Devpro Resource Centre
Bangladesh’s Community Support Systems for maternal and newborn health
|© UNICEF Bangladesh/2008/Noorani|
|A woman with pregnancy complications arrives at Fatikchori Upazila Health Complex by auto rickshaw.|
Context and challenge: High rates of maternal and neonatal mortality; barriers to facility-based care
The South Asian nation of Bangladesh has a stable, growing economy, but the poorest and most vulnerable segments of the population are yet to benefit from this growth. Bangladesh is also vulnerable to the effects of catastrophic flooding and cyclones nearly every monsoon season.
The country has made tremendous strides in reducing child mortality; between 1990 and 2007, child mortality was reduced from 151 deaths per 1,000 live births to 61 deaths per 1,000 live births. But maternal and neonatal mortality rates continue to be a pressing health concern. Bangladesh is among the 25 countries of the world that account for the highest number of newborn deaths, and 1 in 51 women there will die from causes related to pregnancy and childbirth. According to the most recent estimates, the main reasons for these deaths are low rates of institutional delivery (15 per cent) and lack of skilled birth attendants, who are present at only 18 per cent of deliveries.
Efforts are under way to reinforce the health infrastructure with the capacity to provide essential obstetric care at the district and upazila, or sub-district, levels. Facilities are, however, still underutilized. Some barriers to the utilization of these life-saving services include a traditional preference for delivering in the home, inadequate information about existing health services, the financial burden of associated costs of maternal and newborn health care, including transport to a health centre and the price of medicines, and a gap in decision-making powers for women. In a survey on empowerment between 2000 and 2004, nearly half of Bangladeshi women respondents reported that their husbands alone make the decisions about their health.
Action: Linking communities with health centres to better serve pregnant women and new mothers
|© UNICEF Bangladesh/2008/Amin|
|A Jugnidha Community Support Group health worker conducts a regular checkup with a pregnant woman in her house.|
Through the Community Support Systems, communities coalesce to identify the key barriers to health care and to decide on the most appropriate interventions to address these. A pilot initiative was implemented in 2005 in 30 communities of six upazilas. In 2008, the project expanded to another 30 communities and now serves around 15,000 families.
Among the innovative programme activities that help bridge the gap between health facilities and women in need of crucial services:
- Each community support group member receives an identity card from the Upazila Health Complex signed by the Upazila Health and Family Planning Officer.
- The community contributes resources to pay for activities, and mobilizes blood donors as well as transport for bringing emergency cases to health facilities.
- Men are equal participants in community support groups and acknowledge the role fathers play in ensuring safe motherhood.
- Volunteers make household visits to identify pregnant women and inform them and their families about how to ensure safe motherhood, recognize the danger signs of pregnancy complications, make use of related services such as antenatal care, post-natal care and immunization, and seek medical attention to address the same in a timely manner.
- Pregnant women are issued a health card with details about their particular condition.
- Each woman who participates is provided with referral slips to consult doctors and health workers in the Upazila Health Complex and community-level satellite clinics.
- Volunteers communicate regularly with government health workers at the complex.
- Volunteers accompany pregnant women to health facilities in emergency cases.
- Agreements have been reached with local providers to ensure there is ready transportation – including boats, rickshaws and vans – to health centres.
- Communities have prepared maps and action plans, as have sub-districts.
- Courtyard meetings are organized at least once a month to orient families on the importance of birth planning, birth spacing, and recognizing the danger signs of pregnancy and newborn health.
- Communities celebrate ‘Safe Motherhood Day’.
Impact and opportunities: Community Support Systems bring innovation and improvement to maternal and neonatal health
|© UNICEF Bangladesh/2008/Noorani|
|Community elders and leaders discuss maternal health issues during the monthly support group meeting in Fatikchori Upazila.|
Since the Community Support System in Bangladesh has been in place there have been no reported maternal deaths in the 30 pilot communities. One factor in this success is that volunteers refer cases as soon as complications arise, thus, health facilities report that cases from villages where the Community Support System is in place are simpler to manage when compared to cases from other villages. Among other factors:
- Volunteers and community support group members are trusted by families.
- Linkages between communities and health facilities have been strengthened.
- Antenatal care has increased both in facilities and community-based health services such as community-level satellite clinics.
- Community Support Systems have grown to provide support for other maternal, neonatal and child health services such as nutrition and the Integrated Management of Childhood Illnesses.
- Advocacy has encouraged the Government of Bangladesh to incorporate the Community Support System initiative in all areas where basic and comprehensive essential obstetric care services are available.
There are opportunities for Community Support Systems to grow. To retain unpaid volunteers, support groups are looking towards developing income-generating activities and skills-based training. Opportunities to engage the participation of adolescent girls and boys are also present. And closer collaboration with the Bangladeshi Government could promote progress. The Ministry of Health Services, for example, could include information about the Community Support Systems, and the Government could incorporate the model in all those communities where basic, comprehensive essential obstetric care services are available.
3 February 2009
To learn more
UNICEF, The State of the World’s Children 2009: Maternal and newborn health, January 2009 | access report
UNICEF Bangladesh | website
UNICEF, The State of Asia-Pacific’s Children 2008: Child survival, 2008 | access report
WHO, Maternal Mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA, and The World Bank, 2007 | PDF English