat, Chief Advisor, HDRC, Professor, Dept. of Economics, University of Dhaka Dr. Barkat presented the findings from a research study: Increasing access to maternal health services for poor women in rural Bangladesh: Findings from baseline Survey of Safe Motherhood Project, Family Planning Association Bangladesh. Dr. Barkat’s presentation condensed the report findings from over 200 pages from the 2005 study funded by EC. The study included a KAP quantitative survey of 479 women of reproductive health with 100 from destitute families. Mapping was done with focus group discussions for 5 different categories from deprived or better off households. The deprivation index uses 6 indicators for 4 categories. One map showed 68% of a village as moderately to severely deprived. Families’ priority rankings: 1) food, 2) education, 3) health, 4) housing/shelter, 5) and law & order. Preference rankings without the health category were: 1) ANC 2) delivery care and 3) postnatal care. Adolescent health was not categorized as necessary by the very deprived populations surveyed. The survey revealed that service providers lack knowledge of services needed at what times. Adolescent care, EOC and MR and prevention of unsafe abortion have biggest knowledge gaps in providers’ response. Client’s privacy rights have low knowledge from providers. Demand for family planning very low in several districts. Abortion is not considered a right by health providers. Only 27% received any ANC visit in Naniarchar with only 8% receiving 3 ANC checkups. 88% did not receive any postnatal care for their newborn. FWAs experienced many complications. Most maternal complications were untreated (70%). Most destitute women go to quack or kobi raj because most service providers oppose MR. Women’s freedom of movement is limited, and husbands’ participation is limited in going with wives to ANC or hospital care. Infertility is usually blamed on wives by her husband’s family and divorce is common. A large percentage of women experience violence: verbal abuse 80%, beating 70%, and dowry-related violence is common. Gender discrimination is deep rooted. Remarriage means more dowry to some husbands. Harmful practices and beliefs are also common. 60% of women of reproductive age felt that pregnant women should not take sufficient food or the baby would be too large. Respondents ranked radio and TV more effective information sources than small group meetings. Demand based supply is needed: need to increase access to sexual reproductive health information. Conclusions: Need to strengthen access to safe delivery with EOC; promote women’s right to safe motherhood; target poor communities; and design and utilize effective MIS to monitor health services for poor women.

Dr. Kaosar Afsana, Programme Coordinator RHU, BRAC Dr. Afsana presented: Strengthening the health systems for child health for over 35 years (BRAC began as HELP in 1971-2). Inequities still show in child health status in most poor sectors. Current intervention includes essential health care, TB & Malaria programmes with

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the government, water, sanitation and hygiene. Maternal, neonatal and child health in rural areas focused on MDG 4 & 5. Human health resources, community empowerment, partnership development, service provision, referral linkage between community and facilities are the key component’s of BRAC’s program. BRAC’s MNCH target population is pregnant and lactating women, neonates, and under 5s The primary components are FP, maternity care, ID pregnancy status, ANC, postnatal care, manage complications and referrals, as well as addressing newborn care, neonatal sepsis, birth asphyxia, low birth weight. Community health care workers trained by BRAC are covering up to 1500 households. Achieving high levels of skilled birth attendants will take a long time so BRAC is training village dias to recognize complications with mobile numbers for referrals to call the programme organizers to get the woman to a facility. The problem is the lack of good health care for EOC if only one obstetrician is on duty at the hospitals. Upgraded health facilities are non functional and blood transfusions very difficult at ground level. Whatever facility is close, private clinics or NGOs are part of referrals. BRAC areas have 68% contraceptive prevalence rates. Matlab child survival improved with good holistic health preventions brings equity. BRAC reaches 80% of the rural Bangladesh population. Panel Discussion Mr. Mosud Mannan, Director General, Ministry of Foreign Affairs Mr. Mannan spoke about how he helped to draft the MDGs for Bangladesh in the 2000; he also represents the Society for International Development and is the in-coming President of Rotary. He shared that while there has been much progress in the field of health care but if we look at the recipients, many geographic and gender areas are neglected. Press coverage emphasizes population growth and lack of preparation – child health and safe motherhood are much needed. We must not procrastinate in reaching out and continuing successes – must rethink population control in light of safe motherhood and equity and human resources issues through our networks with viable projects.

Kanis Almas Khan, Editor and Publisher, Canvas Magazine; CEO, Persona Hair and Beauty Ms. Khan gave observations in Bangla on the presentations. She highlighted her role in empowering the women from the marginalized tribal community. Rights of women to have maternity leave from jobs is important for child health and reduction of stress. Women need to be involved in family decision-making. Dr. Halim, National Consultant, WHO Dr. Halim highlighted the various activities of WHO in Bangladesh, and emphasized the need for a strong partnership to effectively meet the MDGs.

Session 4: Human Resources Issues and Quality of Care of Maternal, newborn and child health services

Dr. Azizul Alim, Medical Officer, Director General Health Services Dr. Alim’s presentation was on Human Resources for Maternal, Newborn, and Child Health. Dr. Alim highlighted the many government programmes and strategies that address these areas including the Upazila health complexes, medical college hospitals, community based

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skilled-based training for family welfare workers, newborn care, IMCI, etc. He also outlined the categories of medical personal under the government system and the length of training received. Comprehensive EOC services need at least one year training in Obstetrics and Gynecology and Anesthesiology but the numbers willing to be trained are dropping recently. Only 6 were interested in OBGYN in 2005. The number of facilities is to be increased form baseline of 37 District Hospitals in 2000 up to 59 in 2006. In 2006 132 Upazila Health Complexes want to offer EOC but less than 50 are ready with health staffing. Challenges/Constraints: • Lack of anesthesiologists • poor retention of skilled manpower in peripheral areas since they need to work in pairs • vacant posts, • transfers without replacements • issues related to career planning in those who were trained in safe motherhood moved to other specialties • lack of interest in specialties like anesthesia • most of the EmOC trained medical officers have reached the end of their “bond” for government service and are leaving Steps for the future include: Need to emphasize pre-service curriculum in ob, pediatrics, IMCI; encourage awards in anesthesia, awards incentives and allowances for hard to reach and remote areas; proposals for special recruitments; buildup career planning; training nurses to cover MNHC services, multi-sectoral coordination. There are future plans to expand Human Resources for MNCH, EmOC, community-based SBA services, IMCI, newborn care, as well as to strengthen interactions with other health care providing agencies.

Dr. Malay Kanti Mridha, Coordinator of MotherNewbornNet, ICDDR,B Dr. Malay’s presentation focused on the global comparative review of human resources for health, with a particular focus on Bangladesh and the Asia region. He covered health worker definitions, distributions throughout globe, and what can be done in Bangladesh to improve health work force to meet needs of child and maternal health, using a review of WHO report 2006 and four Bangladesh DHS reports. Health workers are “people engaged in actions whose primary intent is to enhance health”, not just the health service providers but also those who support health enterprises or who also work in other areas. There are 59 million health workers for the world’s 6 billion population. If density of health workers in improved, survival of women and children improves. We have only 4.3 health workers per 1000 population in South East Asia but most do not give direct care. A graph compared the burden of disease with numbers of health care workers and level of expenditure. Only 10% of health burden in is the Americas, but that region contains 35% of workers and most of the expenditures. 80% of Bangladesh doctors are in urban areas although most population is in rural areas. Dr. Malay posed the question: who will serve the rural populations? Bangladesh has a critical shortage of qualified health providers. If we were to achieve 80% skilled birth attendance, the density of health workers needed shows an extreme increase to reach 2.6 health workers per 1000 population. We would need to add 116,000 doctors to reach this goal. Total expenditure of GDP for health has slightly increased over time but is still less than 5%. Much of the health expenditure is from out of pocket, not from government funds.

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He explored what can be done, including: education, recruitment, attrition (give better career choices to retain), workforce supervision, better compensation and incentives, life-long learning. We also need to make the workforce accountable. We have to examine where real shortages exist, and make decisions accordingly. Partnerships are key to achieving a sustainable work force in sharing information, already discovered interventions, changing education for needs, health systems improvement, and equity in delivery of health services. “We have to work together to ensure access to a motivated, skilled, and supported health worker by every person in every village everywhere,” Lee Jongwook, Former director of WHO.

Dr. Subir Saha, Technical Manager, Concern Dr. Saha examined equity issues and their effects on MNCH. Bangladesh statistics show lowered poverty levels in 1991 from 58.8% in poverty to 50% in poverty. But to meet the MDGs by 2015, we must reduce the proportion to 29.4 %. Currently 60% of income is going to the highest quintile and 40% go to the lowest three quintiles. Infant mortality is used as an indicator of social health; it is now 28% higher for poorest quintile compared to highest. Rural areas did a better job of reducing poverty than the growing urban areas where there is the highest infant mortality (111 per 1000 live births amongst the poorest quintiles). Lifetime risk of infant risk 95/1000 in Sylhet with 26% risk of losing a newborn. Extreme urban poor have highest infant mortality. Comparisons of Districts in food insecurity: Barishal, Bhola but not high infant mortality. In Patuakhali food insecurity and infant mortality are both high. Bogra and Giabanda show higher infant mortality with same food insecurity indicators. Bangladesh is on course for MDG in reducing child mortality.

Panel discussion The panel discussion was moderated by Jean Sacks, an informatics consultant. Dr. Setara Rahman, Programme Officer, Engenderhealth Dr. Rahman gave the perspective of obstetrics and gynecology training and program experiences. She felt that retaining trained health manpower is a burning issue to ensure the retention of doctors and nurses essential for Bangladesh in every village every where.

Dr. Abul Barkat, Chief Advisor, HDRC, Professor, Dept. of Economics, University of Dhaka Dr. Barkat addressed some of the research issues/assumptions within this section of presentations. He explained that social science researchers sometimes draw direct conclusions from small samples. The inventory of training by types of human resources is useful but needs to be analyzed by the WHO definitions of health workers. Good in answering the question “What?” but we are not good at answering “Why?” If numbers of health workers being trained is declining, why? The problem of retaining the right person is universal: transfer, vacant posts, bond period ending. If problems and solutions are known, why is there no solution? We need to examine the system of governance now during caretaker government. Is 76% access to electricity and doctors in urban areas the same by coincidence? Why is access to care for ARI and diarrhea declining? If Pakistan has more doctors than Bangladesh but twice the infant death rate, what is reason? Dr. Aparajita Gogoi, National Coordinator, White Ribbon Alliance India

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Dr. Gogoi shared that “Who is the skilled birth attendant” is a recurrent issue in India, Nepal and Bangladesh. How do you measure the competencies? There is also a balancing act between in-service training and ensuring providers are present in the facilities for service delivery. There are many efforts given to nurses and paramedics in neonatal care, IUD insertion, IMCI, but taking away so much time in training gives a gap in service provision. There is also an issue of lack of transparency in postings – mostly because of political interference. While we often look at the gap in doctors, what about midwives? Also, we have to keep the emphasis on the socio-cultural factors of maternal, newborn and child deaths: mothers’ lives are not valued enough to save her life or her children. All of us can do something to prevent maternal and newborn deaths.

Closing session White Ribbon Alliance Oath (see Annex 1) was read out by Dr. Halida Akhtar of FPAB with signature of the Honorable Advisor for Ministry of Women and Child Affairs, Yasmin Morshed. Honorable Advisor Yasmin Morshed gave personal observations: These are very critical times for us but I want to share some important thoughts that I had. Living in South Asia all my life, I have had first hand experiences of deaths in pregnancy and neonatal deaths. I felt drawn to this type of initiative and decided to come. It was absolutely shocking to look at the statistics – they are really quite alarming with 2/3 of women delivering without SBA. The number of women dying in childbirth is more than double those dying from HIV/AIDS. We should be able to inform people about health needs. I was surprised to discover that there is a national health strategy under Ministry of Health but no strategy in the Ministry of Women’s Affairs. I want to add Child and Maternal health care guidelines, starting from today to the Ministry of Women and Child Affairs. The MDGs clearly state commitments towards child and maternal health. The only way to take any movement forward, (health politics civics) is through teaching/education. Low cost wide-scale interventions can be taught – the basic safeguards during pregnancy, birth and infancy. It is a dream for us to provide modern health care. We have limited resources stretched thin for the short term. In the long term Bangladesh should be able to develop those services for all the populations. Television is a good medium getting information and tips into the homes, those who assist in child birth, those who give birth, and those who raise the newborn. The second point is that nothing can be done alone. No organization can work alone. We need networks and partnerships to most effectively share expertise, views, and common experiences in a much more focused and quicker fashion. It is good that you have set up this alliance. If there is anything that I can do to help your alliance achieve these goals, call on me. Education plays the most important part in delaying pregnancies in young girls who need to continue education and value that event of bearing children. Use education as the single most important way of disseminating information! I remember my own mother had her last baby at home. Pans and pans of hot water were boiled to ensure sterile conditions and prevent infections in either mother or child. Our traditional old values of home and family should be revived to give these health initiatives more strength. Dr. Halida Akhtar commented that the findings that women did not have the perception of risk so therefore do not seek antenatal care or recognize emergencies. If we can educate

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rural women, give pregnancy tests, detect eclampsia to save lives of mothers and children. We would like to do some simple interventions within the Ministry of Women and Child Affairs, Dr. Farhana and I. We will join our resources, skills and expertise to safe the poor of our country.

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Dr. Hashina, Head Social Franchising and Quality Assurance, Social Marketing 100 participants from donors, private sectors, NGOs, government attended this consultation. 51 males and 49 female participants show that male involvement and commitment is high. The 540 minutes we have been meeting means than 540 women have died during our talk about details, pilots, scale up statistics – we don’t have time to wait, we have to work now! I see that four milestones have been reached today: the declaration signed by all partners; the launch of the first WRA Bangladesh newsletter, the launch of the new WRAB website, and the commitment of the Caretaker Advisor to improve Woman and Child Ministry responses. Acoustical guitarist and vocalist Ornob gave a vocal ending to the White Ribbon organized National Consultation Meeting at the Summer Palace Hotel.

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ANNEX 1

“Synergies in Partnership for Maternal, Newborn, and Child Health”

Dhaka Declaration

January 10, 2007

I hereby declare that following this meeting, building upon ideas exchanged and synergies created, in my capacity within my role and sector, to take action to contribute to the following:

1. Take an integrated approach to reproductive, maternal, newborn and child health, ensuring a continuum of care through pregnancy through childhood, recognizing that maternal, newborn and child health are inseparable and interdependent;

2. Contribute to the collection and use of high quality data to guide evidence-based policies and programs;

3. Strengthen health systems, from community to referral levels, to ensure sustained and long-term improvement in maternal, newborn and child health;

4. Incorporate specific strategies to address inequities in reproductive, maternal, newborn, and child health programmes to ensure that interventions reach and benefit the poor, marginalized and underserved;

5. Implement strategies to address gender disparities, raising women’s status in communities and providing equal opportunities to promote gender equality;

6. Build effective partnerships and alliances comprising of government, donors, NGOs, professional associations, the private sector, and individuals from all sectors, united to make maternal, newborn and child health goals a reality.

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ANNEX 2

Participants’ List National Consultation Meeting

Synergies in Partnership for Maternal, Newborn and Child Health Date: January 10, 2007, Venue: The Summer Palace Hotel

Serial Name Organisation Designation 1. Dr. Faisal A. Khan Christian

Reform World Relief Committee

Programme Officer

2. Mostafa Shiblee Working for Better Life

Executive Director

3. Dr. Malay Kanti Mridha ICDDRB Coordinator, MotherNewBorNet

4. Badrul Alam ICDDRB Project Research Physician

5. Nazneen Akhtar ICDDRB Research Investigator, RHU, PHSD

6. Nahid Kalim ICDDRB Senior Research Officer, RHU, PHSD

7. Md. Zafarullah Nizam UNODC National UN Volunteer

8. Laila Rahman Population Council

Programme Officer

9. Subir Saha Concern Worldwide

Technical Manager

10. Hasina Chaklader BWHC Director, MIS, RCH and M& E

11. Dr. Barkat E Khuda Dhaka University

Professor, Economics

12. Rokeya Sultana CWFD Director Training 13. Dr. Farhana Dewan OGSB Associate

Professor, Ob/Gyn, DMCH

14. Rehana Rahman Women Entrepreneurs’ Association of Bangladesh

Member

15. Shakhawat Alam Rano Ad Club Secretary 16. Dr. Kazi Alamgir Directorate

General Health Services

Medical Officer (Neonatal Health), IMCI

17. Dr. Md.Shahjahan Biswas Directorate Director General

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General Health Services

18. Dr. Umme Salma Jahan Meena

NGO Services Delivery Programme/Intra Health

Director, Clinical Services Team

19. Dr. Hashina Begum Social Marketing Company

Head, Social Franchising and Quality Assuarance

20. Yasmin Khan Bangladesh Centre for Communications Programme

Senior Deputy Director

21. Quazi Suraiya Sultana RHSTEP Executive Director 22. Iqbal Anwar ICDDRB Associate Scientist 23. Krishnapada Chakraborty USAID Project Manager 24. Marilyn M. USAID Officer, PHN 25. Dr. Long Chhun WHO Medical Officer 26. Dr. Dipumoni Independent Public

Health Professional 27. Md. Moshiur Rahman Population

Council Assistant Programme Officer

28. Md. Mizanur Rahman Shimantik-UPHCP

Project manager

29. Anneka Knutsson UNFPA Associate Programme Officer

30. Ahmed Rezaul Karim MATTRA Manager, Corporate Affairs

31. Dr. Izaz Rasul Concern Worldwide

Senior Advisor, Health and Nutrition

32. Dr. Nina Dodd Concern Worldwide

Technical Advisor

33. Dr. Mahbuba Khan WHO National consultant 34. Dr. Fahmida Banu NGO Services

Delivery Programme/ Intra Health

Reproductive Health Coordinator

35. Afsari Begum MATTRA M & E Specialist 36. Toslim Uddin Khan Social

Marketing Company

Head of Research and MIS

37. Dr. Samina Sultana ICDDRB Training Coordinator

38. Dr. Sukumar Sarker USAID Project Management Specialist

39. Kieron Crawley Concern Worldwide

Country Director

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40. Aasma Afroz ICDDRB 41. Jean Sack ICDDRB Volunteer 42. Ubaidul Rob Population

Council Country Director

43. Khairuzzaman Kamal BMSF 44. Carolyn Benbow Ross UNFPA Officer in Charge 45. Dr. Yasmin H. Ahmed Marie Stopes

Clinic Society Managing Director

46. Bernard Gomes Lamb Hospital Dhaka Liason Officer

47. Emy Elizabeth WRA,B Volunteer 48. Dr. Jebun Nessa Rahman UNFPA NPPP 49. Dr. S M Abul Khair Miah Directorate

General Health Services

Deputy Director (PHC), Programme Manager, Reproductive Health

50. Dr. Setara Rahman Engender Health

Senior Programme Officer, Ob/Gyn

51. Prof A B Bhuiyan OGSB Member, Ex-president

52. Dr. Ishtiaq Joarder RTM International

Programme Specialist

53. Dr. Rezaul Haque Ad-Din hospital Director, Training and Capacity Building

54. Dr. Jafar Ahmed Hakim Directorate General Family Planning

Director (MCH)

55. Nargis Sultana CWFD Project Director 56. Salauddin Ahmed A. Robbin

Architects Principal Architect

57. Dr. Tazneen Waris Directorate General Family Planning

Deputy Director (MCH)

58. Dr. Maswoodur Rahman Stethoscope of The Independent

Journal Editor

59. Dr. Reena Yasmin Marie Stopes Clinic Society

Director, Services

60. Dr. Z A Motin Al Helal Directorate General Health Services

61. Dr. Aparajita Gogoi WRA, India National Coordinator

62. Raju Ahmed TREE 63. Dr. Halida Hanum Akhter Family

Planning Association of

Director General

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Bangladesh 64. Dr. Abul Barkat Dhaka

University/HDRC

Professor/Chief Advisor

65. Dr. Sadia Dilshad Parveen NGO Services Delivery Programme/URC

Director, QI

66. Nancy Tenbroek CRWRC Child Survival Programme Manager

67. Tahera Ahmed UNFPA Assistant Country Representative

68. Dr. RoushanAra UNFPA NPPP 69. Dr. M A Halim WHO National Consultant 70. Dr. Ayesha Siddique PSTC-FHP Project Manager 71. Dr. Selina Amin PLAN

International Health Advisor

72. Ali Forder DFID Senior Health Advisor

73. Dr. Monira Parveen UNICEF Project Officer 74. Areba Panni Individual Member 75. Dr. Abul Hashem DGHS 76. Kafil Muyeed Grameen Phone Director, New

Business Division 77. Debashis Roy Grameen Phone Manager, New

Business Division 78. Dr. Jahangir Hossain Care

Bangladesh Health Advisor

79. Dr. Ferdousi Begum NGO Services Delivery Programme

Head, Programme Operations

80. Dr. Ashequr Rahman Concern Worldwide

Technical Manager, M & E

81. Dr. Md. Azizul Halim RH Programme, RSD, DGHS

Medical Officer

82. Dr. S M Asib Nasim UNICEF Senior Programme Officer

83. Nawsher Ally Bangla-German Sales Co Ltd.

Head, Sales and Marketing

84. Sayeeda Tanzera A. Robin Architects

Designer

85. Dr. Samina Chowdhury Family Health International

Technical Officer, Care & Support

86. Dr. Taposh Kumar Paul Delta Medical Centre

Consultant, Surgery

87. Dr. Kishwar Azad PCP/Dept of Paediatrics, BIRDEM

Project Director

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88. Dr. Kaosar Afsana BRAC Health Coordinator 89. Mosud Mannan Ministry of

Foreign Affairs, GOB

Director General

90. Md. Imtiazul Islam NSDP/Care Health Equity Manager

91. Shabin Hossain Individual Member 92. Naheed Ahmad Viquarunnessa

Noon School Senior Teacher

93. Dr. ATM Sanaul Bashar NSDP/URC Programme Consultant, QI

94. Tasmiah Afrin Mou BTV News Reporter 95. Md. Obaidur Rahman

Mondol BTV Cameraman

96. Md. Mostafa Hossain BTV Cameraman 97. Md. Nurul Amin Khan DSS MSW Cameraman 98. Md. Akhtaruzzaman DSS MSW Cameraman 99. Md. Mizanur Rahman PRO MSW Public Relation

Officer 100. Afroz Huda LMS, Dhaka Executive Director 101. Dr. Farhana Ahmad WRA,

Bangladesh National Coordinator

102. Sadia Rapporteur 103. Kaniz Almas Khan Canvas/Persona CEO 104. Canvas Photo journalist 105. ATN Cameraman 106. Yasmin Morshed Ministry of

Woman and Child Affairs

Advisor

107. B. A. Shujon MAP Photographer 108. Ornob Chowdhury Bengal Music

Company CEO

109. Betsy Mccallon Global WRA Safe Motherhood Advisor

110. Filmfare Cameraman 111. Filmfare Cameraman

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ANNEX 3 Agenda National Consultation Meeting on Synergies in Partnership for Maternal, Newborn and Child Health January 10, 2007 Consultation Objectives To share information about the landscape of current maternal, newborn and child health

efforts in Bangladesh in relation to utilization of services, equity and human resources. To identify opportunities for synergies between these priorities for possible partnership

building. To identify opportunities and mechanisms for public-private partnership. To reinforce commitment towards a united effort towards improving maternal and child

health scenario in Bangladesh.

TIME AGENDA 09.00-10.50 Introductory Session:

Current Initiatives in Maternal, Newborn and Child Health Time Agenda Organsisation 9.00-9.10

Introduction/Welcome address/PMNCH presentation

Global White Ribbon Alliance

9.10-9.20

Presentation on White Ribbon Alliance, Bangladesh

White Ribbon Alliance, Bangladesh

9.20-9.30

Presentation by Institutional Home/Fund Manager

Concern Bangladesh Worldwide

9.30-9.40

Presentation by USAID

USAID

9.40-9.50

Presentation by DFID DFID

9.50-10.00

Presentation by UNFPA

UNFPA

10.10-10.20

Presentation by UNCEF

UNCEF

10.20-10.30

Presentation by WHO

WHO

10.30-10.40

Welcome Speech by Special Guest

DGFP

10.40-10.50

Welcome Speech by Special Guest

DGHS

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10.50 -11.10 Tea Break Technical Session-1 11.10-12.10 Presentation on Usage of Maternal, Newborn

and Child Health Services Time Organisation 11.10-11.20 DGHS 11.20-11.30 DGFP 11.30-11.40 NSDP 11.40-11.50 Concern

11.50-12.10 Question and Answer Session 12.10-12.30 Panel Discussion 12.30-01.30 Poster Presentation 12.30-01.30 Lunch and prayer Technical Session-2 01.30-02.40

Presentation by Participants on Equity of Maternal, Neonatal and Child Health Services Time Organisation 01.30-01.40 CARE 01.40-01.50 HDRC 01.50-02.00 BRAC

02.00-02.20 Question and Answer Session 02.20-02.40 Panel Discussion 02.40-03.00 Tea Break Technical Session-3 03.00-04.10

Presentation on Human Resource Issues and Quality of Care of Maternal, Newborn and Child Health Services Time Organisation 03.00-03.10 DGHS 03.10-03.20 ICDDRB 03.20-03.30 ICDDRB

03.30-03.50 Question and Answer Session 03.50-04.10 Panel Discussion 04.10-05.30 Closing Session Moderated by Dr. Halida

Hanum Akhter, Director General, FPAB Time Agenda Responsible

Person 04.10-04.20 Sum up Dr. Hashina

Begum, Head, Social Franchising and Quality Assurance, SMC

04.20-04.50 Declaration/Oath Taking

Dr. Halida Hanum Akhter, Director General,

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FPAB 04.50-05.00 Closing Remarks Honourable

Advisor, Ministry of Woman and Child Affairs

05.00-05.30 Performance by Ornob