MaMoni Health Systems Strengthening Activity - pdf.usaid.gov
77
MaMoni Health Systems Strengthening Activity (USAID Cooperative Agreement AID-388-LA-13-00004) Quarterly Report April 01– June 30, 2017 Submitted August 4 2017 Joint Efforts to Restore Confidence in Health Care Delivery System Char Folcon Union Health & Family Welfare Center (UH&FWC) – the image of transformation
MaMoni Health Systems Strengthening Activity - pdf.usaid.gov
MaMoni HSS FY16 Q3 Quarterly Report(USAID Cooperative Agreement
AID-388-LA-13-00004)
Submitted
Joint Efforts to Restore Confidence in Health Care Delivery
System
Char Folcon Union Health & Family Welfare Center (UH&FWC) –
the image of transformation
This document is made possible by the generous support of the
American people through the support of the Office of Population,
Health, Nutrition and Education, United States Agency for
International Development (USAID), Bangladesh (USAID/Bangladesh),
under the terms of Associate Cooperative Agreement No.
AID-388-LA-13-00004 through Maternal and Child Health Integrated
Program (MCHIP). The contents of this document are the
responsibility of the MCHIP Project and do not necessarily reflect
the views of USAID or the United States government.
Cover Story:
Char Folcon Union is a rural community in Komolnagar Upazila of
Lakshmipur district. The Union Health and Family Welfare Center
(UH&FWC) was established in 1982 by DGFP of MoH&FW. Since
the UH&FWC is the closest access point for health services for
the community, its functionality is critical for saving lives and
serving the community, particularly women and children who are
under privileged and the most vulnerable. Previously, services at
the facility were very poor due to scarce resources, limited
availability of health workers, and poor quality of care. It was
not unusual to find the facility locked and ill-equipped to provide
services for maternal emergencies, including stock-outs of key
consumables that are life-saving during such emergencies. To
compound the situation, the center had very poor infrastructure,
including a leaky roof, broken windows, and cracked walls and
ceiling; there was also no access road, power, or water supply.
This unsanitary situation in the clinic was worsened by the lack of
a functional residence and toilet facility for service providers,
making it difficult to ensure staff were available to attend
maternal and newborn emergencies.
The MaMoni HSS program set out to transform this facility into a
functional facility where the community could expect to receive
quality care and services. As a first step and to ensure the
initiative was locally driven and supported, the program conducted
an assessment of the facility in collaboration with local
government. Identified needs included facility upgrading, staff
capacity development, and community engagement. MaMoni HSS has
worked hard with local government, facility leadership and the
community to address these needs, with the following
achievements:
• Facility & Infrastructure Upgrades - The approach road and
the infrastructure were reconstructed, and power and water supplies
were ensured by installing solar panels. In support of this effort,
the Char Folcon Union Parishad allocated a budget of 202,000 BDT
(do you want to include approximate value in USD?) for the approach
road, facility renovation, delivery bed and kits during the 2014-15
fiscal year; a budget of 122,000 BDT for the solar panel in the
2015-16 fiscal year; and 30,000 BDT for furniture in the 2016-17
fiscal year. Additional investments came from MaMoni HSS, with
2,700,000 BDT for dumping pits, a residence for service providers,
and a deep tube well in year three of the program.
• Effectively Engaging Existing Institutions – Sufficient
quantities of relevant drugs and supplies were made available by
bridging DGFP and LG, and MaMoni HSS helped to reinforce the
UH&FWC Management Committee to engage with the community so
that needs and quality issues can be raised and addressed. Under
the leadership of UP Chairman, the committee meets bi-monthly at
the facility to address high priority issues. As a result,
significant improvements have been made in the ability of the
facility to apply basic infection prevention practices and
maternal, newborn, child health, and family planning (MNCH/FP)
standards of care.
“Before the renovation of the facility, patients expressed their
disgruntlement over the poor state of the facility infrastructure
and the environment and the poor quality and absence of services
arises from its condition,” she said. “But now, our clients are
happy and there is up-trend in the demand of services” - Shumi
Majumder, Sub-Assistant Community Medical Officer (SACMO), Char
Folcon UH&FWC
The program’s initiatives and efforts towards the improvement of
the UH&FWC have converged to manifest outcomes that are
consistent with the initial goal of providing high quality services
that are well-utilized. Prior to 2013, the services provided at the
Char Folcon UH&FWC were very poor with low utilization levels.
But since the improvement initiatives began, service utilization
has increased dramatically from 1120 in 2013 to 2926 in 2017.
Furthermore, when 24/7 services began at the facility in 2013,
there were no normal deliveries recorded at the center, but usage
since then has increased dramatically, with 251 normal deliveries
in the first half of 2017 alone.
“We the people are happy because of 24-hours service, improved
facility, and well trained & well-behaved smiling doctor apa
are available for us,” says Mr. Abdul Khaleque, husband of Mosammat
Selina Akhter, a mother who received delivery care and services
from the facility.
“I really appreciate the cleanliness of the facility which is much
far better from private clinics. I thank Allah and pray that they
will do more.” - Mother-in-Law of Marium Begum (a mother who
received services from the facility), Village Zazira, Char Folcon
Union.
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 3
TABLE OF CONTENTS
TABLE OF CONTENTS
....................................................................................................................
3
Way Forward:
.....................................................................................................................................
9 Introduction
.......................................................................................................................................
9
DATA SOURCES
................................................................................................................................
9
Program Results for the Quarter
................................................................................................
10
IR 1. Improve Service Readiness through Critical Gap Management
........................... 10 IR 2: Strengthened Health Systems at
District Level and Below .................................... 29 IR
3. Promote an Enabling Environment to Strengthen District Level
Health
Systems
..................................................................................................................................
39 IR4. Identify and Reduce Barriers to Accessing Health Services
................................... 39 Challenges, Solutions, and
Actions Taken
.......................................................................................
45
Appendix 1: Scope and Geographical coverage of the Mamoni HSS
program ............... 48
Appendix 2: DATA SOURCES
......................................................................................................
49
Appendix 3: Program Performance Indicators (April 2017–June 2017)
........................................ 50
Appendix 4: Additional Indicators
....................................................................................................
66
Appendix 5: QIS ACTIVITIES
......................................................................................................
70
Appendix 6: News Clips Published During ……………………………………………………… 75
Appendix 7: Documentation and Dissemination of MaMoni Program
Learning ... Error! Bookmark not defined.
4 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
ABBREVIATIONS
ACS Antenatal Corticosteroid ADCC Assistant Director, Clinical
Contraceptive AUFPO Assistant Upazila Family Planning Officer AHI
Assistant Health Inspector AMTSL Active Management of Third Stage
of Labor ANC Antenatal Care APK Android package kit BCC Behaviour
Change Communication BEmONC Basic Emergency Obstetric and Newborn
Care BSMMU Bangabandhu Sheikh Mujib Medical University CAG
Community Action Group CBT Competency Based Training CC Community
Clinic CCSDP Clinical Contraceptive Service Delivery Program CDCS
Country Development Cooperation Strategy CEmONC Comprehensive
Emergency Obstetric and Newborn Care CHW Community Health Worker
CHX Chlorhexidine CIPRB Centre for Injury Prevention and Research,
Bangladesh CMPM Community Micro Planning Meeting CS Civil Surgeon
CSBA Community Skilled Birth Attendants CSI Clinical Severe
Infection CV Community Volunteer DDFP Deputy Director Family
Planning DGFP Directorate General of Family Planning DGHS
Directorate General of Health Services DH District Hospital DHIS2
District Health Information System-2 DN Death Notification DP
Development Partner EH Engender Health ENC Essential Newborn Care
EoP End of Project ETAT Emergency Triage and Treatment e-LMIS
electronic-Logistics Management Information System e-MIS
electronic- Management Information System FDR Facility Death Review
FP Family Planning FPCS-QIT Family Planning Clinical Services –
Quality Improvement Team FPI Family Planning Inspector FWA Family
Welfare Assistant FWV Family Welfare Visitor GOB Government of
Bangladesh HA Health Assistant HBB Helping Babies Breathe HEU
Health Economics Unit Hg Habiganj HI Health Inspector HPNSP Health,
Population and Nutrition Sector Program HR Human Resource HRIS
Human Resource Information System HRM Human Resource Management HS
Health Systems HSCS Health Systems Capacity Strengthening
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 5
HSS Health Systems Strengthening IDD Iodine Deficiency Diseases IEM
Information, Education and Motivation IFB Isolated Fast Breathing
IFA Iron Folic Acid IMCI Integrated Management of Childhood Illness
IP Infection Prevension IPHN Institute of Public Health Nutrition
IR Intermediate Result ISQUA International Society for Quality in
Health Care IUCD Intra Uterine Contraceptive Device IUD Intra
Uterine Death Jk Jhalokathi JSV Joint Supervisory Visit KMC
Kangaroo Mother Care LAPM Long-acting and Permanent Method LARC
Long-acting Reversible Contraceptive LG Local Government LMIS
Logistics Management Information System LOC Letter of Collaboration
Lp Lakshmipur MAM Moderate Acute Malnutrition MCWC Maternal and
Child Welfare Center MEC Medical Eligibility Criteria MFSTC
Mohammadpur Fertility Services and Training Centre MNCH/FP/N
Maternal, Newborn and Child Health, Family Planning, and Nutrition
MNH Maternal and Newborn Health MO Medical Officer MOCS Medical
Officer – Civil Surgeon MOH&FW Ministry of Health and Family
Welfare MOLGRD&C Ministry of Local Government Rural Development
& Cooperatives MOMCH&FP Medical Officer-Maternal and Child
Health & Family Planning MPDSR Maternal and Perinatal Death
Surveillance and Response MSCS Marie Stopes Clinic Society MSH
Management Sciences in Health MUAC Mid Upper Arm Circumference NGO
Non-government Organization Nk Noakhali NNS National Nutrition
Services NVD Normal Vaginal Delivery OBGYN Obstetrics and
Gynecology OGSB Obstetrical and Gynecological Society of Bangladesh
OP Operational Plan pCSBA Private Community Skilled Birth
Attendants PDCA Plan-Do-Check-Act PE/E Pre-eclampsia/Eclampsia PHC
Primary Health Care PHD Partners in Health and Development PIP
Program Implementation Plan Pj Pirojpur PM Program Manager PMMU
Planning, Monitoring and Management Unit PNC Post Natal Care PPFP
Post-partum Family Planning PPH Postpartum Hemorrhage PPIUCD
Post-partum Intra-uterine Contraceptive Device PRS Population
Registration System PW Planning Wing
6 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
QI Quality Improvement QIS Quality Improvement Secretariat QoC
Quality of Care RMO Residential Medical Officer RMNCH Reproductive,
Maternal, Neonatal and Child Health RRQIT Regional Roaming Quality
Improvement Team SACMO Sub-assistant Community Medical Officer SAM
Severe Acute Malnutrition SBA Skilled Birth Attendant SBCC Social
& Behavioral Change Communication SBM-R Standards-Based
Management and Recognition SCI Save the Children International
SCANU Special Care Newborn Unit SCMP Supply Chain Management Portal
SDP Service Delivery Point SIAPS Systems for Improved Access to
Pharmaceuticals and Services SOP Standard Operating Procedure SSN
Senior Staff Nurse TAB Tablet Computer TAG Technical Advisory Group
TB Tuberculosis UFPO Upazila Family Planning Officer UHC Upazila
Health Complex UH&FPO Upazila Health and Family Planning
Officer UH&FWC Union Health and Family Welfare Centers UNFPA
United Nations Population Fund UNICEF United Nations Children’s
Fund UP Union Parishad USAID United States Agency for International
Development USC Union Sub-centers WISN Workload Indictors of
Staffing Need WHO World Health Organization
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 7
EXECUTIVE SUMMARY During the third quarter of its fourth year, the
MaMoni HSS program continued with on- going activities for health
systems strengthening at the national and district level, with some
activities expanding at the national level and others under
consolidation at the district level. In addition, there has been a
renewed focus on SBCC activities in specific areas to improve
health behavior and practices of those communities.
Key accomplishments in this quarter include: SBA delivery:
Deliveries by skilled birth attendants has slightly increased than
last
quarter, total 28,568 deliveries were conducted by SBAs during the
reporting period, of them, 12 percent are in upgraded 24/7
UH&FWCs. The number of deliveries by pCSBAs has also increased
in this quarter (309 deliveries) than that of previous
quarters.
Specific newborn intervention revisits - In this quarter, phase two
of the specific newborn intervention (essential newborn care
including HBB and 7.1% CHX) revisits have been completed in 16
districts of Khulna, Chittagong and Dhaka Divisions. Phase 3 of the
revisits were initiated in 16 districts of Rajshahi, Chittagong,
Sylhet and Dhaka divisions. Data collectors from partner
organizations PHD and BSMMU conducted revisits in 868 facilities
and gathered data using the standard checklist.
7.1% Chlorhexidine for newborn cord care - Five divisional
dissemination meetings to share results of the post training
follow-ups on application of 7.1% Chlorhexidine were organized in
Chittagong, Barisal, Dhaka, Rajshahi and Rangpur divisions. The
post training follow-ups were conducted by independent monitors in
64 districts during August and September 2016.
Family planning orientations for health providers - Orientation of
DGHS managers and providers from district hospitals and the upazila
health complexes was held in all four MaMoni HSS districts on FP
and PPFP service delivery. The objective of these orientations was
to strengthen FP services at upazila and district level facilities
and to intensify coordination between health & family planning
departments.
Initiation of Plan-Do-Check-Act cycle for quality improvement - A
residential training on Plan-Do-Act-Check (PDCA) was held in
Rajendrapur targeting 4 district hospitals (Hg, Nk, Lp, Jk).
National level facilitators from the Quality Improvement
Secretariat (QIS) and MaMoni HSS staff at national and district
level who will facilitate the application of PDCA in their
respective districts participated in the training. Participants
were supported to develop a specific Quality Improvement (QI)
project to work on in their respective facilities. This included
the identification of specific improvement objectives, a root-cause
analysis of the selected performance gaps, identification of
counter measures, selection of indicators to measure progress, and
the development of a workplan. Moving forward, divisional and
district QI staff will monitor the progress of the PDCA process in
the four facilities.
Implementation of Human Resource Information System - MaMoni HSS is
supporting the implementation of the central HRIS at Habiganj and
Noakhali districts. A two-day training of trainers (ToT) on central
HRIS was provided to 64 participants in collaboration with the MIS
department of DGHS. One batch was organized at Habiganj and another
at Noakhali. After the ToT, statisticians and HIS coordinators
provided
8 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
training to 207 Community Health Care Providers (CHCPs) and
Sub-assistant Community Medical Officers (SACMOs) from all eight
upazilas of Habiganj.
Introduction of e-LMIS in additional districts - In coordination
with SIAPS, the project is supporting the MOHFW to introduce
electronic logistics management information system (e-LMIS) in
three additional districts (Hg, Nk, Jk) to improve recording,
monitoring, and availability of essential drugs, particularly MNCH
items. During the reporting quarter, the project conducted an
orientation of district level stakeholders in Habiganj, Noakhali,
and Jhalokathi districts on e-LMIS. Because the e- LMIS will be
linked to the national DHIS2 data, the project hired a consultant
to input health facility specific data into DHIS2 as an initial
step for implementing e-LMIS.
E-registers rolled out in Habiganj - In this quarter, maternal,
newborn, and child health (MNCH), family planning (FP), and general
patient and community e-registers were rolled out in all union
facilities of Habiganj. Supervisors/managers of Madhabpur upazila
have started using the e-MIS monitoring tool. The facility module
of the e-Register has been launched in Lakshmipur and
Jhalokathi.
Challenges and Mitigation Strategies:
As the project is approaching its end, the HR gaps filled by MaMoni
HSS need to be absorbed within the MOHFW cadres, or replaced by
MOHFW staff. For ensuring continuation of service the project has
initiated dialogue with local health managers and local government
for resolving this issue.
Every year, a good number of trainings are being conducted by
different programs but there is no formal system of follow up after
training and supportive supervision. MaMoni HSS strongly feels the
need and hence conducted follow-up after ENC training. The project
has now initiated dialogue with DGHS and DGFP for
institutionalization of training follow-up and supportive
supervision after critical technical trainings such as PPIUCD, EOC
etc.
MaMoni HSS has been in continuous dialogue with DGHS, DGFP, QIS and
other development partners for improving the quality of clinical
care at a large scale. Innovative approaches need to be tested to
encourage local ownership and leadership for quality improvement as
well as expanding the involvement of the local government in
problem solving and quality improvement.
Poor case admission and post discharge follow up of KMC as well as
poor day-8 follow up of PSBI cases remain as key challenges for
newborn health. In consultation with national and district health
managers, the project has plans to orient and engage union level
supervisors of public sector providers for the follow up of KMC and
PSBI cases at community level.
In order to reap the benefit of Mobile Camps in boosting LARC&
PM uptake, MaMoni HSS has initiated coordination with Mayer Hashi
II project and DGFP in order to ensure skilled human resource,
supplies, client referral etc. Moreover, In this quarter pace of
work was slow because of Ramadan and Eid festival in late May and
entire June. Also GOB managers were busy with closing of financial
year in June.
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 9
Way Forward:
Orient and engage union level supervisors in follow-up of KMC and
day-8 follow-up of PSBI.
Support coordination between health and family planning
directorates to ensure FP service provision by DGHS staff.
Coordinate with Mayer Hashi II project for effective utilization of
mobile camps. Monitor and document PDCA in 4 district hospitals.
Implement eMIS facility and community modules in Lakshmipur and
Noakhali and only
facility module in Jhalokathi. Linking eLMIS to DHIS2.
INTRODUCTION The MaMoni Health Systems Strengthening (HSS) project
is a five-year USAID-funded award1 aimed at improving utilization
of integrated maternal, newborn and child health, family planning,
and nutrition (MNCH/FP/N) services through a health systems
strengthening approach. In quarter 2 of the fourth year, MaMoni HSS
has continued to support the MOH&FW to strengthen health
systems at the national level as well as at district level. During
the reporting period, the program’s technical assistance at the
national level has expanded, at the same time that implementation
at the district level is under consolidation. However, during this
quarter low performance have been observed for many indicators,
most likely as a result of Ramadan and Eid festival in late May and
through June. The project supports 40 upazilas in 6 districts, 23
of them are designated as high intensity (HI) areas and the
remaining 17 as health systems capacity strengthening (HSCS) areas.
The scope and geographical coverage of the MaMoni HSS Project has
been summarized below. Program coverage is described in more detail
in Appendix 1.
Table 1. Summary of MaMoni HSS geographic scope
Area No. of Upazilas No. of Unions
Population (2015
17 (Bhola-7, Noakhali-5, Pirojpur-5)
Total 40 377 12,226,755 10 33 329 1,107
1The MaMoni HSS program is an Associate Award under the Maternal
and Child Health Integrated Program, with a period of performance
from September 24, 2013 to September 23, 2018. MaMoni HSS is
supported by Jhpiego—in partnership with Save the Children, John
Snow, Inc., and The Johns Hopkins University Institute for
International Programs. National partners include: International
Centre for Diarrhoeal Disease Research, Bangladesh; Dnet; and
Bangabandhu Sheikh Mujib Medical University (BSMMU). Save the
Children serves as the lead operational partner for the Award in
Bangladesh.
10 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
DATA SOURCES Program monitoring data for this report comes from
different sources, including a population based tracer survey (in
high intensity areas), a sentinel survey (selected facilities in
MaMoni areas), service delivery point (SDP) assessments (select
facilities in MaMoni areas), a revisit of specific newborn
interventions (14 districts nation-wide), and routine MIS of DGHS.
A list and detail on the scope of the surveys is attached as
Appendix 2.
PROGRAM RESULTS FOR THE QUARTER
IR 1. Improve Service Readiness through Critical Gap Management 1.1
Introduction and Scale-up of MNCH/FP/N interventions
1.1.1 Maternal Health The program’s major interventions in maternal
health are pregnancy identification & registration through
front line health workers, the provision of at least four antenatal
care (ANC) contacts with Quality of Care (QoC), birth planning,
promotion of, and increase availability and accessibility to
quality skilled birth attendance including active management of the
third stage of labor (AMTSL), distribution of misoprostol for home
delivery, and ensuring four postnatal visits, including the
promotion of post-partum family planning. There are also special
interventions in selected areas, such as the management of severe
pre- eclampsia & eclampsia through the administration of
MgSO4.
1.1.1. a. Pre-eclampsia/Eclampsia (PE/E) management at union level
facility: MaMoni HSS, in collaboration with the Obstetrical and
Gynecological Society of Bangladesh (OGSB), has introduced severe
pre-eclampsia and eclampsia management at the union level where a
loading dose of injectable Magnesium Sulfate (MgSO4) is
administered at the union level by Family Welfare Visitors (FWVs).
This intervention has been rolled out at 140 union level facilities
in 16 upazilas (5 upazilas in year 3 and rest in year 4) of 4
districts. In this quarter, need-based refresher trainings were
organized for union level service providers (FWV, Paramedics) of
Nabiganj, Companiganj, Ramganj, Raipur & Rajapur upazilas. The
purpose of the training was to refresh the knowledge of the service
providers on the identification and management of PE/E as per the
algorithm.
A total of 65 cases of severe PE/E patients (fig 1) were identified
and managed in this quarter. Senior OBGYN professionals from OGSB
continued their monitoring visits to provide on the job support to
the service providers in case identification and management.
Additionally, a
Practical session of refresher training on PE/E at UHC
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 11
meeting was organized with Population Council who is implementing a
similar study in other locations. It has been decided that MaMoni
HSS, Population Council and icddr,b will organize regular meetings
to share experiences and identify areas for performance
improvement.
Figure 1: No. of Severe PE/E cases identified and received pre
referral loading dose of MgSO4 in 16 upazila of 4 districts (Aug 16
–June,17)
Source: MIS-3, DGFP
1.1.1b. Misoprostol to prevent postpartum hemorrhage (PPH) at home
births
MaMoni HSS is facilitating the distribution of misoprostol tablets
to prevent PPH following home deliveries to pregnant women in their
third trimester via FWAs and FWVs. A total of 27,914 tablets were
distributed in this quarter (fig 2). The project also tracks
consumption of the tablets by the mothers immediately after birth
through tracer surveys every six months.
Figure 2: Trends in Misoprostol distribution in MaMoni HSS
districts
1 2
17
0
5
10
15
20
25
30
Aug'16 Sep'16 Oct'16 Nov'16 Dec'16 Jan'17 Feb'17 Mar'17 Apr'17
May'17 Jun'17
No. of SPE/Eclemsia identified by Service Provider No. of cases
(SPE/E) received loading dose of MgSO4
Monitoring field visit by Prof. Sabera Khatun from OGSB at Bamni
& Sonapur
UH&FWCs of Raipur Upazila
12 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
Source: MIS-4, DGFP
1.1.1. c. Increasing Skilled Birth Attendance (SBA) at the District
Level
A total of 28,568 deliveries were conducted by skilled birth
attendants (fig 3) during the reporting period. Of them 3,420 (12%)
were in upgraded 24/7 UH&FWCs (fig 4). Figure 3: Trends in SBA
deliveries in MaMoni HSS districts
Source: DGFP MIS 2 and 4, EmOC and CSBA report in DHIS-2, Project
pCSBA report.
11609
16191
14882 18386
N um
be r
SBA delivery in HI area SBA delivery in HSCS area
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 13
Figure 4: No of deliveries in 24/7 UH&FWCs in MaMoni HSS
districts
Source: MIS-3, DGFP
1.1.1. d. Private CSBAs (pCSBA) assisted deliveries The number of
deliveries by pCSBAs has slightly increased in this quarter (309
deliveries) than that of previous quarters (fig 5).
65 65
Q-2(FY-3) Q-3 (FY-3) Q-4 (Y-3) Q-1(FY-4) Q-2(FY-4) Q-3(FY-4)
No. of 24/7 UH&FWC No. of delivery
FWV of Jhalokathi MCWC is filling partograph during a delivery in
the facility
A happy mother with her baby just immediate after delivery at 24/7
delivery centre, Harni of Hatiya Upazila
14 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
Figure 5: Trends in deliveries by pCSBAs in MaMoni HSS
districts
Source: Project MIS.
In order to improve the quality of services and reporting, the
project organized the following trainings during the reporting
quarter: 1. Refresher training on reporting: To strengthen
reporting mechanisms and to increase
coordination of pCSBAs with GOB providers, MaMoni HSS organized a
refresher training for 11 pCSBAs.
2. Refresher training on ANC, PNC and Infection Prevention: MaMoni
HSS organized a refresher training on ANC, PNC and infection
prevention for FWVs and nurses in Noakhali and Jhalokhati districts
in May, 2017.
1.1.2 Newborn Health National Scale Up Activities: National
scale-up activities for newborn health are being supported by
MaMoni HSS implementing partners - Bangabandhu Sheikh Mujib Medical
University (BSMMU) and
95 93
Refresher Training on Reporting Mechanism and refresher Refresher
Training on ANC, PNC and
Infection Prevention
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 15
Partners in Health and Development (PHD) under the leadership of
the IMCI section of DGHS.
To follow up on support provided by MaMoni HSS for the national
scale up of Helping Babies Breathe (HBB) and 7.1% Chx for newborn
cord care, the program is supporting the MOHFW to conduct a revisit
of these two interventions. This activity includes:
- Identification and training of two medical officers (MO’s) from
each upazila as a newborn focal person
- Divisional and district level advocacy and planning meetings to
sensitize district/upazila managers about the importance of the
program, explain activities and make upazila wise plans as per
their directions.
- Refresher training of skilled birth attendants (SBAs) on
Essential Newborn Care including HBB and application of 7.1%
Chlorhexidine for cord care
- A revisit in all facilities in the district: this includes a
quick assessment of preparedness for newborn interventions with
respect to human resources, skills retention, facility readiness,
medicine and supply stocks (including 7.1% Chlorhexidine)and
replacement or provision of supplies for newborn resuscitation
equipment (bag, mask and sucker) in the facilities. The team also
records the number of live births, still births, total delivery, C
Sections, use of 7.1% CHX, number of preterm deliveries, number of
LBW babies, number of AMTSL, use of oxytocin and number of newborns
required resuscitation.
The national newborn and child health cell is providing management
support for this activity and it will be completed in phases. The
revisit in 16 districts (2nd phase) was initiated in February 2017
and completed by May 2017. Later in May, the revisit started in
another 16 districts (3rd phase). Gradually, all 64 districts will
be covered by this intervention with this phased approach.
1.1.2.a. Revisit of priority newborn interventions:
In this quarter, phase two of the specific newborn intervention
revisits were completed in 16 districts of Khulna, Chittagong and
Dhaka divisions (phase two districts include: Khulna, Bagerhat,
Jessore, Narail, Magura, Kustia, Chuadanga, Meherpur, Jhenaidah,
Satkhira, Rangamati, Bandarban, Khagrachari, Sherpur, Narsingdi,
Narayanganj). Activities under phase three of the revisit have been
initiated in 16 districts of Rajshahi, Chittagong, Sylhet and Dhaka
division (phase three districts include: Rajshahi, Bogra,
Sirajganj, Naogaon, Natore, Chapai Nawabganj, Joypurhat, Habiganj,
Noakhali, Lakshmipur, Jhalakathi, Faridpur, Shariatpur, Gopalganj,
Rajbari, Madaripur).
Data collectors from partner organizations PHD and BSMMU conducted
revisits in 868 facilities in this quarter and gathered data using
a standard checklist. Three district level advocacy meetings and
123 upazila level refresher trainings on a package of HBB & ENC
interventions (including application of 7.1% Chlorhexidine) were
organized for SBAs and CSBAs; a total of 2,427 providers received
the refresher training.
Table 2: Percentage of service and logistics available by types of
facility
Facility types Offer delivery HBB kit 7.1% CHX Gentamycin
Amoxycillin MgSO4 N
DH 100 78 89 67 33 28 18 MCWC 100 76 67 14 90 10 21 UHC 89 79 82 50
34 7 96 UH&FWC-FP 91 89 66 6 86 2 638
16 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
UH&FWC-H 94 97 57 31 91 3 35 USC 55 45 36 27 36 0 11 RD 74 77
45 0 42 0 31 Others 50 50 50 17 50 6 18
Total 89 86 66 14 77 3 868
Training Types n n % 7.1% CHX trained 5304 3966 75 HBB trained 4604
2258 49 Source: Revisit Survey, February to May 2017
1.1.2.b.Divisional Dissemination of post training follow-up of
application of 7.1% Chlorhexidine in newborn umbilical cord Five
divisional dissemination meetings on post training follow up of
7.1% Chlorhexidine for cord care were organized in Chittagong,
Barisal, Dhaka, Rajshahi and Rangpur divisions. The results of the
post-training follow up, conducted by 32 independent monitors in 64
districts during Aug-Sept 2016, were presented in these divisional
dissemination meetings. The presentations included the status of
human resources, skills and knowledge retention from trainings,
availability and use of 7.1% Chlorhexidine in all level of
facilities and pharmacies, and the availability, use, and
cleanliness of HBB equipment in all tiers of facilities. Divisional
and district level managers of health and family planning division
attended the meetings.
The post-training follow-up revealed that 86% of the respondents
(N=3400) who participated in the post-training follow-up received
orientation on ENC including application of 7.1% CHX in the
umbilical cord. At the time of the visit, 7.1% Chlorhexidine was
available in 53% facilities. Eighty-four percent providers could
demonstrate CHX use in right way and 47% of them reported applying
7.1% CHX in the newborn umbilical cord during the last week
preceding the revisit. Eighty-six percent providers advocated
pregnant mothers to use of CHX. It was also found that 7.1% CHX was
available in 54% private pharmacies. Independent Monitors also
found that bag- mask and sucker were available in 84% OT/ delivery
rooms. Bag-mask and sucker was found to be clean in 86%
facilities.
1.1.2.c. Mentoring workshop for Newborn Focal Persons in 21
Upazilas of MaMoni districts
Newborn focal persons were nominated by respective Civil Surgeons
in 21 high intensity upazilas of 4 MaMoni districts (Habiganj,
Noakhali, Lakshmipur, Jhalokathi). They were designated by the
Program Manager-IMCI section on behalf of the Director, PHC.
Doctors from DGHS who are interested to work on newborn and child
health and have some newborn related training were selected as
newborn focal persons. They were further oriented on new newborn
interventions and will be mentored by DGHS and BSMMU. MCH/FP
Medical Officers from DGFP in respective upazilas were also
oriented so that they can work in
Prof. Mohammod Shahidullah is delivering his speech in Dhaka
divisional meeting
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 17
coordination with the newborn focal persons. A total of 32 doctors
attended, 7 of them had attended the previous workshop last
year.
Participants were trained on Essential Newborn Care including HBB
and 7.1% Chlorhexidine for cord care, quality improvement, program
monitoring and record keeping & reporting. The newborn focal
persons will support their managers in rolling out newborn health
interventions in respective districts and upazilas including
monitoring the quality of training sessions. They will also
facilitate district and lower level training sessions as and when
needed, visit facilities to monitor the supply and performance of
health care providers, and provide on the job support for improving
quality of service. They will highlight relevant issues in
different meetings and forums and help support national level
policy and advocacy. 1.1.2.d. Other national activities through
National Newborn and Child Health Cell
MaMoni HSS provides regular and continuous technical support to the
national newborn and child health cell in the MOH&FW to carry
out its priority initiatives. During this quarter, the newborn and
child health cell has supported the Line Director for MNC&AH to
prepare the operational plan (January 2017- June 2022). As a part
of its routine activity, the newborn and child health cell
continuously supported the IMCI program manager (PM) to implement
IMCI as well as the revisit activity for specific newborn
interventions throughout the country. The national cell also
supported the scale-up of kangaroo mother care (KMC), emergency
triage and treatment (ETAT), sick newborn care and newborn sepsis
management.
The cell plays a leading role in the technical sub-committee that
reviews and updates the IMCI-N case recording form and online
reporting form. Along with the Challenge TB program of MSH, the
newborn and child health cell plays a vital role in fostering
inter-sectoral collaboration on childhood TB. The newborn and child
health cell also worked with the ‘National Coordination Cell’ to
arrange a consultative workshop on cervical cancer, fistula, and
the national newborn health program.
The newborn and child health cell has analyzed and circulated
Upazila specific ‘IMCI services and online reporting of 2016’ (IMCI
service related performance analysis) to all the concerned Upazila
Health and Family Planning managers. 1.1.2.e. Support for the
development of the Child Health Strategy:
The IMCI section of DGHS has initiated the development of a
national child health strategy. MaMoni HSS is participating in the
development process through contributions in the technical
sub-committees.
District Level Newborn Interventions:
1.1.2.f. Use of 7.1% Chlorhexidine for cord care to prevent newborn
infection As a part of the essential newborn care package, 7.1%
chlorhexidine application for cord care of every newborn has been
implemented as part of the national scale-up. MaMoni HSS has
provided targeted support in project districts for the national
roll-out. During the period of Apr-May 2017, a total of 15641
babies received 7.1% Chlorhexidine for newborn cord care. Of this
number, a total of 4913 were from Habiganj, 5852 from Noakhali,
4245 from Lakshmipur, 1684 from Jhalokathi, 3627 from Bhola and
2350 from Pirojpur.
18 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
Figure 6: Use of 7.1% CHX in DGFP facilities or by DGFP providers
by place of CHX application in MaMoni 4 districts (Oct'16 to
Jun'17)
Source: DGFP MIS Snapshots from DHIS2 (Fig 7 and 8) also show
increased use of CHX both in community and facility delivery. The
map of Bangladesh presented in Figure 9 shows use of CHX is
comparatively higher in 5 MaMoni HSS districts (46-68%), except in
Noakhali where it is between 29-45%. Figure 7: Percentage of
newborns delivered by SBA in the community who received 7.1%
chlorohexidine to the cord after birth
97 99 100 102 97 98
103 103 103
Pe rc
en t
CHX 7.1 used at facility delivery CHX 7.1 used at home
delivery
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 19
Figure 8: Percentage of newborns delivered by SBA at facility who
received 7.1% chlorohexidine to the cord after birth
Fig 9: Map of Bangladesh showing rates of 7.1% CHX
application
20 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
1.1.2.g. Management of sick children Sick young infant (<2 month
of age) management following the national guidelines has been
implemented out of 148 Union Health & Family Welfare Centers
(UH&FWC) in 4 MaMoni HSS districts. The Sub-assistant Community
Medical Officers (SACMOs) are the designated providers of this
intervention, with the Family Welfare Visitors (FWV) enabled and
authorized to provide a second dose of injectable Gentamycin for
the management of Clinical Severe Infection (CSI) cases where
referral has failed. MaMoni HSS has facilitated the training of all
the SACMOs and FWVs in the facilities that provide this
service.
To improve the 8-day follow up of PSBI cases by union level
supervisors such as the Family Planning Inspectors (FPIs), MaMoni
HSS supported the orientation of FPIs to conduct follow up visits
at the household level. A training of trainers (TOT) for twenty
master trainers (MTs) was completed in Lakshmipur and Jhalokathi
districts. These MTs will conduct the orientations of supervisors
at upazila level. During the period from Apr-June 2017, a total of
1351 sick children were managed from UH&FWCs in Habiganj (614),
Noakhali (236), Lakshmipur (268), Jhalokati (233) districts, the
categories of illness were Critical Illness (CI)-3%, Clinical
Severe Infection (CSI)- 6%, Isolated Fast Breathing (IFB)- 28%,
Local Bacterial Infection (LBI)-26%, Other- 38%.
Figure 10: Number of sick infants (<2 month) managed at the
union level in 21 upazilas of 5 districts during the Jan'16 -
Jun'17 period.
Source: Project MIS
Figure 11: Classification of sick infants (<2 months) presented
at the union level facilities in 21 upazilas of 4 districts during
the Jan'16-Jun'17 period.
474 396
719 640
376
CI CSI IFB LBI Other Total
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 21
Source: Project MIS
1.1.2.h. Kangaroo Mother Care (KMC) Kangaroo Mother Care (KMC)
units were established at 15 facilities (4 district hospitals, 2
maternal and child welfare centers (MCWCss), and 9 upazila health
complexes (UHC) of four MaMoni HSS implementation districts
(Habiganj, Noakhali, Lakshmipur and Jhalokati).
During the period from April-Jun 2017 a total of 46 cases received
KMC services in Hg(10), Nk(15), Lk(15),) from the KMC units. Short
duration of hospital stays and poor post discharge follow up are
the key challenges of this intervention. To address these
challenges, the MaMoni HSS program organized sensitization and
program review meetings with concerned personnel at 4 facilities.
To improve post discharge follow up of cases, the project is
supporting an orientation of union level supervisors (Assistant
Health Inspectors) of respective upazilas who will conduct the
follow up visits at the household level. A TOT of 22 master
trainers (MT) was completed in Lakshmipur and Jhalokathi districts.
These MTs will conduct orientation of supervisors at the upazila
level.
1.1.2.i. Antenatal Corticosteroids (ACS) for threatened preterm
labor MaMoni HSS has been supporting the use of Antenatal
Corticosteroids (ACS) in threatened preterm deliveries following
national guideline in 3 District Hospitals (Habiganj, Noakhali and
Lakshmipur). During the Q3 period of Apr-Jun 2017, a total of 114
eligible pregnant women received ACS from these hospitals (Habiganj
42, Noakhali 51 and Lakshmipur 21).
1.1.2.j. Facility based care for sick children Special Care Newborn
Units (SCANU) in five MaMoni HSS supported district hospitals
(Habiganj, Noakhali, Lakshmipur, Bhola & Pirojpur) have been
providing services to the community. The availability of dedicated
GOB manpower is the main challenge for service delivery in the
SCANUs. MaMoni HSS is supporting the capacity building of GOB staff
and has deployed trained staff nurses in Habiganj, Noakhali and
Lakshmipur district hospitals. During the April-June ’17 period, a
total of 15 doctors and 48 nurses received ETAT training in 3
batches. The project also supported training of 17 nurses in two
batches of on-the-job training for standard operating
233, 3% 536, 6%
Online Reporting Training
22 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
procedures (SOPs), sick newborn management at the SCANUs, online
reporting into DHIS- 2 and hands-on practice for use of equipment.
The trainings were conducted at BSMMU.
During the period April-June 2017 a total of 845 cases were managed
at 5 SCANUs, of them 145 at Noakhali, 113 at Lakshmipur, 465 at
Bhola, 102 at Habiganj and 20 at Pirojpur. Fig 12: Number of cases
managed at SCANU by district
During the period, the project also supported maintenance services
for SCANU equipment of in all project-supported SCANUs by a
technical expert. It may be noted here that the MNCAH Operational
Plan of MOHFW has kept a budget earmark for the maintenance of the
SCANU, but that will not be functional before 2018.
1.1.3 Family Planning 1.1.3.a. Use of modern methods of family
planning The utilization of various methods of family planning
remained almost the same since last year in all intervention
districts (Figure 13).
0 0 0
34 43 25
28 0
28 7 6 6 2 4 6 7 70 0 0 0 0
87
123
0
50
100
150
200
Sep' 16 Oct' 16 Nov' 16 Dec' 16 Jan' 17 Feb' 17 Mar' 17 Apr' 17
May' 17 Jun' 17
Noakhali Habiganj Laksmipur Pirojpur Bhola
Preventive maintenance and on the job coaching at Bhola SCANU
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 23
Figure 13: FP method mix from June 2016 to June 2017
Source: MIS-4, DGFP In this year MaMoni HSS focused on increased
coordination of DGHS and DGFP to intensify FP interventions,
especially long acting and reversible contraceptives (LARCs),
permanent methods (PMs), and post-partum family planning (PPFP) at
all service facilities. Health managers are not oriented on FP or
PPFP, and providers working under DGHS also don’t have adequate
skills to provide FP methods to clients despite an estimated 44%
unmet need for PPFP. MaMoni HSS is contributing to the scaling up
of FP services in general and PPFP in particular. The project is
putting a special emphasis on strengthening the capacity of
providers at health facilities managed by DGHS to ensure service
readiness and provision of care. In addition to strengthening DGFP
activities, a number of activities & interventions in this
quarter have been completed which are exclusive to DGHS. These are
as follows: A. Coordination meeting organized by the Clinical
Contraceptive Service Delivery
Program (CCSDP), DGFP, Dhaka: This is a regular meeting to develop
action plans and prioritize areas to reduce gaps identified in the
assessment findings for facility readiness on LARC & PM
services. An action plan was developed and a team has been formed
to work on the action plan.
B. Family Planning Counseling module: A national working group was
formed during the quarter, and includes members from DGHS &
DGFP, including representatives from MCH, CCSDP, Field Service
Delivery, the IEM of DGFP and PHC, and Hospital Services of DGHS,
as well as NGOs like Save the Children International, Marie Stopes
Clinic Society (MSCS) and EngenderHealth (EH) Bangladesh.
42 43 44 32 32 39 40 36 36 36 36 34 34
6 7 7
4 4 5 5 6 6 8 8 5 5
17 12 12 32 32 15 15 16 16 18 18 23 23
4 3 3 2 3
5 5 5 5 3 3 3 3 4
2 3 4 5
4 4 3 3
7 7 8 3 3 5
5 7 7
0 10 20 30 40 50 60 70 80 90
Jun-16 Jun-17 Jun-16 Jun-17 Jun-16 Jun-17 Jun-16 Jun-17 Jun-16
Jun-17 Jun-16 Jun-17
Standard Habiganj Bhola Pirojpur Jhalokati Noakhali
Lakshmipur
Pe rc
en t
Oral pill Condom Injectable IUD Implant NSV Tubectomy
24 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
C. Orientation of DGHS providers (DH & UHC) on FP service
delivery including PPFP: An orientation of DGHS managers and
providers from the district hospitals (DH) and upazila health
complexes (UHCs) was held in all four MaMoni HSS districts on FP
and PPFP service delivery. The objective of these meetings was to
strengthen FP services at upazila and district level facilities and
to intensify coordination between health and family planning
departments, including the provision of basic information on FP
services to the participants. The event was jointly organized by
MaMoni HSS and DGFP. Participants included the Upazila Health and
Family Planning Officer (UH&FPO),
Medical Officer – Civil Surgeons (MOCS), OBGYN Consultants, the
Residential Medical Officers/UHC’s, Senior Staff Nurses (SSN’s) and
were facilitated by the Medical Officers (MO) -Clinic, and the MOs
MCH-FP of DGFP.
Feedback from one health manager following the training included
the statement that, “This orientation will change the perception,
knowledge, and attitude of DGHS managers, as well as provider’s
roles and responsibilities on FP & PPFP”. The managers will
subsequently inform and build the capacity of other health service
providers in their monthly meetings for effective counseling and
skills building of providers to offer clients easy access to a wide
range of affordable, reliable, and good quality FP & PPFP
contraceptive services with a special focus on promotion of methods
like PPIUCD. A follow up meeting will be organized in each quarter
for intense liaison and communication between DGHS and DGFP
providers.
D. Training on FP policy changes & MEC wheel for Health &
FP Managers: Training on FP Policy changes and medical eligibility
criteria (MEC) wheels were organized in all four MaMoni HSS
implementation districts with the objective of informing health and
FP managers on recent updates of FP policy changes and Government
Orders (from 2010 to 2017) and their implementation status. These
updates aim to: - ensure that clients are able to make informed
decisions on FP - fulfill the huge unmet need of PPFP - promote FP
method acceptance - popularize LARCs & PMs - clarify the 2016
MEC wheel - refresh knowledge and skills on bottom up projection of
FP
The Deputy Director of Family Planning (DDFP) was the Chairperson
and the Civil Surgeon (CS) was the Chief Guest in these events.
Quality Assurance staff from CCSDP, DGFP, and the District Manager
of the QIS of HEU were the key resource people. Partners from
Engender Health facilitated the session on bottom-up projection of
family planning.
CS speaking on FP & PPFP counselling in Jhalokathi
Orientation of DGHS providers on FP and PPFP
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 25
Participants included the CS, MOCS, the Assistant Director Clinical
Contraceptives (ADCC), UH&FPO from Health department and
Upazila Family Planning Officer (UFPO), MO Clinic, Assistant UFPO
(AUFPO), and the MO-MCH in charge from the Family Planning
department. The training ended with the formulation of an action
plan for follow up and monitoring.
E. Interventions for increasing the coverage of LARC & PM in
MaMoni HSS districts:
• Competency based training of newly appointed MO MCH-FP: Three
batches of training on LARCs and PMs have been completed for the
newly appointed MOs (MCH- FP) of DGFP in Sylhet, Barisal and
Chittagong divisions under the direct supervision of CCSDP and with
coordination from the FPCS QIT and MaMoni HSS. The 18 day training
included lectures, dummy practice, and field camps designed to make
the participants competent and skilled on placing implants and
IUD’s, as well as tubal ligation and vasectomy. The training was
organized outside of Dhaka where more cases are available for
practice to further develop the participants confidence and skills.
Supportive supervision to the trainees will be provided by CCSDP
and the MaMoni HSS program and performance reviewed
intermittently.
• Facility readiness of DH, MCWC & UHC: A facility readiness
assessment of 4 DHs,
6 MCWCs and 22 UHCs was conducted to understand the current status
and areas for improvement to address low utilization of LARC and PM
services in MaMoni HSS areas. A structured checklist was used and
the findings were shared with CCSDP, DGFP during this quarter to
engage their support for infrastructure improvements, human
resource strengthening, logistics and supply management, capacity
development, infection prevention and improved QoC to increase
utilization and patient satisfaction. An action plan has been
developed for monitoring progress. CCSDP and MaMoni are jointly
trying to improve the facility for quality service delivery of
LARCs and PMs.
1.1.3.b. PPIUD performance
Two batches of basic training on IUCD and PPIUCD for Senior Staff
Nurses have been completed at the Mohammadpur Fertility Services
and Training Center (MFSTC), Dhaka during this quarter. All
participants were provided with a training manual and other
resources related to IUDs and PPIUCDs. Identifed challenges include
the lack of strong coordination between the Health and FP
departments regarding supply, reporting mechanisms, and fund
mobilization. To mitigate these barriers, the project is
coordinating between DGFP and DGHS at the national and district
level to ensure the availability of essential FP supplies and funds
needed to support services. MaMoni HSS also organized a two-day
refresher training on FP that included PPFP and PPIUCD for FWVs,
Female SACMOs, and Paramedics, with the objective to increase the
performances of FP and PPFP, and particularly PPIUCD in the
UH&FWCs. They received the initial training earlier through the
MaMoni HSS project with technical support from Engender Health,
Bangladesh. Fig 14 shows an increasing trend in PPIUCD performance
in Habiganj, Jhalokathi and Pirojpur districts.
26 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
Figure 14: Trends in PPIUD performance in MaMoni HSS
districts
Source: MIS-4, DGFP
1.1.3.c. Contribution of CSBAs and CVs in family planning The
numbers for PPFP counselling have slightly decreased both in high
intensity areas and health system strengthening areas (Fig 14) in
this quarter. Also the total number of LAPMs recipients has
decreased in this quarter, possibly because of Ramadan and the Eid
festival in late May and through June.
Figure 14: No. of women counseled on PPFP by CSBAs (Oct ’16 to Jun
’17)
92
188
32
N um
be r
1311 1198 1294 1542 1590 1672 1622 1466 1413
466 451 274
No. of PPFP counselling (HI) No. of PPFP counselling (HSCS)
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 27
Source: MIS-4, DGFP Though the total number of LAPM recipients has
decreased in this quarter, the contribution of Community Volunteers
(CV) has increased from 21 percent to 25 percent in this quarter.
(Fig 15).
Figure 15: CV contribution in LAPM performance Jan'16-Jun'17 by
quarter
Source: Project MIS
1.1.4 Nutrition Malnutrition is one of the most serious health
problems affecting infants, children and women of reproductive age
in Bangladesh, among others. Despite progress made, millions of
children and women still suffer from different forms of
under-nutrition, including low birth weight, stunting, underweight,
wasting, vitamin A deficiency, iodine deficiency disorders, and
anemia. The nutritional status of children is a proxy indicator of
the state of health of a community or population. With this status
in consideration, MaMoni HSS has been working in four districts
(Noakhali, Lakshmipur, Jhalokathi and Habiganj) under the directive
of the Institute of Public Health Nutrition (IPHN) and with the
district and upazila level health and family planning authorities.
MaMoni HSS has taken the initiative to develop skilled front line
health workers on primary nutrition screening and counseling at
household and outreach centers, which will help the program expand
coverage through active case identification and lower the burden of
malnutrition during the project life to strengthen the nutritional
landscape and support related objectives in the HPNSDP (2011-2016).
1.1.4.a. Logistic for Nutrition Screening:
MaMoni HSS facilitated the distribution of basic equipment and
supplies (50 Spring Scales, 50 Height/Length Boards, 500 MUAC
Tapes) for screening nutrition at Service Delivery Points (SDPs)
from IPHN.
1.1.4.b Service Statistics:
Data from DGFP MIS, DHIS-2 and Project MIS show the following
outcomes in MaMoni supported districts during this quarter:
5969 6066
1195
500
1500
2500
3500
4500
5500
6500
7500
Total LAPM CV contribution
28 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
151,910 children and mothers (31,607 mothers & 120,303
children) were reached with nutrition interventions from different
types of service delivery points (Community Clinics, UH&FWCs,
UHCs and DHs from where IMCI services are being provided)
37,490 caretakers received BCC interventions on essential infant
and young feeding practices, hand washing, IDD, Vit-A etc.
31,607 pregnant mothers were reached with Iron Folic Acid (IFA)
supplementation during ANC visits
1,726 children were identified who have been suffering from
MAM
314 children were identified as SAM patients and referred Among the
reached children about 14,670 (12.19%) children were identified
as
malnourished. Among them 4,943 were stunted (4.12%), 3,596 were
wasted (2.99%) and 6,131 were under weight (4.77%).
1.1.4.c. Management of acute malnutrition:
As per the national protocol, acute malnutrition is categorized as
Moderate Acute Malnutrition (MAM) where cases are traditionally
treated in the home and Severe Acute Malnutrition where cases are
referred for facility based management (SAM Unit/Corner at Upazila
Health Complexes and District Hospitals). These children get
therapeutic treatment as well as treatment for other co-morbidities
(complicated SAM). In therapeutic treatment the F-75 is used for
initial or ‘Stabilizing Phase’ and F-100 is used for ‘Catch-up’
phase. During the reporting period (Apr – Jun 2017), a total of 36
SAM patients were admitted into 10 SAM units of MaMoni HSS
supported project areas. At the end of the quarter 28 SAM patients
were discharged. Among them 10 were cured (27.77%), 11 were
discharged after stabilizing (30.55%), 7 (19.44%) left the facility
without completing the treatment and the rest 8 (22.22%) remained
in the facility for completion of treatment. 1.1.4.d. Monitoring
visits and performance review meeting: Two monitoring visits and
performance review meetings were organized and attended by the Line
Director of NNS and the Director of IPHN at Noakhali and Lakshmipur
districts. The visits were held in the Upazila Health Complexes,
Union Health & Family Welfare Centers and Community Clinics.
After the visits the Deputy Program Managers (DPMs) met with
District and Upazila level managers and reviewed the district
performance. During the visits and performance review meetings the
DPMs discussed the nutrition activities in the respective districst
and way forward for mitigating current bottle necks.
28%
31%
19%
22%
Representatives from IPHN visiting Nutrition activities at UHC,
Ramganj, Lakhsmipur
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 29
1.2 Management of critical human resource gaps of GOB service
providers:
Table 3: Critical human resource gaps filled-in by MaMoni HSS
D is
tr ic
ac an
O B
V ac
an cy
fi lle
d up
b y
M aM
on i
Noakhali 165 0 0 18 0 2 67 0 0 6 0 0
Lakshmipur 71 0 0 10 0 0 48 0 0 4 0 0
Habiganj 92 0 12 27 2 24 54 0 13 5 0 0
Jhalokathi 74 0 0 7 0 2 0 0 0 0 1 0
Total 402 0 12 62 2 28 169 0 13 15 1 0
MaMoni HSS is currently supporting 12 FWAs, 28 FWVs, and 13 nurses
to fill in the critical human resource gaps of GOB service
providers. The decisions for filling such vacancies are made
through local level discussions with district/upazila
managers.
IR 2: Strengthened Health Systems at District Level and Below The
MaMoni HSS program is implementing a comprehensive quality
improvement strategy to support the MOHFW at the national and
district levels to improve the quality of clinical care for
MNCH/FP/N services. The project’s QI strategy comprises of three
main components:
• National level support to QI efforts; • Improving service
delivery of MNCH/FP/N services; and • Measurement of QI indicators
and recognition of achievements for QI.
The progress in improving the quality of clinical care during Year
4, Quarter 3 of the project is summarized below:
2.1.1. Supporting the national Quality Improvement Secretariat
(QIS):
During the reporting quarter, MaMoni HSS continued its support to
the QIS in implementing the national QI strategy and aligning it
with WHO MN QI Framework. The project’s seconded staff at the
national and division level continue to provide vital assistance to
the QIS in implementing the QI interventions nationwide. In
addition, MaMoni HSS has provided assistance to the QIS in the
following areas:
• Curriculum development and training on Plan-Do-Check-Act (PDCA):
The residential training, held in Rajendrapur on May 7-9, 2017,
targeted 4 district hospitals (Hg, Nk, Lp, Jk). National level
facilitators from QIS and MaMoni HSS staff at national and district
level that will facilitate the application of PDCA in their
respective districts participated in the training. The outcome of
the training was the development of a DH specific QI project to be
implemented by DH members of the QIC in their respective hospitals.
The performance gaps selected for participating district hospitals
to address ranged from increasing service utilization for
deliveries and KMC, to improving crowd management and sterilization
of used instruments. Specific QI projects were developed including
identification of the specific “aim” for the improvement, root
cause analysis of
30 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
the selected performance gap, identifying counter measures,
indicators to measure progress, and developing a workplan.
• Developing National RMNCH QI indicators: The project contributed
to the national effort led by the QIS and with participation of
several international partners to develop RMNCH QI indicators based
on the standards included in WHO MN QI Framework.
• Developing National Patient Safety Guidelines: Based on QIS
request, the project has recruited a consultant to develop national
patient safety guidelines. The guidelines include several domains
such as: infection prevention, medication safety, patient
identification and procedure matching, clinical handover, blood and
blood product handling, and preventing pressure injuries.
• Developing QIS Communication Plan: the project is in the process
of recruiting a consultant to work with the QIS to develop a
communication plan to help advocate for QI at the national level,
increase ownership and interest in quality of care by service
providers, and engage community and other governmental and private
entities in QI.
Please see Annex 5 for a detailed description of MaMoni HSS QIS
supported activities.
2.1.2. Improving the quality of clinical care in stages:
The project continues to provide support to the district health
managers to improve the quality of clinical care provided by health
facilities in stages as follows:
• Stage 1: to improve the cleanliness, infection prevention, and
medical waste management;
• Stage 2: to improve sterilization measures and compliance with
antenatal care and newborn care services, and
• Stage 3: to improve compliance with all range of MNCH/FP/N
standards.
The following graph summarizes the progress in the number of
facilities succeeded in passing the first stage of QI.
Figure 16: Number of Health Facilities in 4 Districts Meeting
*Basic Infection Prevention Standards
Total Habiganj Noakhali Lakshmipur Jhalokathi
Total number of facilities 230 79 57 59 35
% with acceptable IP 33 42 21 37 26
*Basic Infection Prevention Standards=Cleanliness; Hand Washing;
Use of Gloves; Decontamination by 0.5% Chlorine Solution; Basic
Medical Waste Management.
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 31
2.1.3 Increasing local ownership of QI through establishing and
supporting QI committees:
MaMoni HSS continues to support the establishment and facilitation
of QIC at district, upazila, and health facility levels. Project
facilitation includes supporting QIC meetings, summarizing action
points, and following up on implementation for improvement with the
involvement of local government.
The table below includes an update on the status of the formation
and activation of QI Committees by district.
Table 4: Status of Quality Improvement Committee Formation and
Activation by District, May 2017
Number of QI Committees District
Habiganj Noakhali Lakshmipur Jhalokathi
Actually formed 86 42 54 35
Active (had at least 1 meeting in the last 3 months)
86 41 49 25
The project supports districts in developing monthly visit plans
and conducting joint supervisory visits (JSV) with district and
upazila supervisors. Supervisory visits take place using structured
supervisory checklists in the areas including: infection prevention
measures, service delivery management, ANC, nutrition, FP, newborn
and child health, IMCI, normal vaginal delivery, and postnatal
care. MaMoni HSS facilitation ensures that each supervisory visit
identifies gaps, action plan for improvement, and follow up on
results.
Table 5: Planned and Conducted Second JSVs by District (April -
June, 2017)
District
Habiganj Noakhali Lakshmipur Jhalokathi
Number of JSV Planned
49 62 06 24
Number of JSV Conducted
50 43 04 17
32 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
Table 6: Example of Joint Supervisory Visit (JSV) Observations and
Follow-Up Action Taken :
SL# Observations during visits Recommendations/ Action Taken
Facility
Date of Observat
ion Noakhali
01 a. Facility is not net and clean,0.5% chlorine solution and
autoclave are available
b. Performance board is not updated.
a. Ensure regular preparation of chlorine solution..
b. Ensure Performance board update regularly.
Kadirpur UH&FWC, Begumganj
02 a. Weight scale and b. IFA was not available
To ensure Weight scale and IFA regular Satellite Clinic.
Aleyarpur UH&FWC, Begumganj
03 a. No use of height scale, b. Inadequate hand
washing facility and c. Not maintaining privacy
for patients.
FWV noticed to use a. Height scale for ANC mother &
children
under 5 b. Arrange hand washing facility for interim
period and the concerned persons will take care to solve the
problem permanently and
c. Maintain the patient privacy as per guideline.
Arjuntola UH&FWC, Senbagh
3rd May’17
04 Delivery room is not eligible for conducting delivery due to
lack of power supply, spot light and electric ceiling fan.
Ensure supply of power, spot light and ceiling fan(s).
Dumuria UH&FWC, Senbagh
Suggested to take some steps for maintaining basic infection
prevention including hand washing. Follow up will be
continued
Char Clark UH&FWC; Subarnoch ar
7th Jun’17
for primary collection of waste
b. No waste management provision within the premise of the
facility
c. Performance board is not up-to-date
a. The other two color coded waste bins (yellow & black) need
to be provided
b. UFPO will sit with Union Parishad to address the issue to create
a permanent solution by constructing dumping pits.
c. The concerned FWV, SACMO & FPI have been instructed toupdate
it immediately and to continue doing so.
Bhadur UH&FWC; Ramganj
07 a. Pregnancy and EDD list were not updated
a. The responsible FWV was instructed by the UFPO to update the
list by getting information from FWA at Union Follow up
meeting
Char Mohona UH&FWC; Roypur
7th May’17
08 a. Color Coded bin was not available (yellow and black)
b. No dumping pit. c. Display board was not
updated.
a. The UHC store will be explored to see if bins can be provided
from there.
b. UFPO will sit with Union Parishad to address the issue to have
permanent solution by constructing dumping pits.
c. The concerned FWV, SACMO & FPI have been instructed to
update it immediately and to continue doing so.
Ichhapur UH&FWC, Ramganj
2.1.5 Supporting the implementation of Maternal and Perinatal Death
Surveillance and Response (MPDSR):
During the reporting period, MaMoni HSS continued to support the
QIS in scaling up of facility level MPDSR in Hg, Nk, Lp, Jk
districts. The capacity building initiative of Death Notification
(DN) and Facility Death Review (FDR) has been designed in two
steps. In the first step a TOT on DN and FDR were conducted with
the technical assistance of CIPRB
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 33
followed by cascading training of service providers at District
Hospital, Upazila Health Complex and MCWC. During the reporting
quarter, the following TOTs and trainings have been
completed:
TOT on DN and FDR :
District Category of trainees Number trained
Noakhali MOCS, OBGYN & Pediatric Consultant, Sr. Staff Nurse,
Sr. FWV, MO-Clinic, RMO/MO
36
2.1.6 Supporting CEmONC through Regional Roaming QI Teams
(RRQIT):
The project has been supporting the RRQIT as an additional
supervisory and mentoring team focused on monitoring and improving
the quality of CEmONC provided at the district level in Hg, Nk, Lp,
Jk. RRQIT includes OBGYN and neonatologist from medical colleges
close to the project districts as well as district level
supervisors. RRQIT visits are conducted using structured checklists
to assess general CEmONC infection prevention measures, delivery
services, readiness to provide CEmONC, and neonatal care including
SCANU. During the reporting quarter, the 4th RRQIT visit has been
conducted in Jk district hospital and MCWC. Based on the findings,
an action plan has been developed in coordination with the district
hospital service providers and quality improvement committee. The
RRQIT’s 4th visit included follow up on progress of implementation
of action points identified during previous visits. Table 6 below
summarizes results: Table 6: Progress in implementing RRQIT action
plan – Jhalokathi district:
Major findings from previous visits Improvement Dirty environment
& hospital floor in DH Basic Cleanliness of DH improved Only
one labor table was available in DH Two more labor tables supplied
in DH OT lights with fused bulbs OT light arranged Autoclave of
labor room was not functional Autoclave for labor room at DH
arranged
RRQIT visits to Jahlokathi DH delivery room RRQIT debriefing MCWC
staff
34 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
Major findings from previous visits Improvement Inactive QI
Committee at DH & MCWC Functional QI Committee at DH & MCWC
Poor medical waste management at MCWC Dumping pit at MCWC is under
process Only one MO-MCHFP in the district Posting of 4 new MO-MCHFP
in the district Post for nurse was vacant in DH Posting of 35 SSN
at DH, so a new maternal
complex has been designed No use of partograph & practice of
AMTSL for NVD at DH & MCWC
Use of partograph & practice of AMTSL for NVD at DH & MCWC
has been started
Nonfunctioning digital X-Ray & USG machine at DH
Functional digital X-Ray & USG machine at DH
Cesarean section at MCWC could be performed only on Sundays with
support from DH
Regular caesarian section in MCWC because of new MOMCH has
anesthesia training in sadar upazila
2.2 Support human resource for health
2.2.1 Workload and staffing needs assessment study The study on
“Workload and Staffing Needs Assessment at Public Sector Healthcare
Facilities” is in the final stage. The objective of the study is to
understand the existing workload of different cadres of health
workers at health facilities and at the community level. The study
has adapted WHO’s “Workload Indicators of Staffing Need” (WISN)
methodology to the Bangladesh context. The study includes one
medical college hospital (Rajshahi Medical College Hospital), two
district hospitals (Kushtia and Brahmanbaria), two MCWCs (Kushtia
Sadar and Brahmanbaria Sadar), four selected Upazila Health
Complexes (Daulatpur, Kumarkhali Nabinagar, Sarail), eight union
level facilities, and four Community Clinics and corresponding
community level workers of selected unions at Kushtia and
Brahmanbaria districts. A Technical Advisory Group (TAG) formed by
the MOHFW with representatives’ key departments of the ministry,
professionals and key stakeholders provided guidance and advice on
technical issues, methodology, and tools to expedite the study.
During the second phase of the study the workload components and
activity standards obtained from analysis of the first phase data
was shared with key persons at each facility for reconfirmation.
These were further fine-tuned by matching with findings from direct
observation of actual delivery of services. Relevant annual service
data were also collected from respective facilities. Data analysis
was done using WISN method. A draft report has been preparedand a
summary of findings will be shared with the TAG in the next meeting
and the report will be finalized incorporating comments from the
TAG. 2.2.2 Support implementation of the HRIS The central Human
Resource Information System (HRIS) is a web-based software
developed by the MOHFW for capturing human resources information of
all directorates/ agencies under the ministry at various levels
across the country. MaMoni HSS is supporting implementation of the
central HRIS at Habiganj and Noakhali districts. A two-day ToT on
central HRIS was provided to 64 participants in collaboration with
MIS department of DGHS. One batch was organized at Habigonj and
another at Noakhali. Participants were UHFPOs, Statisticians, HIS
coordinators and M&E Officers of MaMoni HSS project. Following
the ToT, statisticians and HIS Coordinators provided training to
207 CHCPs and SACMOs from all eight upazilas of Habiganj.
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 35
2.2 Monitoring and improving the availability of essential MNCH/FP
drugs:
2.2.1 Scaling up the implementation of electronic logistics
management information system (eLMIS), in coordination with
SIAPS:
In coordination with SIAPS, the project is supporting the MOHFW in
introducing electronic logistics management information system
(e-LMIS) in three additional districts (Hg, Nk, Jk) to improve
recording, monitoring, and availability of essential drugs,
particularly MNCH items. During the reporting quarter, the project
conducted an orientation for district level stakeholders in Hg, Nk,
and JK districts about the e-LMIS. Because the e-LMIS will be
linked to the national DHIS2 data system, the project hired a
consultant to input health facility specific data of the these
districts into DHIS2 as an initial step for implementing e-LMIS.
The project conducted district level orientation on e-LMIS for
health managers in Jhalokathi, Noakhali and Habigonj districts. The
purpose of this orientation was to refresh the district level GOB
manager’s knowledge on basic logistics management system, their
roles and responsibilities in improving LMIS status, the supply
chain management portal (SCMP) of MOHFW and the LMIS activity done
so far at each district. The MOCS facilitated the sessions and
MaMoni staff shared the overall concept on the scale up of e-LMIS
activity. The new e-LMIS is expected to improve essential drugs
stock monitoring, procurement processes, and to reduce stock
outs.
2.2.2 Supporting Sylhet Regional Warehouse, DGFP: The project LMIS
advisor provided technical assistance to the Sylhet Regional
Warehouse, of DGFP to review storage conditions, documentation
processes, and the condemnation process of expired drugs. The QIS
Sylhet team participated in the visit.
Jhalokathi district eLMIS orientation, Jhalokathi Civil Surgeon
Conference Room
Reviewing temperature maintanence and storage conditions, Regional
Warehouse, DGFP, Sylhet
36 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
2.2.3. Use of a color-coded system to monitor the availability of
essential drugs:
The project continued to provide support to Hg, Nk, Lp, Jk
districts to monitor availability of essential MNCH drugs and
engage district managers in using stock information to take action
to avoid stock-outs. This stock data monitoring is conducted by a
color-coded chart to simplify data interpretation and use. The
following is an example of the color-coded chart for tracking
misoprostol stock in DGFP store in Noakhali district from October
2016 to May 2017.
Noakhali district from October 2016 to May 2017:
Color-coded chart showing availability of Tab.Misoprostol 200 MCG
at DFGP stores, Noakhali district.
Green= stock available; Yellow = stock avaible, yet expiring within
6 months; Red = stock-out 2.2.4. Monitoring availability of MNCH
essential drugs at service delivery points:
As part of the joint supervisor visits, the stock of essential MNCH
drugs is checked and action is identified to avoid stock out. The
following box summarizes some of the action taken during the
reporting period to improve availability of essential drugs.
Examples of action taken to improve the availability of essential
MNCH drugs:
• MaMoni HSS facilitated moving Inj. Oxytocin from CS Store to
Rajapur and Kathalia UHC where NVD services are available.
• Facilitated the process of redistribution of 750 bottles of 7.1%
Chlorhexidine from Jk Health store to Barisal Medical College. The
expiration date was on 30 May’17. But as a result of
redistribution, the supplied amount of 7.1% Chlorhexidine were used
up.
• The food supplement (F-75 and F-100) was inadequate at SAM
corners of district hospital and Rajapur UHC of Jhalokathi district
early in the month of April, 17. After discussion with CS-
Jhalokathi, it was revealed that Pirojpur district had sufficient
stock. Through coordination with Pirojpur CS office, Zianagar UHC,
the DNSOs of unicef, 1 carton (90 sachet F-100) and 1 carton (120
sachet F-75) were distributed to the SAM corners of Jhalokathi DH
and Rajapur UHC.
• MaMoni facilitated the supply of 304 bottles of 7.1%Chlorhexidine
and 304 packs of Tab. Misoprostol (2 tab. in a pack, total 608 Tab.
Misoprostol) from DGFP to all Community Clinics of Sadar Upazila,
Lakshmipur in April and May, 2017 as there were no supply of
7.1%Chlorhexidine and Tab. Misoprostol from DGHS. These were given
to the mothers who did not receive those from the FWAs.
TAB. MISOPROSTOL 200 MCG (2 tab. = 1 dose) Sl No.
Name of the store
2 Companiganj 3 Hatiya 4 Senbag 5 Subarnochar
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 37
• Facilitated the replacement of nonfunctional HBB kits from DGHS
stores to different UH&FWC of Sadar upazila, Kamalnagar upazila
and Roypur upazila of Lakshmipur district in April and May,2017. In
Sadar upazila it was Khusakhali UH&FWC, Digholi UH&FWC,
Dalal Bazar UH&FWC and Dattapara UH&FWC. In Kamalnagar
upazila it was in Char Kadira UH&FWC, and Hajirhat UH&FWC.
In Roypur upazila it was in Sonapur UH&FWC, Charpata UH&FWC
and MCH-unit of Upazila Health Complex.
• Mamoni facilitated the supply of ARI Timer from DGHS to DGFP
UH&FWC level to roll out sepsis intervention after receiving
the training of DGFP SACMOs in Lakshmipur district and also there
were no supply from DGFP source. Total 28 pieces of ARI timer were
supplied, at Sadar upazila14 pieces, at Kamalnagar upazila1 piece,
at Roypur upazila6 pieces, at Ramgoti upazila 5 pieces and at
Ramgang upazila 2 pieces in May 2017.
• Facilitated the supply of IUD from DGFP to DGHS at district
hospital & Upazila Health Complex for PPIUD performance of
nurses in May 2017 after the training. (District Hospital 13,
Kamalnagar UHC 09, Roypur UHC 05, Ramgoti UHC 01, Ramgang UHC 02
total 30 pcs of IUD for PPIUD service)
• Facilitated the supply of Implant from DGFP Roypur upazila store
to DGFP Ramganj upazila store: 25 pcs in May, 2017 as there was
stock out in Ramganj.
• Facilitated the supply of one delivery table from DGFP Roypur
upazila store to DGHS Ramgonj Upazila Health Complex as there was
no delivery table available through DGHS supply.
• Facilitated the supply of 1000 bottles of 7.1%CHX from DGHS store
to cSBA (FP) and all UH&FWC, Chatkhil Upazila, Noakhali in
April 2017 to overcome insufficient supply from DGFP.
• Supplied HBB Kit from DGHS store to Harni UH&FWC of Hatiya
Upazila in April’2017 after establishment of new DGFP
facility.
• Facilitated the supply of around 500 unit of Inj. Oxytocin to
UH&FWC (24/7 Delivery Centers) from union parishad e.g. to
Durgapur UH&FWC (24/7 Delivery Centers) under Begumangonj
Upazila, Char Kakra UH&FWC under Companiganj Upazila, Jahajmara
UH&FWC and Char King UH&FWC under Hatiya Upazila,
Mohammadpur UH&FWC under Senbag Upazila. It was done in
April& May 2017 and will continue in future.
2.3. Monitoring quality of care (QoC) indicators in sentinel
sites:
During the reporting quarter, the project completed preparation for
conducting the third round of the QoC sentinel survey. This
included updating data entry tools, preparation of data entry
platforms, and training of data collectors and project district
staff. Four data collectors and 8 participants (Manager QA and
FCQA) were trained on new tools and the web based data entry
platform. Data collection started in Hg, Nk, Lp, Jk districts. In
this round of data collection a new tool for exit interviews with a
sample of postpartum women who delivered in the health facility
will be conducted to assess the client’s experience of childbirth
services. Data collection is ongoing in Noakhali, Lakshmipur,
Habiganj and Jhalokathi.
2.4 Routine Health Information Systems (RHIS)/eMIS Initiative
This quarter activities focused on the integration between FWV and
FWA modules of the e- register, enhancement of the monitoring
tools, and addressing feedback from the field level GoB
supervisors. Initiating the expansion of e-MIS to new districts is
one of the major milestone achieved this quarter.
38 MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report
2.4.1 Implementation and Support
A ToT on the facility module e-register has been completed for
Tangail and Lakshmipur districts. Following the ToT, the facility
module e-register training has been completed for Tangail district.
The reference document and manual for the e-register were
re-developed as per of icddr,b and MEASURE Evaluation’s
requirement. The developed hypothetical scenarios are embedded in
the manual are practiced during the training session.
The e-MIS design team is also helping to resolve implementation
issues of the FWA e-register throughout Habiganj and Tangail. Team
members are testing APK in TAB before releasing to the field and
are continuously monitoring e-MIS reports from unions using the
monitoring tool.
In this quarter, the MNCH, FP, General Patient, and Community
e-registers were rolled out in all union facilities of Habiganj.
Supervisors/managers of Madhabpur upazila have already started
using e-MIS monitoring tool and it will be replicated in the rest
of the upazila by next quarter.
A total number of 37 FWAs were trained on the FWAs e-Register. A
ToT on facility module e-register has been completed for Lakshmipur
district, and the UFPO and MO (MCH-FP) from Lakshmipur, HIS
Coordinators, IT Officers and M&E personnel from Lakshmipur and
Noakhali were trained on the module. All the Health ID cards are
printed for Madhabpur and almost 92% of the registered population
has received Health ID cards. In Lakhai upazila 60% of the Health
ID cards were printed and 40% of the registered population has
received HID cards. The GOB field workers are distributing the HID
cards during their HH visits and also counseling the community to
bring the HID cards during facility visits.
2.4.2. Development Activities:
In this quarter, more MNH and FP indicators have been added into
the monitoring tools. The team also incorporated GIS plotting for
all of the Habiganj facilities and started work on facility
plotting on the other five districts. A lot of feedback from the
field and other stake holders have been incorporated. Some of the
major changes include the ability to associate a single provider
with multiple facilities as they fill gaps, , enhanced search
facilities for faster performance and implant e-register. Facility
Registry table with Geo-Location has been developed. The newly
developed login tracking system with new screen allows tracking of
health providers with geospatial coordinates.
The team has completed the development of the implant e-register
and the permanent method register for family planning is near
completion. A lot of feedback from GoB officials have been
incorporated for the smooth flow of the system. Also lists of
pregnant women collected by the CHWs are now automatically being
reflected on the facility system.
2.4.3 Inauguration of e-MIS:
A district sensitization meeting on e-MIS has been completed in
Lakshmipur and Jhalokathi districts in this quarter. In Lakshmipur,
the Director General of DGFP graced the meeting as Chief Guest; the
Director of MCH Services, the Line Director of MC-RAH, the Line
Director of CCSDP, and DGFP were present at the meeting as special
guests. Participants from MaMoni HSS, district and upazila level
managers from DGHS and DGFP, local
MaMoni Health Systems Strengthening Activity: FY’17 Q3 Quarterly
Report 39
government members and officials, different NGO officials, and
journalists were also present in the meeting. The DG highly
appreciated the system and expressed his interest in seeing it in
practice where the system is already being implemented (Habiganj
District). 2.4.4. Visit of Government officials
Following his interest from the Lakshmipur Inauguration, the
Director General of DGFP, an officer of DGFP, and the MaMoni HSS
Chief of Party visited the Madhabpur upazila of Habiganj district
to observe the e-MIS field level activities during this quarter.
During his visit, the FWV demonstrated the various advantages and
features of the e-register as compared to the paper based register,
such as continuum of care and embedded medical intelligence for
risky categories. 2.4.5 Other activities:
1. The e-MIS team participated in the D4D Session in Hotel La
Meridian. 2. The eMIS team is also extending support to other
MaMoni activities. In conjunction
with a consultant, the team supported the development of the
Sentinel Survey forms during this quarter.
3. More indicators and improvements have been done for the eMIS
monitoring tool and it has been demonstrated to the MaMoni HSS team
and GoB officials. Their feedback is being incorporated for further
enhancement.
IR 3. Promote an Enabling Environment to Strengthen District Level
Health Systems 3.1 National level technical Assistance The Program
Management and Monitoring Unit of the Ministry of Health and Family
Welfare (MOHFW) has been playing a significant role in providing
technical support in management, monitoring and evaluation
functions of the HPN Sector Program, which is being implemented by
the MOHFW. The Program Management and Monitoring Unit (PMMU),
Planning Wing (PW), of the MOHFW consists of GOB officials, TAST
and an administrative support team consisting of 19 staff in
different positions, who are working for the PMMU/PW of MOHFW. As
an important partner to the Health, Population and Nutrition Sector
in Bangladesh, the MaMoni HSS program is associated with supporting
the MOHFW in matters related to policy formulation, health systems
strengthening, and program implementation through an LOC signed
between the MOHFW and MaMoni HSS to ensure the continued
availability of administrative and operational support.
MaMoni HSS has provided regular sa