Bangladesh has made significant progress to reduce maternal mortality in recent years. The Bangladesh Maternal Mortality and Health Care Survey reports that maternal mortality has declined from 322 per 100,000 live births in 2001 to 194 per 100,000 live births in 2010 and that Bangladesh is on track to achieving the Millennium Development Goal 5.
To accelerate this reduction, CIPRB has been operating various programmes through its Centre for Reproductive and Child Health.
– Maternal and Perinatal Death Review (MPDR)
The Maternal and Perinatal Death Review (MPDR) is an evidence based intervention undertaken by the government and initially piloted in Thakurgaon, Bangladesh in 2010. The Director General of Health Services (DGHS) in collaboration with the Director General of Family Planning (DGFP) under UNICEF – CIPRB partnership experienced for the first time a MPDR system within its health system.
MPDR is being implemented through district health and Family Planning units of the health system using field level staff and health care providers. The key activities include death notification (maternal, neonatal and stillbirth) both at community and facility level. The data has been used for death mapping and identifying death dense geographic areas for focused interventions. Verbal autopsies are conducted in all maternal deaths and a representative sample of neonatal deaths and stillbirths. From this the system is able to identify medical and/or social causes for those deaths. The process provides ample scope to the health managers and providers in planning and developing need based strategies and approaches for the reduction of maternal and perinatal deaths.
The experience in Thakurgaon was encouraging and effectively implemented. DGHS, DGFP, UNICEF, UNFPA, WHO, CIPRB and professional experts recognized its successful implementation with visibility and positive outcomes, and it was unanimously recommended for scale up. DFID and UKaid provided necessary funds for the project from 2010 to mid-2012 and the remainder of 2012 was funded by the Canadian CIDA. In October 2013 – September 2015 phase, the Department of Foreign Affairs, Trade and Development (DFATD) Canada extended their financial support to implement the intervention in 10 districts of Bangladesh including Thakurgaon, Jamalpur, Narail, Moulvibazar, Panchagarh, Sirajganj, Bagerhat, Netrokona, Bandarban and Cox’s Bazar districts of Bangladesh.
MPDR is covering a population of approximately 18 million people in 70 sub-districts under ten mentioned districts. The intervention is also covering 70 facilities at Upazila level (Upazila health complex), 10 district hospitals and 11 Maternal and Child Welfare Centers (MCWCs).
Implementation of Making it Happen 2 (MiH2) in Bangladesh
Bangladesh has made significant progress towards MDG 4 and 5. To accelerate reduction of maternal and neonatal mortality, the country needs to enhance access to skilled care during child birth and obstetric and neonatal complications.
The ‘Making It Happen’ programme aims to reduce maternal and newborn mortality and morbidity (MDG4 and MDG5) by increasing the availability and improving the quality of Skilled Birth Attendance (SBA) and Emergency Obstetric and Newborn Care (EmONC). Liverpool Tropical School of Medicine (LSTM), UK and CIPRB are jointly implementing the ‘Making It Happen-Phase 2’ (MiH2) programme (2013-2015) under the policy support and guidance of the Line Director, MNCAH, DGHS and Line Director, MCRAH, DGFP of the government. The Obstetrical Gynaecological Society of Bangladesh (OGSB) is also providing technical assistance. A national Coordination committee chaired by Line Director, MNCAH, DGFP was formed on 20th July 2013 and provides support and supervision.
The programme applied evidence-based training, using proven adult education techniques, together with improved supervision and data management. The LSS-EOC & NC training package was developed by LSTM and Royal College of Obstetricians and Gynaecologists in collaboration with the Department of Making Pregnancy Safer at WHO. The training programme will be implemented in the following hospitals and their referral medical college hospitals.
|Name of intervention districts||Population coverage(x 1000)||Govt. Hospitals at District level||Number of Upazila Health Complex (UHC)||Referral Medical College Hospital (MCH)|
|Panchagar||981||2 (DH, MCWC)||4||Dinajpur & Rangpur|
|Sunamganj||2,443||2 (DH, MCWC)||9||Sylhet|
|Sirajgong||3,072||2 (DH, MCWC)||8||Bogra|
|Borguna||882||2 (DH, MCWC)||4||Barishal|
|Potuakhali||1,517||2 (DH, MCWC)||6||Barishal|
|Bagerhat||1,461||2 (DH, MCWC)||8||Khulna|
The major MiH-2 activities include (i) Baseline survey for mapping HR and EmONC services (ii) Training of HCPs (iii) National capacity building (TOT) (iv) M&E in intervention hospitals (v) Quality of Care (QoC) (vi) Organizing workshop on Confidential Enquiry on Maternal Death.
As part of the programme already implemented a base line survey was undertaken in government hospitals (DH, MCWC, UHCs) of 6 districts and their referral 6 medical college hospitals on 22nd July, 2013. The baseline assessment recorded the current status of those facilities on availability and quality of EOC-NC care/services in addition to human resource mapping in maternal and neonatal health care.
The aim of MiH2 is to reduce maternal and new born mortality and morbidity by ensuring the availability of Emergency Obstetric Care (EOC) and new born care at facility level by skilled health professionals by training at least 80% of all EOC health care providers.