A programme in Bangladesh trains community health workers to provide essential maternal and newborn care in remote villages.
Watch in RealPlayer
By Munima Sultana
On 13 September, UNICEF and partners reveal new numbers on global progress towards ending preventable child deaths. The organization’s 2013 Progress Report on Committing to Child Survival: A Promise Renewed, which examines trends in child mortality since 1990, analyses the main causes of under-5 deaths and highlights national and global efforts to save children’s lives.
A programme in three upazilas in Tangail district, Bangladesh, is training local women like Alo Rani Pal to provide essential maternal and newborn care – at village level.
TANGAIL DISTRICT, Bangladesh, 11 September 2013 – Alo Rani Pal’s days are quite hectic. Her work begins when the first villagers arrive in her courtyard, and, as the day progresses, she’s hardly free to do her own chores – until the last person leaves her home.
Alo Rani Pal allows her courtyard to be used as the Extended Programme for Immunization (EPI) centre of Pal Para village, in the Bashail upazila (sub-district) of Tangail district. Pregnant women, new mothers and children under the age of 5 gather at her home for their vaccinations.
Training a cadre of caregivers
In three upazilas of Tangail district, Alo Rani Pal and a number of other women, including midwives, have been trained with the goal to improve home-based interventions to provide essential maternal and newborn care through a cost-effective approach. The initiative was undertaken by the Directorate General of Health Services, Ministry of Health and Family Welfare under the UNICEF-funded project Tangail Maternal, Neonatal and Child Health Project. The upazilas were chosen because of low performance on certain indicators pertaining to maternal and newborn care.
Programme Manager Mainul Haque discusses one role that these newly trained caregivers can play in pregnancy and delivery. “As most of the complications during [pregnancy and delivery] could be avoidable, the community health volunteers are actually providing field-level support until they reach the institutional health care service providers,” he explains.
Community health worker Johra Begum says she and her colleagues can now easily identify a low-weight baby, anaemic mother and critical situations during childbirth and guide people to take prompt action to prevent other health complications – and death.
If a patient has complications, the community health volunteers refer her to the upazila health complex. In some cases, they will also arrange transport for them. A roster of suitable drivers is provided to the volunteers, under the project.
Kaki takes a decision
Since the training, Alo Rani Pal, along with colleagues Aleya, Johra Begum, Julekha and other community health volunteers, has been supporting the government’s effort.
Physicians check a newborn baby at Tangail General Hospital. One role of community health volunteers is to provide field-level support until patients can reach institutional health care providers like these.
“Now I understand how important the vaccines are for a pregnant woman and for newborn,” says Alo Rani Pal. “I also realize how a small or a prompt decision can avoid many unwanted complications for a mother or a baby and can save their lives,” she adds.
Alo Rani Pal – known fondly by the villagers as ‘Kaki’ (aunt) shares the story of a 7-day-old boy whom she saved by taking a prompt decision. She says that, on finding blood in the baby’s urine, she immediately sent the newborn to Tangail General Hospital.
“He is now a two-month-old healthy boy,” she says.
A community in the know
During a routine EPI programme conducted in March, villagers in Pal Para say they hardly forget their vaccine dates; they know which vaccines are necessary, and when.
“Kaki keeps us reminding all the time of our vaccines,” says Lota Rani Pal, a neighbour of Alo Rani Pal’s. Lota Rani Pal is pregnant, and today she is having an injection. “We think of her first when any emergency strikes,” she adds.
Villager Rani Begum says, “Kaki is welcomed everywhere irrespective of religious faith.” She credits Alo Rani Pal’s acceptance to her “caring nature towards all”.
“Even during their leisure,” adds Rani Begum, “these women go from door to door to have a chat with the villagers…So, they come to know about any development in a family very easily and are able to guide them in a timely manner.”
Expertise on site
Under previous government programmes, health assistants and health workers would often have difficulty serving their assigned working areas, which covered at least 4,000 people. The new community health volunteers can reach the mothers and children in the areas they cover, which include about 1,000 to 2,000 people.
It may be early to assess the success of community health volunteers. But, it is already clear that, by virtue of their accessibility alone, Alo Rani Pal, Johra Begum and their colleagues are becoming an important part of maternal and newborn care within small communities.
A Promise Renewed is a movement based on shared responsibility for child survival, and is mobilizing and bringing together governments, civil society, the private sector and individuals in the cause of ending preventable child deaths within a generation. The movement seeks to advance Every Woman Every Child — a strategy launched by United Nations Secretary-General Ban Ki-moon to improve the health of women and children — through action and advocacy to accelerate reductions in preventable maternal, newborn and child deaths.
Since its launch, 176 governments have signed the Committing to Child Survival: A Promise Renewed pledge, and thousands of civil society groups and private individuals have mobilized actions and resources in support of the goal. A diverse array of governments are setting bold new targets for maternal, newborn and child survival, while, around the world, civil society is increasingly holding governments accountable for their promises, facilitated by new communication technologies and tools.
A Promise Renewed recognizes that leadership, commitment and accountability are vital if we are to end preventable child deaths. And because child survival is increasingly recognized as a shared responsibility, everyone has a role to play.