Bangladesh has witnessed significant gains in increasing institutional delivery in recent years. In ten years ending in 2016, the percentage of births in health facilities increased from 23 percent to 47 percent (BMMS). This rise however masks a worrying trend - the private sector accounted for most of the increase with a paltry share going to the public sector. But, the private sector facilities are mostly based in urban and semi-urban areas, which signifies little improvement as far as access to institutional delivery is concerned for disadvantaged communities living in remote rural parts of Bangladesh.

USAID’s MaMoni Health Systems Strengthening (MaMoni HSS) Project is supporting the government to change that scenario. At a dissemination event titled “Improving institutional deliveries by strengthening public health facilities for 24/7 services”, the project shared its experience as to how this shift to institutional delivery was achieved in the public sector health facilities in Noakhali, Lakshmipur, habiganj and Jhalikathi districts. The Directorate General of Family Planning (DGFP) of the Ministry of Health and Family Welfare (MOH&FW) hosted the event with support from MaMoni HSS project.

The project put its focus was on to strengthening the public sector facilities, especially at the Union Health & Family Welfare Centers (UH&FWC), because they are closest to the communities and often the only health centers within the reach of the poorest and underserved communities in remote parts of the country. And in the three years between 2014 and 2017 the four districts saw substantial improvement -- births at the Union Health & Family Welfare Centers (UH&FWC) tripled between 2014 and 2017.

Joby George, Chief of Party, MaMoni HSS Project, in his presentation explained the innovative approaches the project undertook to increase the access and utilization of life-saving services, particularly before and during the time of delivery. The project facilitated collaboration involving the local government institutions, Family Planning Department officials and community groups in order to strengthen the UH&FWCs to mobilize additional resources and establish accountability for quality health services. In three years, the project thus helped over 100 UH&FWCs undergo facility upgrades, purchase necessary equipment and supplies, and hire staff to fill crucial vacancies in order to begin offering round-the-clock delivery services, Joby pointed out in his presentation. The number of deliveries in these facilities rose from just over 1,000 in 2013 to 15,500 in 2017. Overall, the rate of institutional deliveries increased from 25 percent in 2014 to 44 percent in 2017. The proportion of deliveries at the union level increased from less than one percent to over seven percent. Nationally, this proportion has always remained below one percent.

Mohammed Nasim, MP, Minister, Ministry of the Health and Family Welfare, as well as Chief Guest of the event, appreciated MaMoni HSS’ work and expected that this learning would help the government’s efforts to increase the availability and use of critical maternal and newborn health services in the public sector facilities across the country. He also asked the health managers, Upazila and Union Parishad Chairmen and service providers, who were invited as the champions of institutional delivery to the event, to speak about their work and how that helped to advance the cause of delivery services.

Dr. Kazi Mostafa Sarwar, Director General, DGFP, and Chair of the event, mentioned about the advocacy initiatives DGFP has been conducting to engage the local government representatives I strengthening the union level facilities in view of MaMoni HSS Project’s success. The government is committed to improving the maternal and newborn health services, he remarked adding that the 4th HPNSP OP had an allocation of 450 crore taka to upgrade 310 UH&FWCs.

Dr Mohammed Sharif, Director, MCH Services, DGFP, in his welcome speech mentioned the assessment of the union level facilities to determine their readiness to provide delivery care. MaMoni HSS supported the DGFP to onduct the study, which, Dr Sharif observed, informed the development strategy of these facilities.

Caroll Vasquez, Director of USAID’s Office of Population, Health, Nutrition, Education in Bangladesh, and a special guest of the event, spoke about USAID’s long-term support of Bangladesh’s health sector and reaffirmed the U.S. Government’s support for MOHFW initiatives to enhance maternal and newborn care.

Other Special Guests who addressed the event included Zahid Maleque, MP, State Minister, MOHFW, Faiz Ahmed, Secretary, Medical Education and Family Welfare Division, MOHFW, Professor Dr. Abul Kalam Azad, Director General, Directorate General of Health Services. Among others government officials from the MOH&FW, representatives from donor agencies, development partners, and media took part in the event.

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