mamoni health systems strengthening activity

MaMoni Health Systems Strengthening Activity

(USAID Cooperative Agreement AID-388-LA-13-00004)

Annual Report October 01 2016ndash September 30 2017

Submitted

November 07 2017

At the end of Year 4 we wanted to follow-up on some of the early cases of birth asphyxia that were managed in the field In March 2012 in Faridpur district Sakhina a Community Skilled Birth Attendant helped revive Rikta Begumrsquos baby Tayeeba Five years later our Field Officer Sarwar Hossain Topu visited Tayyeba and captured her story Photo A (on the left) taken in 2012 shows Tayeeba laying in her motherrsquos lap as Sakhina sits beside them while photo B (on the right) taken in 2017 shows a five-year old Tayeeba standing next to her parents

Cover photo credits Photo A ndash Unknown Photo B ndash Mr Sarwar Hossain BSMMU 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 (USAIDBangladesh) 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 Photo Story

A Most Beautiful Cry How Tayeeba Survived Her Day of Birth

Tayeeba the second child of Rikta Begum and Md Tara Mia is now five years old They live in a remote village of Ganibyaparir dangi of Sadarpur Upazila Faridpur district Tayeeba is not going to school yet but she has grown like a normal child of her age There was a chance that this asphyxiated babyrsquos cognitive development could have been compromised nevertheless she has memorized the Bangla alphabets numbers and rhymes and plays with her friends It is now incredible to imagine what this child went through in the first few hours of her life

It was March 9 2012 Tayeeba was not crying and had difficulty breathing after birth She could not move Fortunately Sakhina Begum a Community Skilled Birth Attendant (CSBA) who had just completed her Helping Babies Breathe (HBB) training was around Following the training Sakhina also received HBB kits to provide delivery-related assistance at home

When Rikta experienced labor pains her husband Tara Mia quickly called Sakhina Begum to their home Sakhina Begum first tried to clean the meconium from the mouth and nose of the newborn using a Penguin Sucker She then attempted to stimulate the baby by rubbing the babyrsquos back near its spinal cord However the baby did not cry so she started artificial ventilation using a bag and mask She managed to get through 40 rounds of artificial breathing per minute when all of a sudden the baby moved and cried

ldquoIf I hadnrsquot received HBB training I couldnrsquot imagine how I would have helped the baby survive such a serious condition at homerdquo Sakhina said with pride and joy

Tayeebarsquos mother Rikta Begum is grateful to Sakhina ldquoHad Khala (Sakhina Begum) not been around my child would not have survivedrdquo Rikta said For her third pregnancy Rikta has already ensured that Sakhina will be beside her when she delivers

Sakhina Begum has worked as a Health Assistant (HA) in her area since 2007 She received CSBA training for six months In February 2012 she received HBB training that was organized by the Integrated Management of Childhood Illnesses unit supported by the MaMoni HSS Project and funded by USAID She was promoted to the role of an Assistant Health Inspector (AHI) in the same year for her good performance

MaMoni Health Systems Strengthening Activity FYrsquo 17 Annual Report 3

TABLE OF CONTENTS

MaMoni Health Systems Strengthening Activity 1

Key accomplishments this year 7

Way forward 11 IR 1 Improve service readiness through critical gap management 13 IR 2 Strengthen health systems at the district level and below 44 IR 3 Promote an enabling environment to strengthen district level health systems 68 Appendix 1 Scope and Geographical coverage of the Mamoni HSS program 80

Appendix 2 Data Sources 81

Appendix 3 Program Performance Indicators 82

Appendix 4 Additional Indicators (Added in 2016) 92

APPENDIX 5 List of Union Facilities Upgraded 94

Appendix 6 News clips published by MaMoni HSS 98

Appendix 7 Forums where MaMoni HSS lessons were disseminated 102

Appendix 8 list of process documentation activities 104

4 MaMoni Health Systems Strengthening Activity FYrsquo17 Annual Report

ABBREVIATIONS AAP American Academy of Pediatrics ACS Antenatal Corticosteroid ADCC Assistant Director Clinical Contraceptive AHI Assistant Health Inspector AMTSL Active Management of Third Stage of Labor ANC Antenatal Care APK Android package kit BCC Behavior Change Communication BEmONC Basic Emergency Obstetric and Newborn Care Bh Bhola BR Birth Registration 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 Center for Injury Prevention and Research Bangladesh cMPM Community Micro Planning Meeting CNCP Comprehensive Newborn Care Package CS Civil Surgeon CSBA Community Skilled Birth Attendant 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 DO Development Objective DQA Data Quality Assessment ENC Essential Newborn Care EOC Emergency Obstetric Care EPCMD Ending Preventable Child and Maternal Deaths EPI Expanded Program on Immunization EoP End of Project ESD Essential Service Delivery eLMIS Electronic Logistics Management Information System eMIS Electronic Management Information System ETAT Emergency Triage Assessment and Treatment FDR Facility Death Review FP Family Planning FP-FSD Family Planning Field Service Delivery FPCS-QIT Family Planning Critical Supervision ndash Quality Improvement Team FPI Family Planning Inspector FSO Field Service Officer FWA Family Welfare Assistant FWV Female Welfare Visitor GIS Geographic Information System GoB Government of Bangladesh HA Health Assistant HBB Helping Babies Breathe HEF Health Economics and Financing HEU Health Economics Unit Hg Habiganj HI High Intensity HIS Health Information System HPNSP Health Population and Nutrition Sector Program


HPNSDP Health Population and Nutrition Sector Development Program HR Human Resource HNN Healthy Newborn Network HRD Human Resources and Development HRIS Human Resource Information System HRM Human Resource Management HRMU Human Resource Management Unit HS Health Systems HSCS Health Systems Capacity Strengthening HSS Health Systems Strengthening icddrb International Centre for Diarrhoeal Disease Research Bangladesh ICT Information and Communication Technology IDD Iodine Deficiency Disorder IEC Information Education and Communication IFA Iron Folic Acid IMCI Integrated Management of Childhood Illness Inj Injection IP Infection Prevention IPHN Institute of Public Health Nutrition IPC Inter Personal Communication IR Intermediate Result IUCD Intra Uterine Contraceptive Device IUD Intra Uterine Death Jk Jhalokathi Jhpiego Johns Hopkins Program for International Education in Gynecology and Obstetrics JSV Joint Supervisory Visit KMC Kangaroo Mother Care KOICA Korea International Cooperation Agency 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 LRP Labor Room Protocol MCRAH Maternal Child Reproductive and Adolescent Health MCHIP Maternal and Child Health Integrated Program MCWC Maternal and Child Welfare Center MEC Medical Eligibility Criteria MFSTC Mohammadpur Fertility Services and Training Centre MgSO4 Magnesium Sulfate MIS Management Information System MIS-FP Management Information System Family Planning MNCHFPN Maternal Newborn and Child Health Family Planning and Nutrition MNCampAH Maternal Neonatal Child and Adolescent Health MNH Maternal and Newborn Health MO Medical Officer MOCH Medical Officer Child Health MOCS Medical Officer Civil Surgeon MOHFW Ministry of Health and Family Welfare MOLGRDampC Ministry of Local Government Rural Development amp Cooperatives MO-MCH-FP Medical Officer-Maternal and Child Health amp Family Planning MPDSR Maternal and Perinatal Death Surveillance and Response NGO Non-government Organization NIPORT National Institute of Population Research and Training Nk Noakhali NNHP National Newborn Health Program NNS National Nutrition Services NTC National Technical Committee NVD Normal Vaginal Delivery OBGYN Obstetrics and Gynecology OGSB Obstetrical and Gynecological Society of Bangladesh OP Operational Plan OPHNE Office of Population Health Nutrition and Education


OT Operation Theatre PAC Post Abortion Care pCSBA Private CSBA PDCA Plan-Do-Check-Act PEE Pre-eclampsiaEclampsia PHC Primary Health Care PHD Partners in Health and Development PIP Program Implementation Plan Pp Pirojpur PM Program Manager PMMU Planning Monitoring and Management Unit PMP Project Monitoring Plan PNC Post Natal Care PPFP Post-partum Family Planning PPH Postpartum Hemorrhage PPIUCD Post-partum Intra-uterine Contraceptive Device PSBI Possible Serious Bacterial Infection PRS Population Registration System QI Quality Improvement QIC Quality Improvement Committees QIS Quality Improvement Secretariat QoC Quality of Care QPRM Quarterly Performance Review Meetings RHIS Routine Health Information Systems RMO Residential Medical Officer RMNCH Reproductive Maternal Newborn Child and Adolescent health RRQIT Regional Roaming QI Teams RTC Regional Training Center SACMO Sub-assistant Community Medical Officer SAM Severe Acute Malnutrition SARRC South Asian Association for Regional Cooperation SBA Skilled Birth Attendant SBCC Social amp Behavioral Change Communication SBM-R Standards-Based Management and Recognition SC Save the Children SCANU Special Care Newborn Unit SCMP Supply Chain Management Portal SDP Service Delivery Point SIAPS Systems for Improved Access to Pharmaceuticals and Services SIP Sector Improvement Plan SOP Standard of Protocols SPEE Severe Pre-eclampsia and Eclampsia SSN Senior Staff Nurse SWPMM Sector-wide Program Management and Monitoring Tab Tablet Computer TAG Technical Advisory Group TIS Tracer Indicator Survey ToT Training of Trainers TO Technical Officer UEHampFPSC Union Education Health and FP Standing Committee UFPO Upazila Family Planning Officer UHC Upazila Health Complex UHampFPO Upazila Health and Family Planning Officer UHampFWC Union Health and Family Welfare Center UNFPA United Nations Population Fund UNICEF United Nations Childrenrsquos Fund UP Union Parishads USAID United States Agency for International Development USC Union Sub-center WISN Workload Indictors of Staffing Need WIT Work Improvement Teams WHO World Health Organization


EXECUTIVE SUMMARY

The MaMoni Health Systems Strengthening (MaMoni HSS) project continued to support the Ministry of Health and Family Welfare (MOHFW) to strengthen health systems at the national and district levels During Year 4 the programrsquos technical assistance at the national level and implementation at the district level were under consolidation The project currently supports 40 upazilas in 6 districts 23 of which are designated high intensity (HI) areas and 17 of which are health systems capacity strengthening (HSCS) areas At the district level MaMoni HSS continued to support the scale-up of priority Ending Preventable Child and Maternal Deaths (EPCMD) interventions and to improve the quality of facility-based care

Key accomplishments this year A National level accomplishments

MaMoni HSS has been actively engaged in supporting the MOHFW in the development of the fourth Health Population and Nutrition Sector Program (HPNSP 2017-22) and its related Operational Plans (OPs) The priority areas advocated by MaMoni HSS have been incorporated in OPs along with allocation of government budget for implementation MaMoni HSS continued its formal support to the Planning Wing of MOHFW to provide operational and management support for the coordination and sector-wide management of the OPs

During Y4 the project facilitated post-roll-out follow-up of essential newborn care (ENC) including 71 chlorhexidine (CHX) for newborn cord care and Helping Babies Breathe (HBB) through a revisit of priority newborn interventions The revisit included rapid assessment of skill retention availability of supply and stocks of 71 CHX and HBB equipment and skill refresher sessions The revisits in 46 districts (2811 facilities) of phase 1 phase 2 and phase 3 are completed From the revisits it has been observed that 49 percent of facilities have 71 CHX available and 81 percent of facilities have HBB kits available It was also found that 75 percent of facilities have trained staff on use of 71 CHX and 53 percent of facilities have staff trained in HBB These findings were shared through divisional meetings with the managers in all eight divisions so appropriate measures based on the findings could be taken to increase utilization of newborn health care services

In order to strengthen an effective monitoring system and follow-up actions for the managers the project provided technical support through the National Newborn and Child Health (NNHP) Cell to establish a newborn health dashboard in District Health Information System-2 (DHIS-2) As per the requirement from national level managers four major newborn indicators on 71 CHX use at facility number of asphyxiated babies successfully resuscitated using bag and mask PNC services within 2 days of birth and initiation of breast feeding within an hour after birth incorporated in newborn health dashboard into DHIS-2 and also included in monthly local health bulletin Accordingly the managers from upazila to national level can monitor the progress identify the gaps and take appropriate measures

The project 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 Maternal Newborn Child Health Family Planning and Nutrition (MNCHFPN) services


The project supported the national Quality Improvement Secretariat (QIS) to roll out the National Quality Improvement (QI) Strategic Plan During the year MaMoni HSS collaborated with other partners and stakeholders to support the development of a draft Reproductive Maternal Neonatal Child and Adolescent Health (RMNCH) Framework in alignment with the World Health Organizationrsquos (WHO) Quality of Care (QoC) Framework for maternal and newborn care Through QI specialists deployed at the national QIS and divisional levels MaMoni HSS supported the strengthening and capacity-building of QI implementation structures at the divisional district and sub-district levels By the end of Year four 41 districts out of the total 64 have functional QI committees These committees meet at least once every three months to review clinical service performances using district data and to identify and address critical quality gaps in service provision Model QI facilities are being supported by the project in Lakshmipur and Bhola districts MaMoni HSS provided substantial technical support to the MOHFW to finalize and approve maternal health standard operating procedures (SOPs) and the maternal health strategy These documents have now been approved by the national technical committee

MaMoni HSS supported the Human Resources Management Unit (HRMU) to conduct an assessment using the ldquoWorkload Indicators of Staffing Needs (WISN)rdquo The study findings were shared with the Technical Advisory Group (TAG) of the MOHFW The study will inform decisions related to human resource (HR) planning deployment and workload re-distribution The project supported the MOHFW to implement the Human Resources Information System (HRIS) in two MaMoni HSS districts which will now be extended to the other districts

In Q4 of Year 4 MaMoni HSS signed a letter of collaboration with the National Institute of Population Research and Training (NIPORT) to develop and implement a capacity development program for the community health workers to implement the new essential services package As part of this initiative an assessment of the institutional capacity of the Regional Training Centers (RTCs) has been completed The training modules for health workers supervisors and sub-district level managers are being developed

B District level accomplishments In order to track the service coverage MaMoni HSS has conducted six-monthly population-

based surveys known as Tracer Indicator Surveys So far six rounds of surveys have been completed in 23 high intensity upazilas Overall the survey data indicates a significant increase in the proportion of women who received antenatal care (ANC) skilled birth assistance (SBA) during delivery postnatal care (PNC) for mother and newborn and essential newborn care Facility delivery increased from round-I to Round-VI in Habiganj from 26 to 35 Lakshmipur from 30 to 41 Noakhali from 26 to 45 and Jhalokati from 39 to 49 respectively The coverage of modern contraceptive prevalence is almost stagnant in most districts with marginal improvements in all areas

During Year 4 a total of 33 Union Health and Family Welfare Centers (UHampFWCs) were strengthened in the six project districts to provide maternal and newborn health (MNH) services on 247 basis Thus the total number of 247 UHampFWCs in the project area has increased from 80 in Y3 to 108 in Y4 This has contributed to a significant increase in the number of deliveries conducted by SBAs from 92123 last year to 122330 this year which is 51 percent ofestimated deliveries in y4 and 39 percent in y3

In Year 4 MaMoni HSS continued to support 12 Family Welfare Assistants (FWAs) 40 ParamedicsFamily Welfare Visitors (FWVs) and 22 nurses to fill-in the critical human resource gaps of GOB service providers These efforts resulted in a large number of underserved population into MNCHFPN service coverage The project has continued to advocate with local leaders (Union Parishad Chairman and Members of Parliament) for


long-term solutions by filling the vacancies through government recruitment Meanwhile in Noakhali the Union Parishad (UP) of Charbata union has recruited paramedics in the UHampFWC using their own funds and in Rajganj union the Union Parishad is in the process of recruiting another paramedic

In collaboration with the Obstetrics and Gynecological Society of Bangladesh (OGSB) the project has introduced severe pre-eclampsia and eclampsia management at the union level where a loading dose of injectable Magnesium Sulphate (MgSO4) is administered at the union level by FWVs This intervention has been rolled out at 140 union level facilities in 16 upazilas of 4 districts In Year 4 a total of 291 pre-eclampsiaeclampsia (PEE) cases were identified and administered a pre-referral loading dose of MgSO4

As a part of essential newborn care 71 CHX application has been implemented in six project districts The use of 71 CHX in Year 3 was 32224 which increased to 77477 in during the reporting year During Year 4 project initiatives focused not only on increasing coverage but also on improving the quality of service delivery through capacity building availability of logistics and job aids and on the job coaching along with community awareness

MaMoni HSS has been implementing sick young infant (lt2 months of age) management following national guideline from 148 UHampFWCs in 4 project districts The intervention was only in union level facilities where there is a SACMO in Habiganj Noakhali Lakshmipur and Jhalokati districts In Year 4 a total of 5972 sick young infants were managed under this initiative

In Year 4 the project has strengthened family planning interventions in collaboration with the Directorate General of Family Planning (DGFP) Directorate General of Health Services (DGHS) and Mayer Hashi II project This year the project supported to finalize post-partum family planning (PPFP) counselling module of DGFP A total of 49 senior staff nurses from DGHS were trained in basic intra-uterine contraceptive device (IUCD) and post-partum intra-uterine contraceptive device (PPIUCD) and 66 FWVs received a two-day refresher on PPFP and PPIUCD This resulted in an increasing trend in the performance of PPIUCD in Year 3 from 1179 to 1785 in Year 4 MaMoni HSS also supported the training of 19 newly recruited Medical Officers on long acting reversible contraceptives (LARC) and permanent method (PM) services which contributed to the increase of LARC and PM performance from 47414 in Year 3 to 48308 in Year 4 in the project districts

Challenges and mitigation strategies Staff turnover in key management positions in DGHS and DGFP remained a major

challenge in the timely implementation of program activities For example the Director General of the DGFP changed twice while the Director-MIS in the same directorate changed three times within a year These key positions were also vacant for some time

The MOHFW has been recently divided into two divisions the Health Services Division and the Medical Education and Family Welfare division Each of the divisions will have one secretary This division has created uncertainties because of a lack of clear guidance on operational mechanisms MaMoni is closely observing the changes and will adapt strategies accordingly

A chronic shortage of human resources at service delivery points also hinders all project activities particularly in improving the quality of health care MaMoni HSS is facilitating the better use of available human resources the project also fills-in the critical human resource gaps of GoB service providers on a temporary basis while continuing to advocate


with local leaders for long-term solutions by filling the vacancies through GoB recruitment Simultaneously the project advocates with the government for newly recruited staff to be posted in underserved areas with major human resource shortages As the project is approaching its end it is important to engage with the MOHFW to ensure that the paramedics will be absorbed within the MOHFW cadres or replaced to ensure continuation of services in the health facilities where paramedics are currently working

Frequent stock outs of essential MNCH drugs is another challenge The project is

building the capacity of local managers to monitor the availability of essential drugs and is taking local measures to avoid stock outs through routine tracking of the supply chain management portal (SCMP)

The coverage of the use of misoprostol for home deliveries remains low and below the target This is primarily due to interruptions in the national procurement and distribution of misoprostol and due to the increasing number of vacancies of FWAs who are responsible for home-based distribution of misoprostol

The establishment of QI committees has been a positive step in increasing the staff

capacity in identifying gaps and implementing actions to address them There are encouraging examples of QI committees that have been able to solve local problems and engage local government in resource mobilization However they still require significant facilitation by project staff and need to develop ownership of the program

There has been significant progress in updating clinical standards guidelines and

training in the past year but the implementation of interventions leading to improvement of the quality of clinical care at health facility levels needs to be strengthened MaMoni HSS is exploring innovative approaches to encourage local ownership and leadership for quality improvement

A good number of trainings are being conducted by different programs but there is no

formal system of follow-up after training or supportive supervision MaMoni HSS has supported post-training follow-up after ENC training (71 CHX and HBB) MaMoni HSS has initiated dialogues with the DGHS and DGFP for institutionalizing follow-up training and supportive supervision after each technical training as these are important for skills retention and quality of care

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 MaMoni HSS has arranged sensitization meetings and mentoring visits in implementation districts by national level managers and professionals The project also plans to orient and engage union level supervisors of public sector for the follow-up of KMC and PSBI cases at community level Orientation of Assistant Health Inspectors (AHI) of DGHS and Family Planning Inspectors (FPI) of DGFP have been planned for ensuring day-8 follow-up of PSBI and post-discharge follow-up of KMC

There is a need to improve the preparation organization and utilization of mobile camps

for LARC and PM MaMoni HSS is playing an active role in coordinating mobile camps with national level and district level partners and health managers The purpose is to ensure availability of skilled service providers and supplies strengthening health facility readiness and strengthening community utilization of services provided by the mobile camps


Way forward In Year 5 MaMoni HSS will continue to provide support to the MOHampFW in strengthening health systems at the national level and to serve as a strategic partner for the government to implement the priorities identified in the new sector plan In the upcoming year the project will expand the technical assistance role at the national level while consolidating the implementation at the district level At the national level MaMoni HSS will continue to work closely with the MOHampFW through the DGHS and DGFP the Ministry of Local Government Rural Development amp Cooperatives (MOLGRDampC) as well as key development partners MaMoni HSS held extensive consultations with the Planning Wing and the Program Monitoring and Management Unit (PMMU) of the MOHampFW and the relevant Operational Plans of DGHS and DGFP to identify the priority areas for technical and management support at the national level Some of the major focus areas for implementation are

bull The workload and staffing need assessment study findings will be disseminated and policy briefs will be developed The project will provide support to the Health Service Delivery (HSD) for capacity strengthening on central Human Resource Information System (HRIS) National level stakeholder workshops on HRIS will be organized monitoring guidelines developed and data quality assurancecontrol (DQA) mechanisms will be developed in collaboration with DGHS and DGFP Capacity of DGFP staff will be developed to facilitate regular updates to HR data in the HRIS at upazila and district level (DGHS and DGFP)

bull In Year 5 the project will facilitate the establishment and operationalization of the decentralized QI management structures at sub-national levels and provide technical assistance to the development and updating of national guidelines protocols and tools to support the implementation of the national QI strategy The national guidelines for infection prevention hygiene practices and patient safety will be updated The WHO-MNH QOC framework will be piloted in Narshingdi district Line Directors and Program Managers of Hospital Services Management unit of DGHS participated in different workshops The documentation of the QI initiative led by MOHFW and supported by various partners will be completed

bull Continue the remaining design of facility-level modules of the automated electronic management information system (eMIS) as well as support the national scale-up Both community and facility modules will be implemented in Habiganj Noakhali and Lakshmipur and only the facility module will be implemented in Jhalokathi

bull Support the establishment of three special care newborn units (SCANUs) one in Khulna Shishu Hospital and two in national level facilities of the DGFP

bull The project will also develop the information and communication technology (ICT) capacity of NIPORT and help in digitalize the training database Both the national level and regional level facilities will be upgraded with modern ICT equipment enabling innovative ways to deliver trainings The project is also supporting the review and revision of the existing Team Training Curriculum of NIPORT and adapting it for community based workers (HA FWA and CHCP) training A Leadership and Management training curriculum for upazila health and family planning managers (UHFPO UFPO and MOMCH) is being developed by NIPORT under this project


INTRODUCTION

The MaMoni Health Systems Strengthening project is a five-year USAID-funded award1 aimed at improving utilization of integrated maternal newborn and child health family planning and nutrition (MNCHFPN) services in Bangladesh The projectrsquos objective is to increase availability and quality of high-impact interventions through strengthening district-level local management and health systems This objective is well-aligned with the Government of Bangladeshrsquos (GoB) Health Population and Nutrition Sector Program (HPNSP) 2017-2022 and its Sector Improvement Plan (SIP) 2016-2021 MaMoni HSS provides support and assistance to the Ministry of Health and Family Welfare (MOHFW) at national and district levels and directly supports the ldquoUSAIDBangladesh-Health Status Improvedrdquo Activity under the Investing in People Objective Health Project Area of the US Foreign Assistance Framework The four Intermediate Results (IR) of the project are to bull Improve service readiness through critical gap management bull Strengthen health systems at the district level and below bull Promote an enabling environment to strengthen district-level health systems bull Identify and address barriers to accessing health services The project has expanded the technical assistance role at the national level while consolidating the implementation at the district level The project supports 40 upazilas in 6 districts 23 of which are designated high intensity (HI) areas and the remaining 17 of which are designated health systems capacity strengthening (HSCS) areas

The scope and geographical coverage of the MaMoni HSS project has been summarized in Table 1 Detailed coverage has been included in Appendix 1 Table 1 Summary of the geographic scope of MaMoni HSS

Area Number of Upazilas

Number of

Unions

Population (2017

Projection)

Number of Health Facilities

DH MCWC UHC UHampFWC USC CC

High Intensity Areas

23 (Habiganj-8 Noakhali-4

Lakshmipur-5 Jhalokathi-4

226 6662456 4 7 20 213 619

1MaMoni HSS is implemented through an Associate Award under the Maternal and Child Health Integrated Program which is led by Jhpiego with a period of performance from September 24 2013 to September 23 2018 MaMoni HSS is led by Save the Children in Bangladesh in partnership with Jhpiego John Snow Inc and The Johns Hopkins University Institute for International Programsmdashwith national partners International Centre for Diarrhoeal Disease Research Bangladesh Dnet and Bangabandhu Sheikh Mujib Medical University (BSMMU)


Pirojpur-2)

Health Systems Capacity Strengthening (HSCS) Areas

17 (Bhola-7 Noakhali-5 Pirojpur-5)

151 4870933 2 5 14 126 488

Total 40 377 10718274 6 12 34 339 1107

In response to the recommendations of the mid-term evaluation a few strategic shifts in human resources and program structure were implemented this year such as a fifty percent reduction in the number of Field Service Officers (FSOs) in high intensity areas and their complete withdrawal from other areas The Technical Officer (TO) position has been terminated across all project areas Additionally new positions were created including Facilitator-Service Delivery (26) in all high intensity districts Upazila Facilitator-HIS (13) in Habiganj and Noakhali and Upazila Facilitator-Community Based Service (CBS-13) in Noakhali and Jhalokathi These staff are now on board and have received intensive job-based training

DATA SOURCES This report uses data from various sources including the population-based Tracer Indicator Survey (TIS) in high intensity areas sentinel surveys in selected facilities in MaMoni HSS districts Service Delivery Point (SDP) assessments in selected facilities2 re-visitation of specific newborn interventions in 14 districts and routine MIS from the DGHS and DGFP The complete list and scope of the surveys are attached as Appendix 2

PROGRAM RESULTS OF THE YEAR

IR 1 Improve service readiness through critical gap management 11 Increase availability of health service providers

111 Management of critical human resource gaps of GOB service providers

2 DH MCWC UHC UHampFWC and USC in 21 high intensity areas in 4 districts (Habiganj Noakhali Lakshmipur and Jhalokathi)


In Year 4 MaMoni HSS continued to provide support by appointing 12 FWAs 40 paramedicsFWVs 22 nurses and one obstetrics and gynecology (OBGYN) consultant to fill-in the critical human resource gaps of GoB service providers (Table 2) while continuing to advocate for long-term solutions with local leaders (Union Parishad Chairman and Members of Parliament) by filling vacancies through recruitment efforts involving the GoB In addition the project continued to advocate with the government for newly recruited staff to be posted in underserved areas with major human resource shortages The decisions to fill such vacancies are made through discussions with districtupazila managers Community health workers (CHWs) in Habiganj were appointed to vacant FWA positions to initiate population registration and roll out of the community based electronic Management Information System (eMIS) Paramedics were deployed to substitute for FWVs in strategically placed Union Health and Family Welfare Centers (UHampFWCs) to ensure 247 delivery Additional paramedics were posted to help manage the case load in a few UHampFWCs where the patient load was too high to be managed around the clock by a single provider Nurses were placed in Habiganj and Lakshmipur District Hospitals as patient loads were high and additional staff were required for around the clock delivery service as well as for newborn care especially at the Special Care Newborn Unit (SCANU) An OBGYN consultant was posted in Hatiya which is an isolated island without any facility to handle obstetrical emergencies MaMoni HSS also continued its support to provide technical assistance (TA) and financial support for a yearlong Emergency Obstetrics Care (EOC) training for 12 medical officers from the Maternal and Child Health and Family Planning (MO-MCHFP) unit of the DGFP 1

Table 2 Critical human resource gaps filled-in by MaMoni HSS

District FWA FWVParamedics Nurses OBGYN Consultant

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

CHW

)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

Para

med

ic)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni

(Nur

se)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni

Habiganj 88 3 12 27 1 11 71 48 14 2 0 0 Jhalokathi 81 0 0 11 0 2 7 46 0 0 1 0 Noakhali 161 0 0 18 2 9 89 76 0 5 2 1 Lakshmipur 70 0 0 11 0 4 69 17 0 2 0 0

Total 400 3 12 67 3 26 236 187 14 9 3 1 In Year 4 the government appointed new staff to fill vacancies while gradually reducing the numbers of project support staff This year three paramedics were replaced by GoB FWVs The project strategy is to only provide technical staff in hard to reach areas and gradually decrease the number of supported positions As there has been no FWA recruitment since 2014 there are many vacant positions The project is advocating with


DGFP for placement of recently recruited paid volunteers in MaMoni districts Only in Madhabpur 12 CHWs have been hired to support eMIS implementation

For Paramedics the project is advocating and following up with DGFP to post newly recruited FWVs in MaMoni areas as well as advocating with the local government to recruit Paramedics

12 Strengthen capacity of service providers to provide quality services 121 Introduction and scale-up of MNCHFPN interventions 121a Maternal health The programrsquos major interventions in maternal health are pregnancy identification and registration through frontline health workers the provision of at least four antenatal care (ANC) contacts with Quality of Care (QoC) birth planning promotion of and increased availability and accessibility to quality skilled birth attendants including active management of the third stage of labor (AMTSL) distribution of misoprostol for home-based deliveries 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 and eclampsia through the administration of Magnesium Sulfate (MgSO4)

i ANC coverage ANC is the gateway intervention wherein a woman makes what might be the first contact in her life with a health facility or health care provider as a result of her pregnancy MaMoni HSS has taken a multipronged approach to address the shortage of service providers to ensure satellite clinics and to confirm the availability of equipment and provide logistical support for providers The population based tracer survey reveals a steady increase in ANC-1 uptake for all the project supported districts with all districts achieving the set End of Project (EoP) targets and most achieving up to 10 percentage points over their targets (Figure 1) A remarkable achievement has also been observed in ANC 4+ coverage in the districts particularly for Habiganj Lakshmipur and Noakhali (Figure 2) Figure 1 Percentage of women who received at least one ANC check-up from a medically trained provider


Source Tracer Indicator Survey (TIS) Figure 2 Percentage of women who received four or more ANC check-ups

Source Tracer Indicator Survey (TIS)

ii Severe pre-eclampsiaeclampsia (SPEE) management at union level facilities In collaboration with the Obstetrics and Gynecological Society of Bangladesh (OGSB) the project has introduced severe pre-eclampsia and eclampsia (SPEE) management at union level facilities (UHampFWC) where a loading dose of injectable MgSO4 is administered by trained FWVs and the patients and their family members are counselled for referral care at higher level facilities In some cases the staff also facilitates and supports the process of arranging for referral transport This intervention has rolled out at 140 union level facilities in 16 upazilas (5 upazilas in year 3 and the remainder in year 4) in 4 districts ndash Habiganj Noakhali Lakshmipur and Jhalokathi

37

64 60

51

73

66 61

53

65

81

70 70 68 69

81

74 71

66

75 80

76 75 72 74

83 82 77

74 72

85 83 77

87

71 70

73 70

67 70

0

10

20

30

40

50

60

70

80

90

100

Habiganj Jhalokati Lakshmipur Noakhali Pirojpur

Perc

enta

ge

2012 2013 2014 (Round-I)

2015 (Round-II) 2016 (Round-III) 2016(Round-IV)

2017(Round-V) 2017 (Round-VI) EoP target

9

22

14 12

34

42

19 15

30

40 35

25 26

36 39 39

21 23

38 41

44

30 26

37

44 43

31

43

36

45 46

32

49

40

26

50

26 26

36

0

10

20

30

40

50

60


2012 2013 2014 (Round-I) 2015 (Round-II) 2016 (Round-III)

2016 (Round-IV) 2017 (Round-V) 2017 (Round-VI) EoP Target


3

49

72 65

94

0102030405060708090

100

Y3-Q4 Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber

Quarter

The expansion of intervention from 5 upazilas to 16 upazilas refresher training of the service providers periodic monitoring visits by OGSB professional bodies and on the job orientation and discussions related to SPEE case identification and management issues during monthly meetings at upazila HealthampFP resulted in increased SPEE case identification and referral with pre-referral loading dose of injectable MgSO4 (Figure 3) Figure 3 Number of patients with severe PEE that received pre-referral loading dose of Injectable MgSO4 at UHampFWCs Source MIS-3 DGFP

Practical session of refresher training on PEE at UHC

Practical sessions on PEEclampsia

(L) Prof Firoza Begum Secretary General-OGSB facilitates a session

(R) Prof Latifa Shamsuddin visits Auskandi UHampFWCs


Estimates of PEE cases are not available nationally or globally An operation research is on-going under which population based surveillance are being conducted Estimated figures will be available by end of project Though WHO estimates the incidence (or number of new cases) of pre-eclampsia to be seven times higher in developing countries (28 of live births) than in developed countries (04) (Dolea et al 2003) If assumptions are made as per this estimate the incidence in quarter four in the 16 upazilas would be 809 however the reported number is 94 The reported number of detected cases lags behind the estimated number of cases suggesting challenges in case detection The project is carrying out a number of initiatives to improve the situation With support from MaMoni HSS an electronic Management Information System (eMIS) was introduced that will assist the supervisors in monitoring eligible cases that are supposed to be referred by the provider The supervisor will be able to follow up on referral cases after complete roll out of eMIS in MaMoni HSS districts MaMoni HSS also tracked the outcomes of these referred patients After receiving the loading dose 60 percent of cases had normal deliveries 25 percent needed caesarian sections and 15 percent waited for final results post-discharge after consultation with a consultantdoctor Maternal and fetal outcomes showed 100 percent survival of mothers 96 percent live births and 4 percent still births MaMoni HSS plans to expand this intervention in 7 additional upazilas of Noakhali district in Year 5

iii Misoprostol to prevent postpartum hemorrhage (PPH) for home births MaMoni HSS facilitated the distribution of misoprostol tablets to pregnant women in their third trimester through FWAs and FWVs in order to prevent PPH following home deliveries Routine MIS data shows that the distribution of misoprostol tablets to pregnant women was very low in MaMoni HSS districts (Figure 4) Figure 4 Number of pregnant women who received misoprostol tablets in year four

Use of referral transport after receiving the loading dose


Source MIS-4 DGFP

Assumption Estimated number of pregnant women is 35 of the population

The project also tracks misoprostol consumption through TIS Although there was an increasing trend in misoprostol consumption it was still very low compared to the EoP target (Figure 5) Misoprostol is distributed by FWAs through home visits and during the third ANC by FWVs Some of the primary contributors to the low distribution coverage of misoprostol were low coverage of ANC during the 3rd trimester (Table 4) stock out of tablets vacancies of FWAs (29 vacancy in 4 HI districts) and FWVs (22 vacancy in 4 HI districts) inadequate home visits by FWAs and the lack of a need based distribution system for misoprostol The project continues advocacy at the national level for recruitment of vacant positions but there is a court stay order for new recruitment by DGFP The project is also following up on supply issues of misoprostol at the national level as well as at the district level At the district level the issues are discussed with local MOHFW managers in quarterly performance review meetings Another contributor to low coverage is that a large number of private sector providers give ANC services but they do not have a misoprostol supply and are not distributing it Moreover private sector providers also have a lack of knowledgetraining on use of and distribution of misoprostol MaMoni will explore alternate options for misoprostol distribution ie through BRAC workers or other community based workers as well as to sensitize private sector providers for misoprostol use Figure 5 Percentage of women who consumed misoprostol tablets immediately after birth following home delivery

3871

0

6363

1923

4 3487

3

7148

3595

6

5207

1717

5

2855

0

1052

4

81060

23714

62788

106004

37722

0

20000

40000

60000

80000

100000

120000


Num

ber

Number of pregnant women received ANC3

Number of pregnant women received misoprostol

Estimated number of pregnant women


68 172

385 938

600

94 145

24

870

8

89 90

77 620

68

69 183 117 603

87

58 110 152 501

86 211 338 212 1016

93

0102030405060708090

100

Lakshmipur Noakhali Jhalokati Habiganj Pirojpur

Round-I Round-II Round-III Round-IV Round-V Round-VI


Misoprostol consumption coverage is lower in Lakshmipur and Pirojpur However the results for Pirojpur include only two upazilas out of seven and do not reflect the full district scenario However like other HSS districts the project has limited input in Pirojpur in terms of interventions and resource allocation from the program Although the coverage levels in Lakshmipur are still low the rate of improvement for misoprostol consumption is actually highest among all the program districts A new strategy of combined distribution of misoprostol and 71 CHX was introduced in Lakshmipur starting from August 2016 and was aimed at increasing the use of misoprostol The recall period of round-VI was from September 2016 to February 2017 and it shows an increased trend of misoprostol distribution and consumption in Lakshmipur which is highest ever among all the districts

Figure 6 Number of misoprostol acceptors by districts among a comparable sample size per round of tracer survey data collection

Source Tracer survey

35 34

14 19

42

23

3 8

21

43

3 8

14

2

33

11 8 10

22 32

17

5

16 25 28 26

5

15

27

38

25

14

25 23

50 55

30 30

45

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge




85 91 91

98 96

0

20

40

60

80

100

Habiganj Noakhali Lakshmipu Jhalokati Pirojpur

Perc

ent

6 0

519 308

635 558 671

143 64 146

1041 1283 1342

1201 1441 1402

2148

1081

1335 1247 1049

1409 1333

1644

0

500

1000

1500

2000

2500

No of misoprostol acceptor at community

The figure above also shows that among all rounds of tracer survey the highest rate of increase in misoprostol acceptors from the previous round was between round V and round VI in Lakshmipur (124 increase) and in Noakhali (84 increase)

The MIS data shows a significant change in misoprostol distribution in Lakshmipur after the introduction of combined distribution of misoprostol and 71 chx at community level starting from August 2016

Figure 7 Community distribution of misoprostol in Lakshmipur

Source MIS-2 DGFP

Therefore considering the recall period and the trend of increase in misoprostol acceptors we expect the rate of misoprostol acceptors and consumption in home delivery may show an upward trend next tracer survey

However TISrsquos reveal that the majority of women who received misoprostol during pregnancy consumed the drug (Figure 8) following home delivery Therefore compliance was not a major issue the majority of women who delivered at home were likely to consume the tablets if they had the supply in hand Figure 8 Percentage of women who consumed misoprostol tablets following home delivery among pregnant women who received misoprostol tablets during pregnancy


Source Tracer Indicator Survey (TIS) Round VI

The project has begun working with the MOHFW to develop a need-based system of misoprostol distribution which involves closely monitoring the stock and distribution status as well as focusing on increasing the ANC3 coverage We hope to see improved distribution and consumption of misoprostol tablets in Year 5 iv Deliveries assisted by skilled birth attendants (SBAs) MaMoni HSS supported the clinical placements of 20 FWVs and paramedics in District Hospitals (DH) and Maternal and Child Welfare Centers (MCWCs) The objective of the clinical attachment was to increase the numbers of facility deliveries and to improve the quality of normal vaginal delivery (NVD) services at UHampFWCs in MaMoni HSS areas FWVs and paramedics from selected UHampFWCs were placed at the gynaecology outdoor ward gynaecology ward labor room and postnatal and antenatal wards including the post-partum family planning (PPFP) services of the DH and MCWC in batches for 21 days Senior staff nurses acted as full time mentors while district level supervisors such as the Hospital Superintendent Civil Surgeon (CS) Deputy Director of Family Planning (DDFP) and Medical Officer of the Clinic (MO-Clinic) supervised and monitored the FWVs and paramedics

SBA assisted deliveries are gradually increasing in MaMoni HSS districts A total of 122330 deliveries were conducted by SBAs in six MaMoni HSS districts in Year 4 an increase from 92123 in Year 3 (Figure 9) A number of initiatives have been taken to improve SBA deliveries in the project areas to create demand Demand creation is mainly done with community mobilization by local government through community volunteers and local level SBCC activities SBCC activities that include street drama video shows and TVCs are the main activities that reach the population in the project area Moreover with the leadership of local government local level advocacy meetings and dissemination events are conducted whenever a 247 union level facility has been established in the respective community A number of quality improvement interventions in the facilities have resulted in improved quality of services which has also increased demand in the

(L) Conducting delivery (R) Practicing ENC on a dummy


community to access delivery care services from the facilities Last but not least a system of pregnancy registration in the project areas also helps providers to track and follow up pregnant women This registration system starts with community volunteers who collect the names of newly pregnant women and their locations and provide this information to the FWA HA FWV and CHCP during community microplanning meetings Subsequently the FWA FWV HA and CHCP includes these lists of pregnant women into their registers for tracking providing services and further follow up


Figure 9 Number of SBA deliveries in MaMoni HSS districts

Source CSBA report of MIS-2 and MIS-4 of DGFP EmOC and CSBA report of DHIS-2 pCSBA report of Project

Assumption Estimated number of deliveries is 222 of the population (Based on national CBR BDHS 2011)

An increasing trend in deliveries in 247 UHampFWCs was also noticed in HI areas As of September 2017 a total of 94 UHampFWCs in 21 HI upazilas and 14 in HSCS upazilas (total 108) were providing 247 delivery services Figure 10 shows the delivery trends in these 247 UHampFWCs of HI upazilas as the delivery data is not available in HSCS areas through the existing DGFP MIS portal Figure 10 Trend of deliveries in 247 UHampFWCs in HI areas

Source DGFP MIS-3

2073

4

5376

1872

2 2513

1

8318

1384

2

2718

4

7793

2090

0

3695

8

1104

2

1845

3

51415

15041

39826

67237

23927

40500

0

10000

20000

30000

40000

50000

60000

70000

Habiganj Jhalokathi Lakhsmipur Noakhali Pirojepur Bhola

Num

ber

Y3 Y4 Estimated number of deliveries

41 54 75 94

4678

8117

11738

15466

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0102030405060708090

100

Year-1 Year-2 Year-3 Year-4

Num

ber

No of 247 UHampFWC Number of delivery in 247 UHampFWCs


Contributors to the increase in the number of deliveries during the last quarter are an increase in the number of facilities in last quarter also some facilities that were new in previous quarters have become fully functional and provided a higher number of normal deliveries Additionally 247 facilities were promoted through a number of BCC activities and local level advocacy in the community through engagement with local government functions (egunion parishad and upazila parishad)

The population-based TIS also reveals increasing trends in SBA deliveries and the project is on track in achieving the EoP targets (Figure 11) Figure 11 Percent of births attended by a skilled attendant


Figure 11 shows a significant increase in coverage of SBA deliveries from the baseline survey particularly in Habiganj where deliveries moved from 19 during the baseline survey to 39 in the Round VI survey Most of the program districts were hard to reach areas and ranked as the bottom in delivery index of Bangladesh As a result even though there are significant improvements in SBA coverage that are close to reaching end of project targets SBA coverage in these areas still lags behind national coverage averages

v Private CSBAs (pCSBA) assisted deliveries MaMoni HSS continued supporting 89 pCSBAs in Year 3 in three districts (Habiganj Noakhali and Lakshmipur) through capacity building facilitating supplies and regular monitoring and supervision pCSBAs are non-salaried community-based private skilled birth attendants whose sole earnings come from charging for different services like ANC deliveries PNC and selling essential commodities In Year 4 21 pCSBAs dropped out owing to the fact that many of them married and discontinued their services The 68 pCSBAs who continued their services conducted 1187 deliveries in their catchment areas during the reporting year Figure 12 shows an increasing trend in deliveries by pCSBAs since their deployment

19

30 34

28 29

45

36

26

43

28

51

39 32

47

32

51

37 35

51

36

52

37 35

50

36

58

39 40

51

39

52

43 48 49

40

53 45

40

50

0

10

20

30

40

50

60

70



2016 (Round-IV) 2017 (Round-V) 2017 (Round-VI) EoP target


52 52

91 89 64 71 68 68

147 112

158

246 276 288

309 314

0

50

100

150

200

250

300

350

Y3-Q1 Y3-Q2 Y3-Q3 Y3-Q4 Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber

Number of pCSBA Number of deliveries

Figure 12 Trend of deliveries by pCSBAs

Source Project MIS

In spite of a reduction in the number of pCSBArsquos the data shows an upward trend of delivery by pCSBAs The initial numbers of pCSBArsquos were higher but due to attrition from marriage and migration to other areas the number has reduced 121b Newborn health A Newborn health national support i Scale-up of priority newborn health interventions

MaMoni HSS continued to support the MOHFW in the introduction and national scale-up of new newborn interventions and in improving the quality of facility based care The project continued supporting the National Newborn and Child Health Cell which provides management support for the national newborn and child health program activities as well as coordinates the national scale-up including monitoring of the interventions through post-training follow-up led by DGHS MaMoni HSS provides technical assistance to the MOHFW through this cell As part of its routine activity the newborn and child health cell continued to support the IMCI Program Manager (PM) in implementing IMCI as well as re-visitation activities for specific newborn interventions through 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 ii Re-visitation of priority newborn interventions

MaMoni HSS played an instrumental role in assisting the MOHFW in planning and


implementing the national scale-up of 71 CHX application for newborn cord care as a part of ENC Previously the project supported the MOHFW for the national scale-up of the HBB program During Year 4 the project facilitated the follow-up of both scale-up interventions through the re-visitation of priority newborn interventions which was conducted in phases Forty-six district revisits (2811 facilities) of phase 1 phase 2 and phase 3 were complete 7 districts revisits in phase 4 are currently on-going By December 2017 all 64 districts of the country will be covered by this intervention

The three-pronged activity included a) identification of newborn focal persons from each upazila divisional and district level advocacy meetings for use of HBB and 71 CHX b) refresher training of SBAs on ENC including HBB and use of 71 CHX on the umbilical stump and c) a quick assessment of preparedness for newborn interventions with respect to human resources skills retention facility readiness medicine and supply stocks (including 71 CHX) The revisit also included the replacement or provision of supplies for newborn resuscitation equipment (bag mask and sucker) in the facilities The National Newborn and Child Health Cell supported by MaMoni HSS provided management support for this activity Data collectors from partner organizations Partners in Health and Development (PHD) and Bangabandhu Sheikh Mujib Medical University (BSMMU) conducted the revisits and gathered data using a standard checklist The findings of the revisit are shown in Table 3 Table 3 Findings of revisit in 46 districts (phase 1 phase 2 and phase 3)

Facility Types Offer delivery

71 CHX HBB kit MgSO4 Amoxicillin Gentamicin N

DH 100 70 70 30 33 65 46 MCWC 100 64 89 15 93 11 61 UHC 91 72 78 10 33 53 304 UHampFWC-FP 89 46 83 7 84 7 2018 UHampFWC-H 86 51 83 10 83 16 172 USC 49 26 34 0 45 11 53 RD 66 32 83 1 61 2 104 Others 42 26 55 4 45 13 53

Total 87 49 81 7 76 14 2811

Training Types n n

71 CHX trained 15252 11484 75 HBB trained 12871 6830 53

iii Divisional dissemination on post-training follow-up of the application of 71 CHX in the newborn umbilical cord As part of the technical assistance to the Newborn and Child Health Cell MaMoni HSS organized 8 divisional dissemination meetings on post-training follow-up of 71 CHX for cord care in Dhaka Mymensingh Rajshahi Khulna Barisal Sylhet Chittagong and Rangpur divisions The results of the post-training follow-up conducted by 32 independent monitors in 64 districts in Year 3 were presented at these divisional dissemination meetings The presentations included the status of human resources skills and knowledge retention from trainings availability and usage of 71 CHX across all level of facilities and


private pharmacies and the availability and usage of HBB equipment and their cleanliness The post-training follow-up revealed that 86 percent of the respondents (N=3400) who participated in the post-training follow-up received orientation on ENC including the application of 71 CHX in the umbilical cord At the time of the visit 71 CHX was available in 49 percent of facilities Eighty-four percent of providers could demonstrate correct use of 71 CHX and 47 percent of these providers had applied 71 CHX on the newborn umbilical cord during the past week Eighty-six percent of the providers counseled pregnant mothers to use of 71 CHX and 54 percent of private pharmacies were found to stock 71 CHX Resuscitation bag-masks and suckers were available in 84 percent of operation theatre (OT)delivery rooms Eighty-six percent of facilities supplied clean bag-masks and suckers The divisional disseminations highlighted discussions on the DGFPrsquos revision of the operational plan (OP) and procurement of 71 CHX distribution and use of CHX at the facility level delays in the distribution of CHX from the district to the sub-district level approaching the district manager for local procurement of CHX for interim periods during stock outs the role of the proposed designated medical officer as a focal person of maternal and newborn activities reporting on the use of 71 CHX from private sector to Civil Surgeons (CS) and an emphasis on cleanliness and service readiness to ensure quality service

The divisional meetings also discussed issues related to the re-visitation of priority newborn interventions Divisional and district level managers from the health and family planning division attended these meetings

iv Other national activities In Year 4 the project supported the Line Director of the Maternal Neonatal Child and Adolescent Health (MNCampAH) unit in preparing the operational plan (2017-2022) Through the National Newborn and Child Health Cell MaMoni HSS facilitated the incorporation of newborn indicators in the sector plan and adaptation of the newborn-related service delivery information in the facility registers and reports

Professor Shahidullah speaks during the Dhaka divisional dissemination meeting


Under the leadership of the National Newborn Health Program and Integrated Management of Childhood Illness (NNHP amp IMCI) unit of the DGHS the project facilitated the development of a national newborn dashboard in DHIS 2 through the National Newborn and Child Health Cell HBB SCANU 71 CHX KMC and ENC related indicators have been incorporated in the dashboard The project continues to provide technical support for the publication of the National Newborn Health Bulletin The third issue of the bulletin was published during the last quarter

The bulletins were shared with stakeholders and uploaded to the Healthy Newborn Network (HNN) web page The Director of PHC and PM-NNHP and IMCI plans to include this bulletin in the MIS bulletin section of DHIS 2

ii Newborn health district interventions Project initiatives during Year 4 focused not only on increasing coverage but also on improving the quality of service delivery through building capacity of service providers on priority newborn interventions including recording and reporting availability of logistics job aids and on-the-job coaching as well as community awareness

Screenshot of the newborn dashboard in DHIS 2

Issue 1 Issue 2 Issue 3


a Helping Babies Breathe (HBB)

The HBB intervention has been implemented in all 64 districts under national scale-up activities In Year 4 a total of 21450 newborns were resuscitated in facilities across the country using a bag and mask Figure 13 shows the number of newborns resuscitated using bag and mask by divisions Figure 13 Number of newborns for whom resuscitation actions were initiated using a bag and mask in 7 divisions of Bangladesh

Source MIS-3 DGFP and DHIS-2 b Application of 71 CHX for newborn cord care The application of 71 CHX to the umbilical cord stump is one of the major interventions to prevent newborn sepsis for all newborns irrespective of their place of delivery As a part of the ENC package 71 CHX application has been implemented in six project districts under national scale-up activities Routine MIS tracks the application of 71 CHX to the umbilical cord for all SBA assisted deliveries both at the facility and in the community Figure 14 shows an increasing trend in the application of CHX The application of 71 CHX increased from 32224 newborns in Year 3 to 77477 newborns in Year 4

127 37

7

352

100

215

113 43

6

208

1081

989

547

281 50

2

449

479

1694

1958

646

369 64

4

704

502

1798

2886

1232

676

737 13

48

1316

4950

6185

2525

1541 1996

2937

0

1000

2000

3000

4000

5000

6000

7000

Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet

Num

ber

Q1 Q2 Q3 Q4 Total


Figure 14 Number of newborns that received 71 CHX on their umbilical cords immediately following birth in Year 4 as reported by SBAs in MaMoni HSS districts

Source MIS-2 amp 4 DGFP EmOC and CSBA report of DHIS-2 and pCSBA report of project MIS

Though the data indicates that progress is being made to close the gaps between the total number of live births total number of SBA-attended deliveries and application of 71 chlorhexidine there is still a gap in coverage A major contributor to this gap is a lack of supply of 71 CHX which DGHS procured once but has not made any procurements since Initially due to the lack of supply in DGFP at the district level and below DGHS provided some CHX to those facilities as a temporary arrangement DGFP also received approximately 110000 bottles of 71 CHX from the CHX working group but the supply did not meet the demand In the 4th sector plan the supply challenges should be addressed as both DGHS and DGFP have included budgets for new procurement of 71 CHX

Population-based TIS reveals that the project is on track in achieving the EoP3 target for 71 CHX application on the newborn umbilical cord immediately following birth except in Pirojpur district (Figure 15) Figure 15 Percentage of newborns that received 71 CHX application on their umbilical cord immediately after birth in MaMoni HSS districts

3 EoP target revised in 2017

59486 59486 59486 59486

32882 28689 31301 29458

15709 16571 22786 22411

0

10000

20000

30000

40000

50000

60000

70000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber

Number of estimated live birth Number of SBA delivery Application of 71 chlorhexidine


Source Tracer Indicator Survey (TIS)During data collection for the tracer surveys it was noted that there appears to be some recall bias related to use of 71 CHX Specifically it was sometimes difficult for mothers that delivered in facilities to remember andor know whether the provider applied 71 CHX to the cord of the newborn or not In most cases the mother was not able to remember c Postnatal checkup for newborns within 48 hours of birth

TIS data shows an increasing trend in postnatal checkups for newborns in all MaMoni HSS districts This indicator achieved its EoP target for Jhalokathi Lakshmipur Noakhali and Pirojpur districts Habiganj district lags slightly behind but is on track in achieving its target (Figure 16) Figure 16 Percentage of newborns in MaMoni HSS districts that received a postnatal check-up within 48 hours of birth from a medically trained provider


d Facility based care for sick children i Management of sick children (lt2 months of age) in union level facilities MaMoni HSS has been supporting the identification and management of sick young infants (lt2 months of age) in accordance with PSBI national guidelines in 148 UHampFWCs of 4

3 0 4 2 0 4 1 1 1 2 10

1 1 2 1 10

2 10 13

4

16 8

24 29

5 20 10

25 30

10

0102030405060708090

100


Perc

enta

ge

2014 (Round-I) 2015 (Round-II) 2016 (Round-III) 2016 (Round-IV)

2017 (Round-V) 2017 (Round-VI) EoP Target

19 12 11

4

24 19 7 3

15 29

20 6

28 19

39

7 11

34 22

42

25 34 38

27

48 34 32

41 31

48 36

48 41

32 33 20 20 18

0

20

40

60

80

100


Perc

ent

2013 2014 (Round-I) 2015 (Round-II) 2016 (Round-III)



12

4 10

10

16

19

23

3 4 8 3 3 28

34

21

29

20

27

39

22

27

19

25

23

164 21

0

133 19

0

172

175

124

112

112

102 12

5 145

216

148

104

91 11

0

90 13

1

100

76

80

93

97

299

244

179

174

168 186 22

7

194

157 21

5

196

204

719

640

447 494 486 497

544

431 376

424 442 472

0

100

200

300

400

500

600

700

800

Oct16 Nov16 Dec16 Jan17 Feb17 Mar17 Apr17 May17 Jun17 Jul17 Aug17 Sep17

Num

ber

CI CSI IFB LBI Other Total

project districts where a Sub-Assistant Community Medical Officer (SACMO) is available Given that they have had three years of training the SACMO is the designated provider for managing sick young infants with PSBI with the first dose of injectable gentamycin FWVs are only authorized to provide the second dose of injectable gentamycin when a SACMO is unavailable and referral is not possible This service is presently underutilized perhaps due to the unavailability of service providers after clinic hours poor case identification and management by service providers and a lack of confidence among service providers in administering injections to small children Figure 16 portrays the trend in sick children management at UHampFWCs in 4 MaMoni HSS districts

Figure 17 Number of sick children (lt2 months of age) treated at 148 UHampFWCs in 4 MaMoni HSS districts

Source Project MIS

Figure 18 shows the composition of PSBI in children (lt2 months of age) during the reporting year in MaMoni districts Fast breathing as a single sign of illness (IFB) was highest among all PSBI (81) followed by clinical severe infection (CSI) and critical illness (CI) which were 14 and 5 respectively Figure 18 Composition of PSBI in children (lt2 months of age) in MaMoni HSS districts

CI 115 5

CSI 314 14

IFB 1764 81


Source Project MIS

ii Management of sick children from Special Care Newborn Units (SCANUs) Of ten Special Care Newborn Units (SCANUs) established by the MOHFW using SAARC development funds four SCANUs are located at districts hospitals within the project area in Habiganj Noakhali Bhola and Pirojpur The MaMoni HSS project exclusively supported the establishment of a SCANU in Lakshmipur These SCANUs continue to provide services for critically sick newborns however this service delivery faces challenges due to a shortage of dedicated manpower and a lack of ownership The project continues to support the capacity building of GoB staff installation and maintenance of equipment and the placement of trained staff nurses at selected SCANUs (Habiganj Noakhali and Lakshmipur) SCANU data from the facilities is entered into DHIS 2 However the completeness and quality of date reported in DHIS 2 is a major issue The project continues to work to improve the timeliness and completeness of SCANU reports Figure 19 shows the number of admissions of sick newborns at five project supported SCANUs Figure 19 Quarterly admission of sick newborns at 5 project supported SCANU centers

Source DHIS-2

Figure 191 The case fatality rate at SCANUs against total numbers of reported newborn admissions in Bangladesh from October 2016 ndash September 2017

273 310

875 900

0

100

200

300

400

500

600

700

800

900

1000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber


Source DHIS-2

e Kangaroo Mother Care (KMC) at district and upazila level facilities

The MaMoni HSS project supported the MOHFW in establishing KMC services at 15 district and upazila level facilities in 4 districts (Habiganj Noakhali Lakshmipur and Jhalokathi) according to the national guidelines for stable preterm and low birth weight babies The facilities include 4 DHs 2 MCWCs and 9 Upazila Health Complexes (UHCs) The project advocated with the GoB for national and local level ownership as well as for compliance in preparing facilities to provide services and post-discharge follow-up During Year 4 a total of 122 cases received KMC services from these 15 facilities However KMC service utilization is low at these facilities Most of the cases who availed of KMC services had a short hospital stay opting for early discharge and discontinuation of services against medical advice The project is trying to explore gaps to identify possible solutions Provider training alone may be insufficient to develop KMC related counselling skills MaMoni HSS is presently working with the MOHFW and has already sensitized the district upazila and union level service providers to refer low birth weight babies to KMC units Furthermore the project has oriented and engaged union level supervisors (Assistant Health Inspectors) to follow-up with cases within the community following prior visits to DHs and UHCs The project has also reproduced and supplied job aids to service providers for the purposes of providing KMC counseling to mothers and other key decision makers within families The project plans to implement KMC services at all UHCs in 4 project districts by December 17 2017

f Scale-up of Antenatal Corticosteroid (ACS) use to prevent complications related to prematurity The MOHFW has decided to scale-up the use of ACS nationwide to reduce neonatal mortality and morbidity in high-risk preterm deliveriesrdquo It has developed a national guideline for the implementation of ACS MaMoni HSS is supporting MOHFW to operationalize and gather learning on the implementation of this intervention in 3 district hospitals in Habiganj Noakhali and Laksmipur During this reporting year a total of 314 pregnant women (Q1-93 Q2-60 Q3-114 and Q4-47) received ACS from Habiganj Noakhali and Lakshmipur district hospitals

142 133 134 140 141 132 140 128 139 126 133 125

0102030405060708090100

0100020003000400050006000700080009000

Perc

enta

ge

Num

ber

No of newborn admission No of death Case fatality rate


g Mentoring visits for newborn interventions at district facilities As a partner of MaMoni HSS the BSMMU continues to provide technical assistance to the MOHFW for the introduction and roll out of novel newborn interventions As part of this activity and as part of the strategy for successful project close-out professionals from the Neonatology Department of the BSMMU conducted technical supervisory visits to the SCANUs and KMC units including ACS application and newborn and child health service units at Noakhali Habiganj Lakshmipur and Jhalakathi district hospitals

The observations and recommendations following these visits were shared in a meeting with hospital superintendents consultants doctors and nurses on the same day The SCANUs face challenges related to the involvement of GoB nurses in the SCANU unit cleanliness and aseptic measures and the functionality of equipment The SCANU at Habiganj currently does not operate around the clock Technical persons have recommended smooth and regular mechanisms for repair and maintenance of SCANU equipment as well as adequate sitting arrangements for mothers with babies admitted in the SCANU to ensure skin to skin care contact for at least 2 hours twice a day They also advised keeping a detailed examination record in the history sheet of each case displaying handwashing posters and KMC counselling materials training more nurses and doctors establishing a mechanism for post-discharge follow-up eye screenings for retinopathy increasing the number of dedicated nurses in the SCANU arranging room temperatures using a recording thermometer establishing monthly perinatal meetings and technical discussions between district and national level resource persons through Skype calls and preparing a checklist for external technical supervisory visits to the SCANU and KMC units Based on the technical recommendations a number of actions have been taken including

bull A checklist for supervisory visits has been developed and is in place for use bull A hand washing poster was obtained and placed appropriately bull Post-discharge follow up of cases has been started in Noakhali district hospital bull The establishment of eye screening for retinopathy is in process with the

collaboration of BSMMU

121c Family Planning (FP)

Prof Mannan visits the Noakhali SCANU and discusses his findings with relevant

authorities and providers


This year MaMoni HSS focused on increasing coordination between the DGHS and DGFP in promoting FP interventions especially long acting and reversible contraceptives (LARCs) permanent methods (PMs) and post-partum family planning (PPFP) at all facility levels Health managers are not oriented with FP or PPFP and providers working under the DGHS do not have adequate skills to provide FP counseling to clients despite a 44 unmet need for PPFP MaMoni HSS supported the scale-up of FP services in general and PPFP in particular The project placed special emphasis on strengthening the capacity of providers at health facilities managed by the DGHS to ensure service readiness and provision of care In addition to strengthening DGFP activities the project supported a number of activities and interventions in Year 4 which were exclusive to DGHS These are as follows i Strengthening coordination between the DGFP and the DGHS

In September 2017 MaMoni HSS supported the DGFP of Noakhali and Lakhsimpur with the organization of post-training follow-up meetings Dr Nurun Nahar Begum Deputy Director (QI) CCSDP DGFP was the chief guest and keynote speaker Participants included consultant OBGYNs UHampFPO UFPO MO clinic MO (MCH-FP) Medical Officer Civil Surgeon (MOCS) and nurses Discussions centered around the strengthening of FP activities chiefly PPFP and the response of the Departments of Health and FP to increase PPFP coverage and providing the resources necessary for better performance

The meeting resulted in the following major recommendations bull The MO (MCH-FP) needs more exposure to tubectomyNSV and supportive supervision

for another 3 months bull Increased coordination among the Departments of Health and FP is required to ensure

an adequate supply of IUDs and registers for recording and proper mobilization of Imprest funds in DHs and UHCs

bull Where the UFPO helps or monitors there is also a need for increased coordination between FWVs and nurses

bull Consultant OBGYNs and EOC doctors need training on PPFP to monitor the performance of nurses

bull Since the DGHS has no PPFP service performance record register a column will be created in the EOC register

The CS and DDFP of the DGHS and DGFP address PPFP-related performance improvement issues in Noakhali and Lakhsimpur


All upazila performances of FP and PPFP will be reviewed in monthly meetings and the highest performing facility will be recognized The promotion of PPFP at the upazila level is one of the project strategies and the project is following up on the recommendations as noted

bull In the regular upazila monthly meeting for FP only the performance of FP is reviewed MaMoni HSS staff is trying to introduce a separate agenda item for PPFP and to share information on the previous monthrsquos PPFP performance in the upazila

bull MaMoni HSS follows up the performance in all upazila monthly meetings as well as Quarterly Performance Review Meetings (QPRM) in Districts

ii Orientation of DGHS providers from DHs and UHCs on FP service delivery including PPFP Orientation sessions on FP and PPFP service delivery were held with DGHS managers and providers from the DHs and UHCs in all four districts These orientation sessions sought to strengthen FP services at the upazila and district level DGHS facilities The sessions were jointly arranged by the Departments of Health and Family Planning with technical support from MaMoni HSS and the DGFP A total of 124 participants including UHampFPOs MOCS consultant OBGYNS RMOUHC and SSNs attended these sessions

Feedback from one health manager following the training stated ldquoThis orientation will change the perception knowledge and attitude of DGHS managers as well as providerrsquos roles and responsibilities on FP and PPFPrdquo During monthly meetings managers will subsequently inform and build the capacity of other health service providers to ensure that these providers are effectively counseled and build skills in offering clients easy access to a wide range of affordable reliable and high quality FP and PPFP contraceptive services with a special focus in promoting methods like PPIUCD A follow-up meeting will be organized in each quarter for intense liaison and communication between DGHS and DGFP providers iii Sharing findings on facility readiness for LARC and PM services

(L) The CS speaks on the DGH role in provision of FP and PPFP

(R) DGHS providers are oriented on FP and PPFP


1179

1785

205

581

0

500

1000

1500

2000

2500

Year-3 Year-4

HI HSCS

Due to the underutilization of LARC and PM services in intervention areas and a need to understand the facility readiness status a facility readiness assessment using a structured checklist was conducted to identify gaps at 4 DHs 6 MCWCs and 22 UHCs The findings were shared with the CCSDP of the DGFP to advocate for support in terms of infrastructure human resources logistics and supply capacity development of service providers infection prevention (IP) and quality of care (QoC) to increase utilization and ensure patient satisfaction The CCSDP found these findings highly beneficial and committed to support the facilities in readiness preparation efforts as they have a budget for facility development in the current operational plan An action plan has been developed to provide support and monitor the progresses of facilities to provide LARC and PM services in MaMoni HSS areas

Family planning performance in MaMoni HSS districts

i Postpartum family planning (PPFP) PPIUCD performance trends increased from 2204 in Year 3 to 2366 in Year 4 (Figure 20) The increase in performance can be attributed to capacity building reviewing monthly performances providing regular feedback to providers through local and central level monitoring and joint supervisory visits by DGHS and DGFP officials Figure 20 Trend in PPIUCD performance in MaMoni HSS districts

Source MIS-4 DGFPAmong all placed IUCDs in Y3 and Y4 the removal rate before the full term of the IUCD was 21 (Y3) and 12 (Y4) respectively for Habiganj 5 (Y3) and 9 (Y4) respectively for Lakshmipur 11(Y3) and 19(Y4) respectively for Jhalokati A study is being conducted in Habiganj district on discontinuation of IUCD and implant that will give more accurate indication of IUCD and implant removal rate

ii Long acting reversible contraceptive and permanent method (LARCampPM) LAPM performances in Year 3 and Year 4 showed overall increasing trends in Habiganj Noakhali and Bhola (Figure 21) and a decreasing trend in Jhalokathi Changes to the trends in Lakshimpur and Pirojpur were negligible In Jhalokathi project-supported FSOs responsible for motivating CVs to refer LARCampPM clients were withdrawn at the beginning


5567

9200

11528

3754

6414

10951

6015

8805

12614

3078

6365

11431

0

2000

4000

6000

8000

10000

12000

14000

Habiganj Lakshmipur Noakhali Jhalokati Pirojpur Bhola

Year-3 Year-4

3888

8064

9353

3230

5600

9474

4369

7817

10709

2607

5710

9886

0

2000

4000

6000

8000

10000

12000


Year 3 Year 4

of Year 4 Additionally the positions of GoB front line workers particularly FWA positions were vacant in Year 3 (37) and in Year 4 (47) The larger number of vacancies in Year 4 than in Year 3 had a negative impact on LAPM performances in Jhalokathi district Figure 21 LARCampPM performance in MaMoni HSS districts in Year 3 and Year 4

Source MIS-4 DGFP

Figure 22 LARC performance in Y3 and Y4 of 6 MaMoni HSS districts

Source MIS-4 DGFP

Figure 23 Performance of permanent method in 6 MaMoni HSS districts in Y3 and Y4


Source MIS-4 DGFP

The above tables on disaggregated FP (22 and 23) show that in most of the districts LARC performance had a slight upward trend but performance of permanent methods remains the same or even reduced (in Lakshmipur Noakhali Jhalokati and Pirojpur) A large number of vacancies for FWAs has had an effect on family planning services The government has taken a few initiatives in the hard-to-reach areas to improve the situation Specifically the government has deployed 45 volunteers in Kabirhat Senbag and Hatya upazila of Noakhali districts against the vacant FWA posts and has deployed 235 paid volunteers in Hatya and Begumganj upazila of Noakhali to assist the FWAs The government has a plan to deploy more volunteers in Lakshmipur as well iii Use of modern methods of family planning Use of modern method of contraceptives has increased gradually across all MaMoni HSS districts Figure 24 shows that the use of modern methods has increased between 2012 and 2017 in all districts Jhalokathi district has already achieved the EoP target All other districts are on track in achieving the target Figure 24 Prevalence of current use of modern method of contraception

1679

1136

2175

524

814

1477 1646

988

1905

471 655

1545

0

500

1000

1500

2000

2500


Year 3 Year 4


Source Tracer Indicator Survey iv Promotion of FP services through community volunteers In Year 4 24 of new LAPM users were referred by community volunteers of the MaMoni HSS Figure 25 shows the current progress in LAPM uptake in project districts A comparison of referrals ascribable to the contribution of community volunteers shows a 6 percentage point increase from 18 in Year 3 to 24 in Year 4 Figure 25 Contribution of community volunteers (CVs) to LAPM performance in MaMoni HSS districts in Year 3 and Year 4

Source MIS-4 DGFP and Project MIS

121d Nutrition

41 41 48 47

42

53 51 50 52

40

56 52 53 54

45

56 54 55 53

42

57 49 49

57

47 56

50 53 55

44

61 52 53 56

48

58 55 53 58

0

20

40

60

80

100


Perc

ent



18

24

82

76

0 10 20 30 40 50 60 70 80 90 100

Year-3

Year-4

referred by CVS referred by GoB staff


Malnutrition is one of the most serious health problems among others affecting infants children and women of reproductive age in Bangladesh Despite progress millions of children and women still suffer from different forms of undernutrition 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 supported the MOHFW in implementing nutrition interventions through an integrated MNCH service in all upazilas of 4 project districts with a special focus in 9 upazilas in 4 districts (Companiganj and Hatiya upazilas in Noakhali all upazilas in Lakshmipur Madhabpur upazila in Habiganj and Rajapur upazila in Jhalakati district) In Year 4 the project facilitated the development of skilled human resources by providing competency-based training on nutrition and severe acute malnutrition (SAM) management training under the leadership of the IPHN The project also facilitated the distribution of basic equipment and supplies (50 spring scales 50 heightlength boards 500 MUAC tapes) received from the IPHN for nutritional status screenings at different Service Delivery Points (SDPs) Data from the DGFP MIS DHIS 2 and Project MIS show the following results in MaMoni supported districts during this quarter 594496 children were reached (Habiganj 272278 Jhalakati 56561 Lakshmipur 81656 and Noakhali 184001) with nutrition interventions through various service delivery points where IMCI services are being provided (community clinics UHampFWCs UHCs and DHs) Of these children 92252 had some form of undernutrition (underweight wasting stunting MAM and SAM) Among the undernourished children 78622 children were identified as underweight stunted or wasted 11137 children were identified as MAM and 2493 children were identified as SAM

At this point IPHN has no tracking mechanism to follow up on outpatient cases The proposed CMAM intervention to address outpatient cases is still under discussion However the project is trying to strengthen counseling and BCC activities based on the existing platform

A lot of BCC materials have been made available at SDPs through IPHN and the project also supplied a lot of BCC materials including a nutrition flip chart food plate with demonstration guide Key messages have also been incorporated into the BCC activities of MaMoni HSS such as the Community Action Group (CAG) meetings Moreover the District Nutrition Surveillance Office (DNSO) of UNICEF also working on it and we are working with them with regular coordinationAmong children identified as SAM only 217 children (4516 male and 5484 female) were admitted in SAM units at UHCs and DHs and received management at these facilities Moreover of these 217 children only 194 children were discharged Of these 217 children 194 were discharged by the end of the month the remaining 23 patients were carried forward as lsquopatient total end of the monthrsquo which is considered as lsquopatient total beginning of the monthrsquo in the subsequent month The outcomes of the management for these cases will be categorized in the subsequent months Furthermore


among these 194 discharged children 105 were cured4 (5412) none died5 38 children were defaulters6 (1958) and 51 (2628) were discharged as ldquoDischarged Stabilized7rdquo

243846 caretakers received social and behavioral change communication (SBCC) interventions on essential infant and young feeding practices hand washing iodine deficiency disorders (IDD) and vitamin A

2932966 pregnant mothers were reached with Iron Folic Acid (IFA) supplementation during ANC visits

13 Strengthen infrastructure preparedness to improve MNCH service utilization

131 Upgrading UHampFWCs to provide 247 delivery services

In year 4 a total of 33 UHampFWCs (19 in HI upazilas in 4 districts and 14 in HSCS upazilas in Bhola Noakhali and Pirojpur districts) were upgraded in the six project districts to provide 247 delivery services Thus the total number of 247 UHampFWCs in the project area has increased to 108 Please see Appendix 5 for the list of UHampFWCs upgraded in MaMoni HSS districts National level activities related to the upgrade of UHampFWCs has been described under IR 3

IR 2 Strengthen health systems at the district level and below 21 Improve leadership and management at district level and below Quarterly performance review meetings (QPRM) district review meetings held jointly by the DGFP and DGHS staff with facilitation from MaMoni HSS were held regularly for data driven problem solving management decision-making and actions plans for program improvement QPRM is the forum where upazila action plans are monitored reviewed progress and followed-up

22 Improve district level comprehensive planning (including human resources) to meet local needs MaMoni HSS supported the development of decentralized MNCHFPN action plans at district and upazila levels using local level data and analysis The data from Tracer Indicator Surveys (TIS) on priority MNHFP indicators along with routine MIS of DGHS (DHIS 2) and DGFP and project MIS informed the prioritization of interventions as well as geographic areas Twenty-six action plans were developed for 26 upazilas

4 Cure Patient that has reached the discharge criteria as per national guidelines 5 Death Patient that has died while enrolled in the program For Outpatient Program the death has to be confirmed by a home visit 6 Defaulter Patient that is absent for 2 consecutive weighing (2 days in in-patient and 2 weeks in outpatient) 7 Discharged Stabilized Patient are discharged after completing the stabilization phase of when the patient is stabilized


Health Workforce Management The project supported the study titled ldquoWorkload and Staffing Needs Assessment at Public Sector Healthcare Facilitiesrdquo The objective of the study was to understand the existing workloads of different cadres of health workers at health facilities and at the community level The study adapted WHOrsquos ldquoWorkload Indicators of Staffing Needrdquo (WISN) methodology to the Bangladeshi context A Technical Advisory Group (TAG) formed by the MOHFW with representatives from key departments of the ministry professionals and key stakeholders provided guidance and advice on technical issues methodology and tools to expedite the study The study was conducted at one medical college hospital (Rajshahi Medical College Hospital) two district hospitals (Kushtia and Brahmanbaria) two MCWCs (Kushtia Sadar and Brahmanbaria Sadar) four selected UHCs (Daulatpur Kumarkhali Nabinagar Sarail) eight union level facilities four community clinics and with corresponding community level workers at selected unions in Kushtia and Brahmanbaria districts Key findings and recommendations was shared with TAG and a draft report has been submitted to Human Resource Branch of MOHFW for review Key findings of the study

bull The workloads of health service providers such as physicians nurses FWVs and FWAs were found to be very high at most facilities and community levels in the study area

bull A significant proportion of the available working time of major health care providers namely physicians and nurses are spent on supporting activities rather than activities related to health care delivery

bull There are inequalities in the workloads of similar categories of staff working at different facility levels (eg medical college hospital DHs UHCs) and at similar facility levels

bull Different types of support services staff such as cleaning laundry attending kitchen and security staff are also important for the optimum performance of facilities The existing numbers of various support staff at different facility levels are inadequate to manage the workload There are significant shortages in almost all categories of support staff

bull The existing record keeping system does not capture all health service related activities particularly prevention and promotion activities Additionally the lack of

Interview with nurses Sharing key findings with TAG


discipline-specific data even at the secondary and tertiary levels makes it very difficult to accurately assess the workload

Implementation of Central HRIS MaMoni HSS is presently supporting the MOHFW with the national roll out of the central HRIS as well as its implementation in Habiganj and Noakhali districts The central HRIS is a web-based software developed by the MOHFW for capturing the HR information for all directoratesagencies under the ministry at various levels across the country The project also supported capacity building through the Training of Trainers (ToT) and provision of training to relevant staff (eg Statisticians Assistant Chiefs Programmers and Assistant Programmers) from division district and upazila levels HRIS has been included as a regular agendum of the QMRM in Habiganj and Noakhali districts Progress and major data gaps in HRIS were presented and actions required for improvement were discussed at the last QPRMs Following a request from the Divisional Director of Health Barisal the MaMoni HSS project also conducted the analysis of the HRIS data from the Barisal division The findings of this analysis were presented at the divisional monthly coordination meeting with all the civil surgeons of the division The DGHS has identified 10 data fields in the lsquoProvider Registryrsquo and 7 data fields in the lsquoFacility Registryrsquo in the HRIS to monitor the improvement in data quality and to ensure completeness Improvements in data completeness in these selected fields in both registries (Provider registry 407 to 513 Facility registry 17 to 91) of the HRIS were observed between May and September 2017 If a complete HRIS system in place then it will help the managers to have a picture of hisher staffing and gaps It helps a manager to manage the work force to

bull Identify gaps or staff vacancies so the manager can initiate further recruitment with the proper authorities

bull On a priority basis the managers can reduce the strain of temporary gaps through re-allocation of staff from more strongly staffed locations to locations where there are significant vacancies

bull It also allows a manager to foresee how many staff will be retiring and when so that the manager can plan how the pending gaps will be managed into the future

ToT on HRIS


Figure 26 Data completeness in provider and facility registries of the HRIS in

Habigonj and Noakhali

23 Strengthen local management information systems Development and scale-up of Electronic Management Information System (eMIS) Under the joint initiative of MEASURE Evaluation International Centre for Diarrhoeal Research Bangladesh (icddrb) MaMoni HSS and MSHSIAPS the electronic management information system (eMIS) initiative has developed automated MIS tools for frontline health workers (HAs FWAs primary level facility workers FWVs SACMOs and their supervisors) A monitoring tool for district and upazila level managers at the DD-FP UHampFPO UFPO and MO-MCH has also been developed MNHFPN indicators have been added into different modules The Geographical Information System (GIS) plotting of categorized facilities included in the monitoring tool enables the district and sub-district level managers to skim through a lot of real time information in a very efficient manner This GIS is capable of showing real-time service data It also allows the incorporation of different geographic information as well as facility information from the UHampFWC assessment work The tool was demonstrated at the GIS workshop organized by USAIDBangladesh

470 518 497

07 23 17

456

553 513

27

135 91

0

20

40

60

80

100

Habiganj Noakhali Overall Habiganj Noakhali Overall

Provider Registry Facility Registry

o

f dat

a co

mpl

eten

ess

May 17 Sep 17


Fig 27 Upazila ANC Services reported through e-MIS in Habiganj (October 1 2016 - September 30 2017)

Under the eMIS initiative the project has also developed an automated FP method screening tool for family planning clients following Medical Eligibility Criteria (MEC) through rigorous consultation with DGFP experts The tool comprises of a number of questions and physical examinations Based on the answers from the ELCO and findings from physical examinations the tool displays suitable method(s) for the client Appropriate counseling for all suitable methods is also ensured Using this tool the provider can only proceed when all required criteria are met This screening tool had been incorporated into the existing FP module Implant eRegister has also been incorporated into the existing facility module Provision of recording Post Abortion Care (PAC) services had also been added in the application

2844 3106

4887

3140

3913

3023

6513

3629

1189 1368

2912

1902 2397

1639

4283

2278

495 630

1804 1156

1526 861

2571

1574

186 257 962

570 803 404

1274 937

0

1000

2000

3000

4000

5000

6000

7000

AJMIRIGANJ BAHUBAL BANIACHONG CHUNARUGHAT HABIGANJSADAR

LAKHAI MADHABPUR NABIGANJ

ANC1 ANC2 ANC3 ANC4

MaMoni HSS eMIS team continuously monitored eMIS reports from UHampFWCs and provided feedback as needed using the monitoring tool


Various indicator based monitoring tools have also been developed including the ldquohigh blood pressure monitoringrdquo tool During pregnancy high blood pressure along with presence of albumin in the urine indicates ldquopre-eclampsiardquo Since all data from ANC visits is now digitally available the system can detect if the mother requires immediate referral and presents this information to upazila level managers The system also alerts the managers if the service provider doesnrsquot refer clients when there is a need for referral

The primary objective of eMIS is to automate the business process of the government providers The digitalization process allows for the development of rule based algorithms (Decision Support System) and alert systems including automated Medical Eligibility Criteria for FP clients detection of pre-eclampsiaeclampsia mothers and detection of Low Birth Weight [LBW] newborns etc This directly improves the quality of services of health providers Moreover integration with the community health workers (HA FWA) and a customized client dashboard ensures better follow up and effective communication with the patientsclients Finally the awareness that all of this activities are accessible though the monitoring system also raises the accountability at service provider end

eMIS digital registers helping providers in identifying risk pregnancy and referral


Figure 28 Referral of pregnant women detected with high blood pressure and PEE in Habiganj

The above graph indicates that after the introduction of the eMIS in Habiganj (in November 2016) there has been an impact on both the quality and coverage of service delivery for PEE case detection and referral in Habiganj From November 2016 to January 2017 the eMIS has shown that the detection of high blood pressure and referral for PEE was 22 and 63 respectively When the monitoring tool was introduced in the eMIS the detection referral rates have increased from Jun to August 2017 from 41 to 78 respectively

22

63

41

78

102030405060708090

Diastolic gt= 90 PE

Nov16 - Jan17 Jun17-Aug17


Case Study 1 Identifying risk pregnancy and PPFP

When Sazeda Khatun became pregnant for the fourth time in her forties she came to the Dharmaghar UHampFWC for her antenatal visits Following the automatic alert from the MNC e-register the FWV Seema Rani Dey informed Sazeda about risk of having more than 3 children The detailed medical records of Sazedarsquos ANC visits were entered into the e-register Following her delivery Sazeda decided to take IUD as a PPFP method When she returned to select an appropriate family planning method all the details stored in the register at the time of her ANC visits were automatically retrieved resulting in a seamless process The details of her follow-up visits were also recorded electronically Now all MNCH and FP records are available at onersquos fingertips should they be require in the future

Case Study 2 Identification and referral of pre-eclampsia through eMIS

Pollobi Rani Deb was a first time mother who came to Jagadishpur UHampFWC for her antenatal visit During her third visit she was diagnosed with high blood pressure (140100) The embedded decision support system (DSS) in the eMIS e-register highlighted the high blood pressure and alerted the FWV Jahanara Begum of a potential pre-eclampsia case since Pollobi also had blurred vision According to the national guideline Pollobi required referral to a higher level facility Realizing the risk Jahanara Begum counselled Pollobi and referred her accordingly Later Pollobi gave birth to healthy boy through caesarian section at the hospital Pollobi expressed her thanks to the FWV for her timely suggestion when she came back to UHampFWC for her postnatal checkup


One of the key features of the UHampFWC eRegister is its built-in medical intelligence The electronic registers of the eMIS have the tremendous potential of improving the quality of care at the provider level For example an embedded requirement of adherence to the minimum standards required for ANC in the e-register ensures that the mother receives proper care and critical advice to avoid complications such as pre-eclampsiaeclampsia in later stages of pregnancy The system can detect cases of high risk pregnancy as well as pregnant woman with severe PEE In Year 4 facility and community modules were piloted in Habiganj and Tangail districts The facility modules are now being scaled up in Lakshmipur and Noakhali districts Community modules will be scaled up at Lakshmipur and Noakhali in Year 5 and only facility modules will be rolled out in Jhalokathi

Dr Kazi Mustafa Sarwar Director General graces the inauguration of e-MIS activities in Lakshmipur as a chief guest

2

24 Establish a quality assurance system for MNCHFPN services at the district level and below 241 Comprehensive strategy for improving the quality of clinical care

The MaMoni HSS project 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 MNCHFPN services The QI strategy has evolved based on lessons learned experience in applying different approaches and results documenting actual improvement of QI indicators The projectrsquos QI strategy comprises of three main components

A Building national capacity and updating national standards and guidelines B Improving delivery of MNCHFPN services in MaMoni HSS districts and C Measuring QI indicators and recognition of achievement

The project adopted the new WHO Framework for the quality of maternal and newborn health care as guiding principles for designing and implementing its QI interventions The new Framework describes eight essential standards for ensuring quality of health care and puts equal weight to standards reflecting Provision of Care and standards reflecting Experience of Care from the clientrsquos perspective


242 Building national capacity and updating national standards and guidelines MaMoni HSS provided support to the national QIS in updating various national standards and guidelines including bull Supporting national and divisional human resources capacity Based on the

Letter of Collaboration with the Health Economic Unit which is hosting the QIS MaMoni HSS has recruited national level staff seconded to the QIS including senior advisor national coordinator information technology support and administrative support staff The project has also recruited QI divisional coordinators and seconded them as part of the technical capacity of all eight divisions of the country to support QI activities at the district level In addition in divisions where MaMoni HSS is working four QI monitors have been recruited to provide more intensive support to QI activities at the district and sub-district levels

bull Supporting the development of QI committees and pool of resource persons

In order to increase local level ownership and participation of the QI process the project provided support to the QIS in forming and facilitating QI committees at DHs and UHCs In addition the project supported the formation of district resource pools composed of MOHFW senior staff supplemented by experts from medical colleges and professional associations to provide monitoring and support to QI efforts at health facilities Table 4 shows the number of district level QI committees and resource pools formed


Table 4 Number of district level QI committees and resource pools formed

Division Number of districts Number of districts where QIC formed

Number of districts where resource pool

developed

Chittagong 11 11 11

Sylhet 4 4 4

Barisal 6 6 6

Khulna 10 10 10

Dhaka 13 13 12

Rajshahi 8 8 8

Rangpur 8 8 8

Mymensingh 4 3 2

Total 64 63 61

bull Developing national RMNCH QI standards and indicators The project

contributed to the national effort led by the QIS and with participation of the DGFP DGHS and several national and international partners to develop RMNCH QI standards and indicators based on the standards included in the WHO maternal and newborn health care QI Framework The developed standards and indicators will contribute to establishing and measuring quality of RMNCH across the country Standards and indicators have been finalized tools are being developed to measure the indicators MaMoni HSS supported the MOHFW in developing the Maternal Health Strategy and Standard of Protocols (SOP) These two important but long pending documents were finalized and approved by the MOHFW this year The project supported the DGFP in finalizing the PPFP counselling module

bull Developing Surgical Safety Checklist Modified from the WHO the Safe Surgery

Checklist for Bangladesh has been developed by QIS with support from MaMoni HSS The checklist aims to minimize mistakes at three points in any surgery before induction of anesthesia before incision and before the patient leaves the operating room

Developing national patient safety guidelines The project is providing technical assistance 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 injuriesThe first draft will be shared with a small group of subject matter specialists professionals and then disseminated to a larger forum for finalization

bull Developing national curriculum and providing training on the Plan-Do-Check-Act (PDCA) QI approach The project led the effort to develop a structured


training course including training sessions and accompanying materials The purpose of the training is to empower health service providers to identify quality care gaps in their health facilities understand the causes of the gaps implement interventions to close the gaps and measure results During Year 4 of the project PDCA training was conducted at nine district hospitals (Habiganj Noakali Lakshmipur Jhalokathi Bhola Chandpur Khagrachari Coxrsquos bazar and Moulovibazar)

bull Developing QIS communication strategy The project continues to provide technical support to develop a communication strategy to advocate for raising the profile of quality improvement efforts at the national level increasing ownership and interest in quality care by service providers and engaging community and other governmental and private entities in QI efforts

bull Updating national infection prevention guidelines MaMoni HSS is providing

technical support to updating the national infection prevention guidelines The effort is led by the QIS with involvement of several national and developing partner experts The guidelines include components of infection control program and practices environmental management practices care of health workers and infection control precautions for selected situations

bull Supporting the implementation of 5S at district hospitals The project is

providing support to the QIS to scale-up the implementation of 5S as a basic QI approach for ensuring health facility cleanliness and organization To date 11 district hospitals received 5S training (Perojpur Comilla Chittagong Meherpur Narail Barguna Netrokona Jhalokathi Braman Baria Jessore and Kulna)


bull Providing support to developing Model Hospitals The project is collaborating

with the QIS to provide intensive support to 14 district hospitals around the country to become Model Hospitals to demonstrate improved quality of care and to inspire other district hospitals The intensive support includes establishing and activating QI committees forming Work Improvement Teams (WIT) 5S training PDCA training and intensive monitoring and supervision Table 5 below includes a list of the selected Model Hospitals

Table 5 List of the selected Model Hospitals

243 Improving delivery of MNCHFPN services in MaMoni HSS districts 243a Increasing local ownership of QI by establishing and supporting Quality Improvement Committees (QIC) and through the engagement of the local government Based on the national guidelines set by the QIS MaMoni HSS project continued to support the establishment and facilitation of QIC at district upazila and health facility levels The project provides facilitation and support to the QICs at different levels so that they can take ownership in the QI process including identifying gaps in infection prevention application of evidence-based standards of MNCHFPN services including counseling and client satisfaction Project facilitation includes providing supervisory checklists supporting QIC meetings summarizing important meeting points including identified gaps action for improvement roles and responsibilities and following up on action implementation Table 6 below includes an update on the status of the formation and activation of QI Committees by district

Division List of Model DHs

Chittagong 1 Coxs Bazar 2 Laxmipur 3 Khagrachari 4 Chandpur

Sylhet 5 Moulavibazar

Barisal 6 Bhola

Khulna 7 Narail 8 Chuadanga

Rajshahi 9 Joypurhat 10 Siranganj 11 Natore

Dhaka 12 Tangail

Rangpur 13 Kurigram

Mymensingh 14 Netrocona


Table 6 Status of the formation and activation of Quality Improvement Committees by district as of August 2017

District

Number of QI Committees

Target Actual

Active (had at least I meeting in last 3 months)

Habiganj 86 86 86 Noakhali 43 42 41 Lakshmipur 54 54 49 Jhalokathi 40 35 31 Total 223 217 207 One key intervention that led to substantial improvements in the basic standards of infection prevention including medical waste management was the engagement of the local government The local government contributed significant resources for health facility renovations repairs and construction of medical waste management dumping pits Char Folcon Union Lakshmipur district provides an illustrative example of the successful engagement of the local government for quality improvement of UHampFWC

243b Strengthening routine supervision system and promoting supportive supervision The project supported the districts in developing monthly visit plans and in the coordination of Joint Supervisory Visits (JSV) by district and upazila supervisors The objectives of the supervisory visit are to identifies gaps develop action plans for improvement and follow-up on results The project introduced structured supervisory checklists and the supervisors conducted the JSVs using the checklists in areas including

Left QIC meeting at Char Folcon UHampFWC

Right A postpartum woman with service providers


infection prevention measures service delivery management ANC nutrition FP newborn and child health IMCI and normal vaginal delivery Based on the findings the supervisors provided supportive supervision including mentoring on-the-job training and problem solving The status of JSVs is shown in Table 7 Table 7 Planned and conducted JSVs in MaMoni HSS supported districts

Districts Planned Conducted

Percent

Habiganj 48 38 792 Noakhali 96 96 100 Lakshmipur 60 33 55 Jhalakathi 16 11 688 Total 220 178 809

243c Improving the quality of clinical care in stages The project continued to support district health managers in improving the quality of clinical care provided by health facilities in stages as follows bull Stage 1 Improve the cleanliness infection prevention and medical waste

management bull Stage 2 Improve sterilization measures and compliance with antenatal care and

newborn care services and bull Stage 3 Improve compliance with all range of MNCHFPN standards

Figure 29 summarizes the progress at facilities that successfully passed Stage 1 of QI

Figure 29 Number of health facilities in 4 districts meeting basic infection prevention standards (Stage 1)

Total Habiganj Noakhali Lakshmipur Jhalokathi

Total number of facilities 230 79 57 59 35

with acceptable IP 42 43 25 66 29

Source Project Record

To measure acceptable IP some criteria have fixed Those facilities who met that affixed criteria are considered as the facilities with acceptable IP The criteria are as follows ndash

5 5 0 0 0

31 16 9 6 0

36

16 8 8 4

97

34

14

39

10

0

20

40

60

80

100

120

Total Habiganj Noakhali Lakshmipur Jhalokati

Jul15 Jan16 Jul16 Jul17


bull Hand hygiene (hand washing with soap or other hand cleaning solution eg Hexisol air drying and appropriate use of clean gloves in outpatient area)

bull Used Instruments decontamination with chlorine solution bull Used instruments are cleaned (after decontamination) with detergent and brush bull Used instruments are disinfected by boiling if autoclave is not available (after

decontamination and cleaning) Every month the district team have Fu whether the facility is maintaining those selected criteria or not

Basic Infection Prevention Standards include cleanliness hand washing use of gloves decontamination by 05 chlorine solution and basic medical waste management

243d Monitoring quality of care at sentinel facilities MaMoni HSS monitors the quality of care at selected facilities through sentinel surveys Figures 30 and 26 display the findings of surveys on the QoC of ANC and FP services conducted in 2017 in Jhalokathi and Lakshmipur districts The surveys were conducted by directly observing women attending ANC and FP services separately Figure 30 Quality of ANC services in Jhalokathi and Lakshmipur districts

Source Sentinel survey 2017

Figure 31 Quality of family planning counseling in Jhalokathi and Lakshmipur districts

100 100 100 100 99 95 96 100

76 84

64

91

50 54

100 88 92

82 95

73 75

0

20

40

60

80

100

120

Blood pressuremeasured

Weight of thepregnantwomen

measured

Hemoglobin testconducted

Urine proteintest conducted

Nutrition dietdiscussed during

pregnancy

Counseling givenon comlication

duringpregnancy

Counseling givenon importnace

of four ANC

Jhalokati Lakshmipur Total

Total of ANC Observation 603 Jhalokathi 301 Lakshmipur 302


Source Sentinel survey

100 100 98 97 97 96 93 100 100 100

53 39 39

52

14

100 100 100

76 68 68 74

53

100

0

20

40

60

80

100

120

Visual privacymaintained

Audio privacymaintained

Asked aboutclients consent

Discussedabout negativeimpact of the

procedure

Discussedabout what todo if there is

negative impact

Asked client forfeedback

Used job aidduring

counseling

Informed aboutfollow up visit



243e Supporting the implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR) MaMoni HSS provided technical support to the QIS in scaling up MPDSR at the district and upazila level health facilities in Habiganj Noakhali Lakshmipur and Jhalokathi districts Steps for MPDSR included improving Death Notification (DN) for maternal neonatal and stillbirths and Facility Death Review (FDR) The project supported ToT on DN and FDR with technical assistance from the Center for Injury Prevention and Research in Bangladesh (CIPRB) The ToT was followed by training for service providers of DHs UHCs and MCWCs In addition the project provided technical support to MOHFW counterparts on the utilization of data collected through MPDSR Data on the number and specific location of reported maternal neonatal and stillbirths have been depicted on a map and a summary of the death review results has been discussed with district and upazila level decision makers to identify health facility and community level actions required to avoid future mortality The following is an example of the mapping and death review results from Begumganj upazila Noakhali district

The following is an example of the use of data from Kutubpur union in Noakhali district Verbal autopsies of maternal deaths result in identifying actions to prevent future maternal deaths These actions include

bull Improving communication between the community and the health facility bull Improving referral to the health facility and establishing informal transportation for

emergency care and bull Increasing community awareness on the importance of delivery at a health facility

243f Supporting CEmONC through Regional Roaming QI Teams (RRQIT) The project continues to support the RRQIT as an additional supervisory and mentoring team focused on monitoring and improving the quality of CEmONC provided at the district level in Habiganj Noakhali Lakshmipur and Jhalokathi districts RRQITs include OBGYNs and neonatologists from medical colleges near project districts as well as district level supervisors RRQIT visits are conducted using structured checklists which assess general CEmONC infection prevention measures child birth services CEmONC provision readiness and neonatal care including SCANUs During the reporting year RRQIT visits were conducted at district hospitals and MCWCs in Jhalokathi (2) Habiganj (3) Noakhali


(2) and Lakshmipur (2) Based on the findings an action plan has been developed in coordination with district hospital service providers and the QIC

The RRQIT visit included following up on the status of the implementation of action points identified during previous visits Table 8 below summarizes these results

Table 8 Progress on RRQIT Action Plan Implementation

Major findings from previous visits Improvement

Jhalokathi Dirty environment and hospital floor in DH Basic cleanliness of district hospital improved Only one labor table was available in DH Two more labor tables supplied to DH OT lights with fused valves Arrangement of OT light Autoclave for labor room at DH was not functional Arrangement of autoclave for labor room at DH Inactive QI Committee at DH and MCWC

Functional QI Committee at DH and 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-MCHFPs in the district

and trained on LARC and PM Two are attending EmOC training

Post for nurses was vacant in DH Posting of 35 nurses at DH so a new maternal complex has been designed

No use of partograph and practice of AMTSL for NVD at DH and MCWC

Use of partograph and practice of AMTSL for NVD at DH and MCWC has begun

Nonfunctioning digital x-ray and USG machine at DH

Functional digital x-ray and USG machine at DH

Only Sunday had the facility for CS in MCWC with support from DH

Regular CS in MCWC because of new MOMCH has anesthesia training in sadar upazilla

Habiganj Overcrowded hospital environment and dirty hospital floor in DH

Crowds have been limited general cleanliness improved color coded beans used cleaners wear protective clothingglovesboots

Senior OBGYN consultant was not present there was no 247 CEmOC services in DH

Senior OBGYN consultant and 6 nurses have joined the DH ndash the gynecology department has improved its performance

Labor tables were old and broken in DH Labor tables were repaired and new one managed in DH

OT lights with fused valves (low illumination) All were repaired (high illumination)

(L) The RRQIT visits a delivery room at a DH in Jhalokathi

(R) The RRQIT debriefs with MCWC staff in Jhalokathi



All GA machines were out of order All were repaired and are now functional Inactive QI Committee at DH and MCWC Active QIC at DH and MCWC and working for

improving facilities Poor medical waste management at DH Municipality is working for medical waste

management at DH Few MO-MCHFP in the district New 6 has been joined and trained on LARC and

PM and two are in EmOC training Post for nurses was vacant in DH Vacant post has been filled Non Functioning radiant warmer at pediatric ward Well-functioning radiant warmer at pediatric

ward SCANUs were non functional SCANU is functional Service register are non-available and record keeping was not done properly in the pediatric and gynecology wards and in the SCANU

Service registers are available and record keeping is done in the pediatric and gynecology wards and in the SCANU Regular online reporting is improving on EmOC

Performance in the OBGYN ward previously admitted patient was less 50-60 NVD was month 20-30 had CS no ACS or KMC service most of the time SPEampE cases were referred and total cases were high

As of March 2017 total admitted patient was 517 of that 351 had NVD 51 had CS 11 got ACS 29 received SPEampE treatment 6 were given KMC for baby only 11 were referred and maternal death was 1

Lakshmipur OBGYN medical officer was absent and there is no pediatric consultant but 2 sectioned post

A senior OBGYN consultant is available A junior pediatric consultant is available

No training of medical officers on ETAT and KMC Already 2 nurses trained on ETAT KMC but there has still been no training for medical officers

No post-operative reporting form Post-operative reporting form available Essential drugs for SCANU are not available Several essential drugs for SCANU are

available with GoB channel No sweeper at MCWC Part-time staff supported by the Municipality

have been hired Inadequate supply for cleaning materials Cleaning materials available Hospital waste management is not collected and disposed of properly by the Municipality

Need based waste management disposal has been arranged through the Municipality

Recommendations from the RRQIT are summarized below

1 Regular QIC meetings and monitoring of hospitals by members is needed Discussions in the QIC and zilla parishad need to continue to arrange for dumping pits waste disposal local resource mobilization hospital security and emergency support

2 An increased number of MOs in the department of Obstetrics and Gynecology as well as nurses in the SCANU and CEmOC pair (both OBGYN Specialist and Anesthesiologist) for quality service of CEmOC and newborn care is required

3 Regular monitoring and support for the maintenance and intermittent supply of instruments supplies and drugs in the DH and MCWC is needed for example a general anesthesia machine in the operating theater in Jhalokathi The local


government must ensure a greater supply of cleaning materials and cleaning personnel

4 Patient diagnosis and management records must be improved for quality reporting particularly on CEmOC PPFP and newborn care

5 National level liaison and advocacy is required to arrange for a pediatrician phototherapy machine radiant warmer and incubator in the neonatal ward and SCANU service at the DH in Jhalokathi Sometimes repairs are insufficient and building reconstruction is required for proper functioning for example at the MCWC in Habiganj The post of an anesthetist remains vacant at a MCWC in Jhalokathi

25 Develop comprehensive logistic management systems for essential MNCHFPN commodities at the district level 251 Monitoring and improving the availability of essential MNCHFPN drugs 251a Scaling up the implementation of electronic logistics management information system (eLMIS) in coordination with Systems for Improved Access to Pharmaceuticals and Services (SIAPS)

In coordination with SIAPS the project supports the MOHFW in introducing eLMIS in three additional districts (Habiganj Noakhali Jhalokathi) to improve recording monitoring and availably of essential drugs particularly MNCH items During the reporting quarter the project oriented district level stakeholders in Habiganj Noakhali and Jhalokathi districts on eLMIS Because the eLMIS will be linked to the national DHIS 2 data system the project hired a consultant to input health facility specific data for the three districts into DHIS 2 as an initial step for implementing eLMIS During the reporting quarter the project conducted district level orientation on eLMIS for health managers in Noakhali and Jhalokathi districts The purpose of this orientation was to refresh the district level GoB managersrsquo knowledge on basic logistics management system their roles and responsibilities in improving LMIS status SCMP of MOHFW and the LMIS activity conducted to date at each district MOCS facilitated sessions and MaMoni staff shared the overall idea of scaling up eLMIS The new eLMIS is expected to improve monitoring the stock of essential drugs the procurement process and reduce stock outs

eLMIS training for priority MNCH medicines with technical support from SIAPS

ToT As part of the eLMIS activity eLMIS ToT was conducted jointly with SIAPS who provided facilitators and the training guide Thirty participants including MOCS district statisticians and managers from Habiganj Noakhali and Jhalokathi districts (Lakshmipur was covered earlier) received the training The training included the eLMIS data entry system through DHIS 2 and practical sessions on stock data entry by the health facility Participants developed a plan for training statisticians and health managers in their respective districts Training of district statisticians and managers Following the ToT cascade training for scaling up eLIMS in Habiganj Noakhali and Jhalokathi districts was conducted with support from MaMoni HSS and SIAPS The training covered a total of 684 facilities under DGHS (322 Noakhali 266 Habiganj 96 Jhalokathi) Facilities included DHs


district reserve stores UHCs community clinics USCs and UH and FWC under DGHS In all districts the training venue was primarily the civil surgeonrsquos office 750 copies of the eLMIS training guide were provided by SIAPS

eLMIS ToT conducted with SIAPS for Habiganj Noakhali and Jhalokathi districts ndash July 27

2017 ndash MaMoni HSS projects office

251b Improving distribution and storage conditions at national and regional levels bull Supported national distribution of 71 CHX from the DGFP central

warehouse MaMoni HSS provided technical assistance to the DGFP to ensure efficient distribution of 71 CHX solution In November 2016 a stock of 184800 bottles was stored at the central DGFP warehouse The project assisted the DGFP by preparing a distribution list for all districts of Bangladesh based on forecasting numbers of health facility deliveries by district and facilitating the distribution of the stock accordingly

bull Provided technical assistance to Sylhet Regional Warehouse The project provided technical assistance to the Sylhet Regional Warehouse DGFP to review storage conditions the documentation process and the condemnation process of expired drugs The QIS Sylhet team participated in the visit

Reviewing temperature maintenance and storage conditions Regional Warehouse DGFP Sylhet



251c Improving data utilization to monitor the availability of essential drugs The project continued to provide support to Habiganj Noakhali Lakshmipur and Jhalokathi districts to monitor the availability of essential MNCH drugs and to engage district managers in using stock information to take action to avoid stock out 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

Sl No

Name of the store

Jan

16

Feb

16

Mar

16

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

17

1 Sadar

2 Lakhai

3 Bahubal

4 Madhabpur

5 Chunarughat

6 Nabiganj

7 Baniachang

8 Ajmeriganj

Stock status of Tab Misoprostol 200 McG in DGFP stores of Habigonj district from January 2016 to August 2017

Green = stock available Red = stock out

Stock out can be addressed through supply chain management portal (SCMP) both at store and service delivery point (SDP) level Regarding misoprostol MaMoni HSS communicated with MCH unit DGFP and Central Ware House(CWH) DGFP after collecting information from Supply Chain Management Portal(SCMP) about availability of Tablet Misoprostol at CWHDGFP So Tab Misoprostol was supplied from CWH DGFP to the related Regional Ware House(RWH) of MaMoni HSS districts Also at the district level MaMoni HSS facilitated the process of distribution of tab Misoprostol from RWH to upazilla stores to address the stock out situation

Data utilization examples of action taken to improve availability of essential MNCH drugs bull MaMoni HSS facilitated moving Inj Oxytocin from CS Store to Rajapur and

Kathalia UHCs where NVD services are available but there was no supply bull Facilitated the process of redistributing 750 bottles of 71 CHX from Jhalokathi

health store to Barisal Medical College The expiration date was 30 May 2017 However as a result of the redistribution the supplied amount of 71 CHX was used up

bull F-75 and F-100 food supplements were inadequate at SAM corners at the Jhalokathi DH and Rajapur UHC early in the month of April 2017 After raising the issue with the CS-Jhalokathi it was revealed that Pirojpur district had sufficient stock By coordinating with the Pirojpur CS office Zia Nagar UHC the District Nutrition Surveillance Officer of the United Nations Childrenrsquos Fund (UNICEF) 1 carton (90 sachets) of F-100 and 1 carton (120 sachets) of F-75 were distributed to the SAM


corners of Jhalokathi DH and Rajapur UHC

26 Strengthen local government planning and engagement in health service provision MaMoni HSS continued to engage the local government to strengthen the expanded program on immunization (EPI) linked birth registration (BR) and to allocate a greater proportion of their annual budget for health-related activities In this regard project staff facilitated the arrangement of bi-monthly Union Education Health and FP Standing Committee (UEHampFPSC) meetings 27 Improve local governance and oversight for MNCHFPN To allocate adequate budget for MNCHFPN services for respective union parishads (UPs) the MaMoni HSS project staff participated and facilitated ward meetings and budget meetings in all unions Advocacy and planning meetings were arranged with all UPs in all districts to engage them in the health service delivery of their unions Some UPs are committed to deploying service providers (paramedics) in the UHampFWCs of their unions with the support of their budget The district teams worked to engage more UPs to motivate them to deploy service providers (paramedics) in the UHampFWCs of their unions In Noakhali the UP of Charbata union recruited paramedics in the UHampFWC using their own funds while the UP in Rajganj union is in the process of recruiting another paramedic A remarkable achievement was made by involving the UPs to take the lead and also to mobilize funds to upgrade andor maintain the services at 247 UHampFWCs Table 9 shows the funds allocation and utilization status by local government bodies for MNCHFPN activities for the period of July 2016 to June 2017 (GoB fiscal year) These funds were mainly used for the construction repair and maintenance of facilities purchasing emergency medicine (especially during stock-outs) purchasing small medical and non-medical equipment and logistics financial support to temporary support staff and work on approaching roads Fund utilization was less due to local government (UP) elections during the past year

Table 9 UP budget allocation and utilization July 2016 to June 2017

District Number of Unions

Number of unions allocated budget

Percentage of unions allocated budget

Total budget allocated (BDT)

Total budget utilized (BDT)

Percentage of budget utilization

Habiganj 77 57 74 7298945 4449311 61

Jhalokathi 32 21 656 3080069 1009640 33

Lakshmipur 58 42 724 6035208 5887871 98

Noakhali 44 38 864 4518000 6260098 139

Total 211 158 749 20932222 17606920 841

From the above table it is visualized that in Noakhali the budget utilization is highest 139 where as in Jhalokati it is very low 33 In Noakhali the local governments founds enough motivated enthuastic and willing to allocate resource for MNCHFPN services A number of union parishad mobilize budget beyond their


allocated money from upazila parishad and zila parishad that exceeds their own allocated budget Though Jhalokati has started to work with local government later than other districts still they are improving in resource mobilization In Jhalokati the local government has less resources than Noakhali Another important factor is local family planning and health managers yet to strengthen relation with local government at the peak level like Noakhali IR 3 Promote an enabling environment to strengthen district level health systems 31 Policy reforms in place to promote local planning and need-based human resource deployment in the public sector MaMoni HSS provided direct technical and administrative support to the planning wing of the MOHFW under a Letter of Collaboration (LOC) This support included the provision of salaries for 19 staff in different positions relevant office supplies support to the organization for policy dialogue and facilitation of workshopsmeetings for the development and finalization of OPs The PMMU of the MOHFW plays a significant role in providing technical support in management monitoring and evaluation functions of the HPN Sector Program and MaMoni HSS had been an important partner in these activities With the support of MaMoni HSS the PMMU published the 10th issue of their quarterly newsletter The project worked closely with the Line Directors to ensure that the project activities are incorporated into the OPs This also helped to ensure that the OPrsquos priorities aligned with the priorities advocated by the project Project inputs have been incorporated or are being discussed with nine OPs ndash Maternal Newborn Child and Adolescent Health (MNCAH) Maternal Child Reproductive and Adolescent Health (MCRAH) Clinical Contraceptive Delivery Program (CCSDP) Health Economics and Financing (HEF) Sector-wide Program Management and Monitoring (SWPMM) National Nutrition Services (NNS) Management Information System-FP (MIS-FP) Human Resources and Development (HRD) and Family Planning Field Service Delivery (FP-FSD) National technical assistance for upgrading UHampFWCs as 247 delivery facilities Following the national assessment in 2015-2016 4461 UHampFWCs were categorized as A B or C based on coverage delivery facility HR training infrastructure furniture delivery services human resource and residence During the assessment 14 of facilities were listed in the ldquoA categoryrdquo 69 in the ldquoB categoryrdquo and 17 in the ldquoC categoryrdquo MaMoni HSS developed models of upgraded UHampFWCs through local level resource mobilization and local government involvement The project is now supporting the DGFP in developing a costed workplan to upgrade these facilities nationally in phases Because of extensive advocacy by the MaMoni HSS the DGFP has already identified this as a priority activity in HPNSP and allocated a budget for upgrading these facilities Journalist engagement This year thirty-one news stories about the MaMoni HSS project and its advocacy issues were published by different media outlets as a result of broader media advocacy The news stories included issue-specific situational updates case studies technical information with a call to action for required health systems improvement The media engagement and capacity building program has resulted in a significant increase in media coverage on MNCHFPN issues and increased engagement of involved stakeholders Representatives from the multiple government ministriesdirectorates and non-governmental partners have been deeply involved in the program This contributes immensely to facilitating closer


collaborations across organizations and resulted in both increased dialogue and news coverage The MaMoni HSS project also facilitated participation of staff and stakeholders (professional bodies local government representatives government counterparts) on television programs to bring attention to critical policy gaps and feasible models Please refer to Appendix 6 for links to published stories

32 Strengthen advocacy and coordination for adoption of evidence-based learning in national policy and program 321 Participate in national and district level campaign activities on various national days MaMoni HSS supported the MOHFW at the national as well as at the district level to observe the following national and international days related to MNCHFPN issues

bull Family Planning Service Week ndash November 12-17 2016 bull World Prematurity Day ndash November 19 2016 bull Safe Motherhood Day ndash May 28 2017 bull World Population Day ndash July 11 2017 bull World Breastfeeding Week ndash August 1-7 2017 bull Family Planning Service Week ndash November 12-17 2016

At the national level MaMoni HSS supported the design of posters for national use printing of Information Education and Communication (IEC) materials to commemorate the events and participation in roundtable discussions and press conferences

Poster for Safe Motherhood Day Poster for World Population Day


At the district level the project supported the Civil Surgeon and Deputy Director of Family Planning by organizing collaborative meetings to present district situation and performance participating in rallies organizing volunteers to refer community members to the health facilities and holding special SBCC events in hard to reach areas For Safe Motherhood Day (May 28) MaMoni HSS also conducted a maternal death count in every district through the volunteers and presented the findings at the respective district seminars By linking the community to each of the national activities the project has created awareness on the health systems issues on a scale that would not be possible through traditional observation of special days 33 Conduct and disseminate operations research and program learning documentation activities

MaMoni HSS collaborated with various partners to document MaMoni HSS lessons on various issues In Year 4 PEE management at community level quality of ANC at satellite clinics viability of private CSBAs use of partograph to inform referral decision-making adherence to LAPM quality standards and roll-out of CHX were documented and shared on a limited scale Eleven of the MaMoni HSS program lesson issues were shared in international forums in six countries through oral and poster presentations In addition twelve other abstracts have already been accepted in upcoming forums At the time of submission of this report two manuscripts have been prepared for peer reviewed journals and are undergoing review Appendix 7 summarizes the topics that have been presented in different global forums MaMoni initiated three program learning initiatives during the reporting period The program learning topics initiated are

bull A national case study on scaling up of 71 CHX nationwide bull A competency assessment of FWVs to effectively screen for pre-eclampsiaeclampsia bull An implementation research to reduce discontinuation of LARCs (IUCD and implants)

Data collection on these program learnings are ongoing In Year 4 two studies were completed that were initiated in the previous year

bull Sustainability of the Private Community Skilled Birth Attendant Model in Bangladesh

bull Implementation research to support the Bangladesh MOHFW to implement its national guidelines of management of infections in young infants in two rural districts of Bangladesh

MaMoni HSS also supported MEASURE DHS to conduct the Bangladesh Health Facility Survey 2017 a validation study on select chronic maternal morbidities and the HRCI project of Johns Hopkins University to conduct an implementation research on PSBI management in union level facilities where referral is not possible Data collection and analysis are underway and the results will be presented in Year 5


The project is also conducting routine process documentation on 25 other topics A summary of these process documentation activities has been provided in Appendix 8

34 Strengthening NIPORT to deliver a capacity-building program for community level health workers to deliver community-based interventions of the essential services package

A LOC has been signed between MaMoni HSS and NIPORT for strengthening the technical and managerial capacity of NIPORT to develop and implement a capacity development program for CHWs their supervisors and first level managers The LOC was signed by the Director General NIPORT and Country Director SCI in the presence of the Director OPHNE USAID and other USAID representatives as well as other stakeholders from the MOHFW DGHS DGFP NIPORT and SCI on 29 August 2017 at the NIPORT conference room Recruitment of temporary staff has been completed and procurement initiated Tools have been developed for assessing the institutional capacity of the RTCs and the assessment was completed in September 2017 A workshop was organized for review and updating the existing Team Training curriculum for CHWs Curriculum for management and leadership skills for UHS strengthening has been initiated

IR 4 Identify and reduce barriers to accessing health services

41 Promote awareness of MNCH through innovative BCC approach

411 Intensive SBCC implementation plan development A communication agency specializing in SBCC was hired to develop and implement a comprehensive area-specific community behavior enhancement strategy (ie Habiganj Lakshmipur NoakhaliHatiya) along with an SBCC activity implementation plan to accelerate a change with care-seeking for appropriate MNCHFPN services as well as improving home-based care practices The SBCC activities are also aimed at creating an enabling environment in families and communities that facilitate and support appropriate care-seeking behaviors By the end of February the plan was drafted based on the outcome of formative research and stakeholder consultations In order to fine-tune the plan and ensure that it is comprehensive and culturally sensitive two SBCC barrier analysis workshops (one in Hatiya and the other in Lakshmipur) were conducted The participants of the workshops included community level health service providers community representatives (local government representative and community volunteers) and MaMoni HSS field level officials who are mostly engaged in community level work Through a rigorous participatory process the workshop identified upazila specific SBCC barriers along with strategiesactivities to address them in a more effective manner 412 SBCC activities


MaMoni HSS carried out comprehensive behavior change communication activities throughout Lakshmipur Noakahli and Hatiya Major activities were focused in the low performing areas based on crucial health indicators such as ANC SBA delivery and facility delivery Activities like video shows micrsquoing (announcements using micorphones sometimes in one location and sometimes through mobile rickshaw van) motherrsquos support groups (Ma Somabesh) advocacy meetings school health sessions and popular theater and community sensitization meetings by external communication agencies were conducted A significant number of mothers their caregivers and adolescents received the health key messages on MNCHFPN issues Masses have gathered knowledge about the importance of facility deliveries offered through 247 centers and the potentials risks associated with home deliveries The project reached 1530020 people in communities (43 female and 57 male) through courtyard meetings video shows local stakeholder meetings popular theatre and other BCC activities 413 Reaching the community through Aponjon services Aponjon continues to provide critical maternal newborn child health nutrition and family planning messages to pregnant and lactating mothers during the pregnancy and postpartum period through the subscription based Shogorbha program As of September 30 a cumulative total of 2015113 women have subscribed to the messaging service A prepaid model was launched and was designed to ensure timely revenue for Aponjon and to ensure subsribers will not miss content due to an insufficient balance Aponjon is exploring avenues for distributing the prepaid cards and has partnered with three commercial dealers to make the card available to subscribers Promoting Aponjon services and increasing the brand visibility has been the major focus this year Digital channels like Facebook and a blog have been used for marketing and have reached roughly 14 million and 56000 users respectively Aponjon is continuing to build its partnership with the GoB and various development agencies participating in a consultative workshop to streamline Aponjon BCC activities with regular MNCH services Aponjon also targeted smartphone users and introduced an interactive Shogorbha app through Android iOS and Windows mobile platforms 29423 women downloaded the app which is more than double the 12597 downloads the previous year The app won mBillionth Award 2017 in the ldquohealth and well-beingrdquo category

Figure 32 Cumulative mobile app downloads of Aponjon Shogorbha


Aponjon has also introduced a regular blog with ten new articles both in Bangla and English over the year which was accessed 493521 times between December 2016 and August 2017 Through the website Aponjon has also introduced a live chat where users can anonymously contact the call center through text The chat service will be integrated into the mobile app 42 Enhance community engagement in addressing health needs Community mobilization In Year 4 MaMoni HSS strategically grouped 6 districts as per the intervention component and scale of intervention 421 Community mobilization in high intensity districts and Hatiya Community Action Group (CAG) meetings and Community Microplanning Meetings (cMPM) were facilitated by HAs and FWAs (front line MOHFW field workers) Field Support Officers (FSOs) supervised CAG meetings cMPM and union follow-up meetings in two unions The upazila level facilitators for service delivery monitored all activities in the upazilas At present there are 23929 community volunteersCAGs active in high intensity upazilas in MaMoni HSS districts Among them 18452 CAGs have provision of emergency transportation arrangement as referral vehicles Table 10 Number of CAGs with an emergency transport system for MNCH care

District Number of CVs Target

Number of CVs

Target of CAG with

emergency transport system

Achievement

Number Percentage

Habiganj 8379 8320 4369 8089 185 Jhalokathi 2731 2305 3746 1492 40 Lakshmipur 6710 6458 6461 6310 98 Noakhali 5900 6846 3876 4355 112 Total 23720 23929 18452 18616 110

422 Community mobilization in other districts


CAG meetings and cMPMs were facilitated by frontline MOHFW field workers ndash HAs and FWAs HAs took over the responsibility of cMPM facilitation and reporting The cMPM report includes CAG meeting information of the area HAs sent the cMPM report to the UHC and the upazila level facilitators for community based services (Uz F CBS) gathered all the cMPM reports from the UHC The Uz F CBS was responsible for monitoring all CAG meetings cMPM and upazila follow-up meetings with the support of HAs and FWAs Eighty-five percent of cMPMs are regularly conducted by HA and FWAs in MaMoni HSS areas 423 Piloting cMPM throug Community Support Group (CSG) One community clinic covering a population of approximately 6000 has one community group (CG) and three CSGrsquos One CSG covers a population of approximately 2000 which is almost similar to the area of a cMPM MaMoni HSS initiated cMPMs through CSGs in 3 unions of 3 districts - Noakhali Habiganj and Jhalokathi In Year 5 cMPMs through CSGs will be scaled up in another 3 unions Based on the experience of these unions it will be scaled in selected upazilas through CBHC 424 Transformation of MaMoni Community Volunteer (CV) to Community Sales Agent (CSA) MaMoni HSS initiated the transformation of selected MaMoni CVs to CSAs in 3 unions of 3 districts This activity is designed in collaboration with Social Marketing Company (SMC) Experience of developing women entrepreneurs as CSAs like ldquoNotun Dinrdquo project of SMC will be replicated in MaMoni HSS Based on the experience of these 3 unions this model will be scaled up in all upazilas in Year 5 In this quarter total 37 CSAs started selling commodities in 9 unions of 3 districts Habiganj Noakhali and Lakshmipur In addition to selling commodities CSAs sold total 34 Hexicort (71 CHX) and ensured application in newbornsrsquo umbilical cord Sales of the CSAs are gradually improving as they are expanding their product range Initially CSAs took only SMC products and Chlorhexidine Recently they are taking Paracetamol Ranitidine and Calcium Tablets as per their community demand CSAs market demand usually determines their product range Sometime lack of supply or short supply of the Blue Star Pharmacies (BSPs) affects CSAs sales

Sales report of 14 older CSAs during Oct ndash Dec 2017

Name of

Union

Sales amount Remarks

Octorsquo17 Novrsquo17 Decrsquo17

Nurpur union of

Habiganj (4 CSA)

4894 4729 1189

In December CSAs got

their supply in last week

Uttar Hamsadi Union of

Lakshmipur (5 CSA)

9729 12545 12027


Charkakra Union of

Noakhali (5 CSA)

8730 7580 8970

14 CSAsrsquo total sale

23353 24854 22186

Monthly average saleCSA

1668 1775 1584 Net

Profit

15-20

CHALLENGES SOLUTIONS AND ACTIONS TAKEN Challenges and Mitigation Strategies Staff turnover There were changes in leadership several times both at the DGHS and DGFP at the national level as well as at the district level These included the Director General of the Directorate General Family Planning (DGFP) the Director - MNCampAH (DGFP) Director - MIS (DGFP) Director - MIS (DGHS) Director - PHC and Line Director ESD (DGHS) at the national level Moreover the Deputy Director - Family Planning (DDFP) of Habiganj retired and a new DDFP has taken over the responsibilities It took a considerable amount of time to orient and sensitize the new personnel which delayed planned activities MaMoni HSS kept continuous communication with the departments to ensure progression of activities Furthermore the MOHFW has been recently divided into 2 divisions the Health Services Division and the Medical Education and Family Welfare division Each of the divisions will have one secretary This division has created uncertainties because of a lack of clear guidance on operational mechanisms MaMoni is closely observing the changes and will adapt strategies accordingly Shortage of staff A chronic shortage of human resources poses challenges to all project activities especially in improving the quality of health care The inadequate clinical and support staff in addition to the inadequate supervisory cadres such as medical officers continued to impede efforts to improve the quality of care MaMoni HSS is facilitating the process of better utilization of available human resources through district and upazila planning The project also supports with a small number of service providers to fill-in the critical human resource gaps of GOB service providers on temporary basis while continuing to advocate with local leaders (Union Parishad Chairman and Members of Parliament) for long-term solutions by filling the vacancies through GOB recruitment Simultaneously the project continually advocates with the government for newly recruited staff to be posted in underserved areas with major human resource shortages


Frequent stock out of essential MNCH drugs Frequent stock-out of essential MNCH drugs hindered efforts to improve health outcomes As a response the project is building the capacity of local managers to monitor the availability of essential drugs and is taking local measures to avoid stock outs through routine tracking of the supply chain management portal

Ownership and capacity development of QI committees Transferring the ownership of the QI process to the projectrsquos counterparts at district sub-district and health facility levels is a continuous challenge The establishment of QI committees has been a positive step in increasing the staff capacity in identifying gaps and implementing actions to address them There are encouraging examples of QI committees that have been able to solve local problems and engage local government in resource mobilization However while the QI committees have made a difference they still require significant facilitation by project staff Improving the quality of clinical care at a large scale MaMoni HSS has been supporting the national QIS in developing and implementing a strategy for improving the quality of clinical care across the country While there has been significant progress in updating standards guidelines and training the implementation of interventions leading to improvement of the quality of clinical care at health facility level needs to be strengthened 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

Community mobilization activities Reduction of project staff (FSO) in the districts has reduced community mobilization activities MaMoni HSS has engaged Has and FWAs to take over the responsibility of cMPM facilitation and reporting

Ensuring continuity of services provided by paramedics MaMoni HSS has been filling the HR gaps in selected health facilities by providing paramedics to provide MNCHFPN services As the project is approaching its end it is important to engage with the MOHFW to ensure that the paramedics will be absorbed within the MOHFW cadres or replaced to ensure continuation of services in the health facilities where paramedics are currently working MaMoni has initiated dialogue with local health managers and local government bodies for ensuring this

Performance of pCSBAs pCSBAsrsquo performance are not as per expectation Strategic re-distribution motivation of pCSBAs linking them with the formal health system and central and district level monitoring should be increased

Follow-up of service delivery after training 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 has supported post training follow-up after ENC training (71 CHX and HBB) However training follow-up and on-the-job support to ensure provision of quality services after training are required after each technical training For example nurses working in district hospitals and UHC who received training on IUD and PPIUCD need support in providing services MaMoni HSS has initiated dialogue with DGHS and DGFP for institutionalization of training follow-up and supportive supervision after each technical training

Poor case admission and post discharge follow-up of KMC and poor day-8 follow-up of PSBI cases 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 To improve these interventions MaMoni HSS has arranged sensitization meetings and


mentoring visits in implementation districts by national level managers and representatives from professional organization for new newborn interventions including KMC amp PSBI 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 Orientation of Assistant Health Inspector (AHI) of DGHS and Family Planning Inspector (FPI) of DGFP have been planned for ensuring day-8 follow-up of PSBI and post discharge follow-up of KMC

Improve organization and quality of LARC and PM services provided by Mobile Camps In order to reap the benefit of Mobile Camps in boosting LARC and PM uptake there is a need to improve the preparation organization and utilization of Mobile Camps MaMoni HSS is playing an active role in coordinating Mobile Camps with national level and district level partners and health managers This includes supporting the preparation of schedule for Mobile Camps within districts coordinating with Mayer Hashi II project DGFP to ensure availability of skilled service providers and supplies strengthening health facility readiness and strengthening community utilization of services provided by the Mobile Camps

Way Forward In Year 5 MaMoni HSS will continue to provide support to the MOHampFW in strengthening health systems at the national level and to serve as a strategic partner for the government to implement the priorities identified in the new sector plan as well as EPCMD in Bangladesh In the upcoming year the project will expand the technical assistance role at the national level while consolidating the implementation at the district level Program activities for the year will also focus on deepening engagement and support to national-level HSS initiatives in health workforce development and management quality improvement strengthening the eMIS and improving capacity and quality of MNCHFPN service delivery At the national level MaMoni HSS will continue to work closely with the MOHampFW through the DGHS and DGFP the Ministry of Local Government Rural Development amp Cooperatives (MOLGRDampC) as well as key development partners MaMoni HSS held extensive consultations with the Planning Wing and the Program Monitoring and Management Unit (PMMU) of the MOHampFW and the relevant Operational Plans of DGHS and DGFP to identify the priority areas for technical and management support at the national level Some of the major focus areas in next quarter are

bull Dissemination of the workload and staffing need study findings and development of policy briefs

bull Provide support to the Human Resource branch of Health Service Delivery (HSD) for capacity strengthening on central Human Resource Information System (HRIS)

bull Organize national level stakeholder workshops on HRIS to share learning and take it forward

bull Develop HRIS activity monitoring guidelines and data quality assurancecontrol (DQA) mechanisms in collaboration with DGHS and DGFP

bull Capacity building of DGFP staff on HRIS and facilitate regular updates to HR data in the HRIS at upazila and district level (DGHS and DGFP)

bull Facilitate the establishment and operationalization of the decentralized QI management structures at divisional district and sub-district levels


bull Provide technical assistance to the development and updating of national guidelines protocols and tools to support the implementation of the national QI strategy

bull Contribute to the development of standards national guidelines protocols tools measurement and monitoring framework for RMNCH interventions

bull Update national guidelines for infection prevention and hygiene practices bull Supervision and clinical quality monitoring tools and protocols bull Develop guidelines for appropriate motivation and recognition mechanisms for quality

improvement bull Complete the documentation of QI initiative led by MOHFW and supported by various

partners across the country bull Pilot implementation of RMNCH framework in Narsingdi district bull Support the development of a system for developing and monitoring QI indicators for

various clinical services bull Continue the remaining design of facility-level modules of the automated eMIS as well

as support their national scale-up Both community and facility modules will be implemented in Habiganj Noakhali and Lakshmipur and only the facility module will be implemented in Jhalokathi Moreover the project team will continue supporting icddrb and MEASURE Evaluation in implementing the facility and community modules in Tangail

bull In Year 5 the project will support the establishment of 3 special care newborn units 1 in Khulna Shishu Hospital and 2 in national level facilities of the DGFP

bull The project will support development of the information and communication technology (ICT) capacity of NIPORT and help in digitalization of the training database Both the national level and regional level facilities will be upgraded with modern ICT equipment enabling innovative ways to deliver trainings

bull Review and revise the existing Team Training Curriculum of NIPORT and adapt it for community based workers (HA FWA and CHCP) training Also support NIPORT in developing Leadership and Management training curriculum for upazila health and family planning managers (UHFPO UFPO and MOMCH)


High Health System

APPENDIX 1 SCOPE AND GEOGRAPHICAL COVERAGE OF THE MAMONI HSS PROGRAM

The programrsquos objectives are well aligned with the GoBrsquos Health Population and Nutrition Sector Development Program (HPNSDP) for 2011ndash2016 and also directly support the USAID Bangladesh Development Objective 3 (DO 3 ldquoHealth Status Improvedrdquo) which is under the ldquoInvesting in Peoplerdquo objective of the Country Development Cooperation Strategy (CDCS) framework of USAID in Bangladesh MaMoni HSS designed a two-pronged approach in which districts and upazilas were categorized into one of two

groupsmdashhigh-intensity intervention areas and health system capacity strengthening areas The aim of the high-intensity areas is to demonstrate best-practice models of MNCHFPN health care delivery through intensive support to the GoB and if

needed direct implementation to maximize learning and advocacy for scale-up nationally Based on an analysis of gaps in coverage and equity of access to high-impact MNCHFPN services the project identified a total of 23 upazilas across five districts to serve as the projectrsquos high-intensity areas Of the 23 upazilas district saturation was achieved in Habiganj Lakshmipur and Jhalokathi districts while in the Noakhali and Pirojpur districts four and two upazilas were supported respectively The health systems (HS) capacity strengthening areas cover a total of 17 upazilasmdashall seven upazilas of Bhola five upazilas of Noakhali and five upazilas of Pirojpur (refer to Figure 1 and Table 1) While the high-intensity areas focus on support for a complete package of MNCHFPN interventions the HS capacity strengthening areas receive less intensive technical assistance on a selected set of interventions Minimal support was provided to GoB health systems to scale-up interventions such as 247 UHampFWCs CHX for cord care and HBB instead the focus was on supporting the strengthening of existing MNCHFPN services MaMoni HSS has four intermediate results (IR) IR 1 Improve service readiness through critical gap management IR 2 Strengthen health systems at district level and below IR 3 Promote an enabling environment to strengthen health systems at the district level IR 4 Identify and reduce barriers to accessing health services


APPENDIX 2 DATA SOURCES Assessment Name

Assessment Type

Frequency Geographical Coverage

Population based tracer survey

Independent cross sectional assessment by third party (icddrb)

2 rounds in a year Each round is for six months

23 high intensity upazilas of 5 MaMoni districts (Habiganj Jhalokathi Noakhali Lakshmipur and Pirojpur) In addition during the initial stages of program ndash starting from October 2013 ndash this population based assessment was also conducted for Bhola District along with Noakhali and Lakshmipur This included a baseline assessment and two rounds of the population-based survey In October 2014 there was a major shift in the MaMoni HSS program strategy and the scale of program activities were reduced in Bhola Accordingly the project monitoring plan (PMP) was revised and the population based survey no longer covers Bhola with the exception of conducting an end line survey in 2017

Sentinel survey

Selected sentinel site assessments using structured tool

Twice in a year

Selected DH MCWC UHC UHampFWC and satellite clinics in Habiganj Jhalokathi Noakhali and Lakshmipur district

Service delivery point assessment

Periodic facility assessment by using structured tool

Twice in a year

21 high intensity upazilas of Habiganj Jhalokathi Noakhali and Lakshmipur district

Newborn revisit

Nationwide assessment by upazila on HBB and 71 CHX using structured questionnaire

Once in project life

All over the country

Routine MIS MOHFW

Routine MIS forms of DGHS and DGFP

Monthly All over the country

Project MIS Routine MIS reports

Monthly Only in high intensity project areas


APPENDIX 3 PROGRAM PERFORMANCE INDICATORS

MaMoni Health Systems Strengthening Program Performance Indicators

Indicator

Target (October

2016-September

2017)

Achievement (October

2016-September

2017)

Target 2018

Remarks Project Goal Improve utilization of integrated maternal newborn child health family planning and nutrition services

Percent of women received at least one antenatal care visit from a medically trained provider

High intensity areas Lakhsmipur 70 77 77

Noakhali 67 87 85 Habiganj 70 85 85

Jhalokathi 73 83 83 Pirozepur 70 71 72

HSCS areas

Tracer Indicatorssurveys are not conducted in HSCS areas

Pirozepur 67 NA 67 Bhola 56 NA 56

Noakhali 63 NA 63 Percent of births receiving at least four antenatal care (ANC) visits during pregnancy




HSCS areas

Tracer Indicator surveys are not conducted in HSCS areas


Noakhali 21 NA 21


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks Percent of Births Attended by a Skilled Doctor Nurse or Midwife

High intensity area Lakhsmipur 45 43 45



HSCS areas



Noakhali 38 NA 38 Percent of women with home births who consumed misoprostol to prevent post-partum hemorrhage




HSCS areas

Tracer Indicators surveys are not conducted in HSCS areas


Noakhali 20 NA 20 Percent of newborns initiated breastfeeding within one hour after birth



Jhalokathi 70 52 55 Pirozepur 63 54 55 HSCS areas Tracer Indicator


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks surveys are not conducted in HSCS areas


Noakhali 76 NA 76 Percent of newborns received chlorhexidine application on their umbilical cord immediately following birth




HSCS areas



Noakhali 35 NA 10

Percent of newborns receiving postnatal health check within two days of birth

High intensity areas

Lakhsmipur 20 36 36 Noakhali 20 48 47

Habiganj 32 31 32 Jhalokathi 33 48 48

Pirozepur 18 41 41

HSCS areas



Noakhali 20 NA 20 Modern contraceptive method prevalence


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks rate




HSCS areas



Noakhali 59 NA 59 Couple years of protection (CYP) in USG-supported programs

Overall 1087492 875046 901298 Lakhsmipur 163817 132281 138942

Noakhali (All upazilas)

235128

209600

217475


Pirozepur (all upazilas) 139069

110200

113933

Bhola 263795 221407 229711

Intermediate Result 1 Improve service readiness through critical gap management

Percent of targeted facilities that are ready to provide essential newborn care



Jhalokathi 90 829 90


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks

Pirozepur 90 NA 90

SDP assessments are not conducted in Pirozepur

HSCS areas

SDP assessments are not conducted in HSCS areas


Noakhali 70 NA 70 Percentage of public health facilities with functional bags and masks (two neonatal size mask) in the delivery room




Pirozepur 50 NA 70


Percent of USG-assisted service delivery sites providing family planning (FP) counselling andor services





Pirozepur 95 NA 95


HSCS areas


Pirozepur 17 NA 17 Bhola NA NA NA

Noakhali 25 NA 25 Number of targeted facilities ready to provide delivery services 24 hours a day seven days a week



Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks Lakhsmipur 25 36 36


Jhalokathi 21 17 21 Pirozepur 4 5 5 Source project MIS HSCS areas Source Project MIS

Pirozepur 9 11 11 Bhola 32 18 18

Noakhali 7 6 7 Sub-IR 11 Increase availability of health service providers Number of vacant positions filled by temporary non-GoB health workers

High intensity areas Lakhsmipur 10 4 4 FWV-4

Noakhali 15 11 11 (FWV-9 Nurse-1 Doctor -1)

Habiganj 10 37 25 (FWV-11 Nurse-14) Jhalokathi 10 2 2 FWV-2

Pirozepur NA Nil Nil Sub-IR 12 Strengthen capacity of service providers to provide quality services

Number of people trained in maternalnewborn health through USG-supported programs

2149 8701 16519

Target 2018 includes 2604 for MaMoni 4 districts and 13915 for national scale up initiatives)

Number of people trained in FPRH with USG funds 225 147 70 Number of people trained in child health and nutrition through USG-supported programs

200 425 0

Sub-IR 13 Strengthen infrastructure preparedness to improve MNCH service utilization

Number of union level public health facilities that are ready to provide normal delivery services

75 119 119

High intensity areas Lakhsmipur 29 29

Noakhali 25 25


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks Habiganj 46 46

Jhalokathi 16 16

Pirozepur 03 03 The sources Project MIS

Intermediate Result 2 Strengthen health systems at district level and below Number of district level quarterly performance review meeting held for data-driven performance review and planning

24 20 12 FY 18 targets are for 2 quarters only

Lakhsmipur 4 4 2 Noakhali 4 4 2 Habiganj 4 4 2 Jhalokathi 4 4 2 Pirozepur 2 2 2 Bhola 2 2 2

Intra partum still birth rate in project assisted facilities

No reliable data available from facility MIS

High intensity areas lt51000 NA NA Lakhsmipur lt51000 NA NA Noakhali lt51000 NA NA Habiganj lt51000 NA NA Jhalokathi lt51000 NA NA Pirozepur lt51000 NA NA Sub-IR 21 Improve leadership and management at district level and below Number of GoB managers supported for leadership and management capacity development

The activity completed in 2015

Lakhsmipur NA NA NA Noakhali NA NA NA Habiganj NA NA NA

Jhalokathi NA NA NA Pirozepur NA NA NA

Bhola NA NA NA Sub-IR 22 Improve district-level comprehensive planning (including human resources) to meet local needs

Number of upazilas with updated comprehensive annual MNCHFPN plan 23 26 23 This activity started in

2015


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks High intensity areas



Sub-IR 23 Strengthen local management information systems Percentage of community micro planning units conducting monthly meeting



Jhalokathi 95 65 85 Sub-IR 24 Establish quality assurance system at district level and below Percent of planned supervision visit conducted where a supervision tool was used and findings shared with providers



Jhalokathi 90 110 90 Sub-IR 25 Develop comprehensive logistic management systems at district level and below

Percent of USG-assisted service delivery points (SDPs) that experience a stock out at any time during the reporting period of a contraceptive method that the SDP is expected to provide


Lakhsmipur lt3 2 lt2 Noakhali lt3 1 lt2

Habiganj lt3 1 lt2 Jhalokathi lt3 0 lt2

Sub-IR 26 Strengthen local government planning and engagement in health service provision


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks

Percentage of unions that had at least 50 percent of the estimated births registered within 45 days of birth


Lakhsmipur 60 NA NA Noakhali 60 NA NA

Habiganj 60 NA NA Jhalokathi 60 NA NA

Sub-IR 27 Improve local governance and oversight for MNCHFPN Number of Union Parishads (UP) that spent funds to support MNCHFPN activities



Jhalokathi 32 23 32 Intermediate Result 3 Promote enabling environment to strengthen district level health system

Number of critical vacancies filled by GoB recruitment or redeployment in project areas

High intensity areas Lakhsmipur 5 17 5 (Nurse-17)

Noakhali 5 80 5

(FWV-2 Conslt GynObs-2 Nurse-76)

Habiganj 5 18 5 (FWA-3 FWV-1 Nurse-14)

Jhalokathi 5 46 5 (Nurse-46) Sub-IR 31 Policy reforms in place to promote local planning and need-based human resource deployment in the public sector

Number of policies strategiesguidelines on MNH developedrevised with MaMoni HSS support

4 4 4

Sub-IR 32 Strengthen advocacy and coordination for adoption of evidenced-


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks based learning in national policy and program Number of program learning initiatives completed and disseminated 10 11 15 Intermediate Result 4 Identify and reduce barriers to accessing health services Number of deliveries with a SBA in USG-assisted programs



Jhalokathi 7054 7793 7793 Pirozepur 2658 2421 2421 HSCS areas

Pirozepur 12148 8621 12148 Bhola 1982 18453 18453

Noakhali 37848 19598 37848 Number of antenatal care (ANC) visits by skilled providers from USG-assisted facilities



Jhalokathi 16553 28770 28770 HSCS areas

Pirozepur 44612 43826 43826 Bhola 68546 73961 73961

Noakhali 97682 85601 85601 Sub-IR 41 Promote awareness of MNCH through innovative BCC approaches Number of people reached through project supported BCC activities 666143 1530020 499607


Women 95784 Men 83507

Noakhali 145556 1290879 109167


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks Women 513452

Men 777427 Habiganj 205000 48391 153750 Women 40835

Men 7556 Jhalokathi 115587 11459 86690

Women 9373 Men 2086

Sub-IR 42 Enhance community engagement in addressing health needs Number of trained community volunteers promoting MNCHFPN through project support

28371

23929

23929




Number of Community Action Groups with an emergency transport system for maternal and newborn health care through USG-supported programs

24355

20229

20229




APPENDIX 4 ADDITIONAL INDICATORS (ADDED IN 2016)


Indicator Target FY 17

Achievement 2017

Target 2018 Remarks

Percentage of newborns receiving CHX application at birth in MoHampFW facilities (By Division)

Source DGFP MIS-3 and EmOC report of DHIS-2

National 50 47 60 Barisal 50 52 60 Chittagong 50 61 60 Dhaka 50 44 60 Khulna 50 54 60 Rajshahi 50 36 60 Rangpur 50 32 60 Sylhet 50 47 60

Number of upazilas where a review of Newborn interventions held (by Division)

Source Project report

Total 326 326 165 Barisal 42 42

Chittagong 38 100 The plan was added after mid-year review

Dhaka 124 90 Khulna 53 60 7 Rajshahi 68 58 Rangpur 0 58 Sylhet 39 38 Number of Newborn for whom resuscitation actions using bag and mask were initiated (by Division)

Source DGFP MIS-3EOC

Total 14817 21450 21450 (31 of annual target within range)

Barisal 640 1316 1316 Chittagong 3137 4950 4950 Dhaka 4453 6185 6185 Khulna 1952 2525 2525 Rajshahi 1995 1541 1541 Rangpur 1716 1996 1996 Sylhet 924 2937 2937 Number of Union Health and Family Welfare Centers (UHampFWCs) in the project area using electronic MIS tools


Total 130 157

Noakhali implementation to begin in April delayed because of Measure procurement

Lakshmipur 51 Noakhali 69 Habiganj 61 71



Achievement 2017

Target 2018 Remarks

Jhalokati 35 Pirojpur NA NA Bhola NA Number of districts having an active Quality Improvement (QI) committee

Total 32 41 64 Barisal 3 4 6 Chittagong 6 9 11 Dhaka 9 8 17 Khulna 5 6 10 Rajshahi 4 8 8 Rangpur 3 3 8 Sylhet 2 3 4

APPENDIX 5 LIST OF UNION FACILITIES UPGRADED


District Upazila Union Facility Name

Habiganj

Ajmiriganj

Badalpur Badalpur Union Health and Family Welfare Centre Jalsuka Jalsuka Union Health and Family Welfare Centre Kakailseo Kakailseo Union Health and Family Welfare Centre Shibpasha Shibpasha Union Health and Family Welfare Centre

Bahubal Snanghat Snanghat Union Health and Family Welfare Centre Mirpur Mirpur Union Health and Family Welfare Centre

Baniachong

Khagaura Khagaura Union Health and Family Welfare Centre Pukhra Pukhra Union Health and Family Welfare Centre Daulatpur Daulatpur Union Health and Family Welfare Centre Sujatpur Sujatpur Union Health and Family Welfare Centre Uttar Purba Baniachang

Uttar Purba Baniachang Union Health and Family Welfare Centre

Chunarughat Shatiajuri Shatiajuri Union Health and Family Welfare Centre Sankhola Sankhola Union Health and Family Welfare Centre

Habiganj Sadar

Lukhra Lukhra Union Health and Family Welfare Centre Poil Poil Union Health and Family Welfare Centre Tegharia Tegharia Union Health and Family Welfare Centre Nizampur Nizampur Union Health and Family Welfare Centre Richi Richi Union Health and Family Welfare Centre Raziura Raziura Union Health and Family Welfare Centre

Lakhai Karab Karab Union Health and Family Welfare Centre Murakari Murakari Union Health and Family Welfare Centre Muriauk Muriauk Union Health and Family Welfare Centre

Madhabpur Bahara Bahara Union Health and Family Welfare Centre Jagadishpur Jagadishpur Union Health and Family Welfare Centre Noapara Noapara Union Health and Family Welfare Centre

Nabiganj

Debpara Debpara Union Health and Family Welfare Centre Dighalbak Dighalbak Union Health and Family Welfare Centre Paschim Bara Bhakhair

Paschim Bara Bhakhair Union Health and Family Welfare Centre

Purba Bara Bakhair Purba Bara Bakhair Union Health and Family Welfare Centre

Auskandi Auskandi Union Health and Family Welfare Centre Bausha Bausha Union Health and Family Welfare Centre Gaznapur Gaznapur Union Health and Family Welfare Centre Kalair Banga Kalair Banga Union Health and Family Welfare Centre Kurshi Kurshi Union Health and Family Welfare Centre Paniunda Paniunda Union Health and Family Welfare Centre

Jhalokathi

Jhalokathi Sadar

Binoykati Binoykati Union Health and Family Welfare Centre Kirtipasha Kirtipasha Union Health and Family Welfare Centre Nathullabad Nathullabad Union Health and Family Welfare Centre Keora Keora Union Health and Family Welfare Centre Ponabalia Ponabalia Union Health and Family Welfare Centre

Kanthalia Chenchri Rampur Chenchri Rampur Union Health and Family Welfare Centre



Patikhalghata Patikhalghata Union Health and Family Welfare Centre

Nalchity

Bhairabpasha Bhairabpasha Union Health and Family Welfare Centre Kusanghal Kusanghal Union Health and Family Welfare Centre Magar Magar Union Health and Family Welfare Centre Kulkati Kulkati Union Health and Family Welfare Centre

Rajapur Saturia Saturia Union Health and Family Welfare Centre

Lakshmipur

Lakshmipur Sadar

Chandraganj Chandraganj Union Health and Family Welfare Centre Dalal Bazar Dalal Bazar Union Health and Family Welfare Centre Datta Para Datta Para Union Health and Family Welfare Centre Dighali Dighali Union Health and Family Welfare Centre Mandari Mandari Union Health and Family Welfare Centre Uttar Joypur Uttar Joypur Union Health and Family Welfare Centre Kushakhali Kushakhali Union Health and Family Welfare Centre Basikpur Basikpur Union Health and Family Welfare Centre Parbatinagar Parbatinagar Union Health and Family Welfare Centre

Kamalnagar Char Falcon Char Falcon Union Health and Family Welfare Centre Hajirhat Hajirhat Union Health and Family Welfare Centre Char Kadira Char Kadira Union Health and Family Welfare Centre

Ramganj

Darbeshpur Darbeshpur Union Health and Family Welfare Centre Chandipur Chandipur Union Health and Family Welfare Centre Lamchar Lamchar Union Health and Family Welfare Centre Kanchanpur Kanchanpur Union Health and Family Welfare Centre Bhatra Bhatra Union Health and Family Welfare Centre

Ramgati

Bara Kheri Bara Kheri Union Health and Family Welfare Centre Char Algi Char Algi Union Health and Family Welfare Centre Char Ramiz Char Ramiz Union Health and Family Welfare Centre

Char Alexandar Char Alexandar Union Health and Family Welfare Centre

Char Gazi Char Gazi Union Health and Family Welfare Centre

Roypur

Bamni Bamni Union Health and Family Welfare Centre Char Mohana Char Mohana Union Health and Family Welfare Centre Keroa Keroa Union Health and Family Welfare Centre Sonapur Sonapur Union Health and Family Welfare Centre Char Pata Char Pata Union Health and Family Welfare Centre

North Char Ababil North Char Ababil Union Health and Family Welfare Centre

South Char Ababil South Char Ababil Union Health and Family Welfare Centre

Noakhali Begumganj

Gopalpur Gopalpur Union Health and Family Welfare Centre Durgapur Durgapur Union Health and Family Welfare Centre Alyerapur Alyerapur Union Health and Family Welfare Centre Narottampur Narottampur Union Health and Family Welfare Centre Rasulpur Rasulpur Union Health and Family Welfare Centre Hajipur Hajipur Union Health and Family Welfare Centre Begumganj Begumganj Union Health and Family Welfare Centre



Companiganj

Char Kakra Char Kakra Union Health and Family Welfare Centre Rampur Rampur Union Health and Family Welfare Centre Sirajpur Sirajpur Union Health and Family Welfare Centre Musapur Musapur Union Health and Family Welfare Centre

Senbagh Kabilpur Kabilpur Union Health and Family Welfare Centre Mohamadpur Mohamadpur Union Health and Family Welfare Centre Bejoybagh Bejoybagh Union Health and Family Welfare Centre

Hatiya

Harni Harni Union Health and Family Welfare Centre Jahajmara Jahajmara Union Health and Family Welfare Centre Sonadia Sonadia Union Health and Family Welfare Centre Chandnandi Chandnandi Union Health and Family Welfare Centre


APPENDIX 6 NEWS CLIPS PUBLISHED BY MaMoni HSS

Media Date Article Title and Link

Daily Kaler Kantho

October 2 2016

httpwwwkalerkanthocomprint-editionlast-page20161002411703

Daily Kaler Kantho

October 12 2016

শত শত

httpwwwkalerkanthocomprint-editionfirst-page20161012415675

Daily Kaler Kantho

November 18 2016

এ পথ


Daily Observer November 21 2016

Baniachong health center raises hope for 25000 people httpwwwobserverbdcomdetailsphpid=44540

Daily Star November 17 2016

Nearly 44 lakh premature babies born every year study httpwwwthedailystarnetcountrynearly-44-lakh-premature-babies-born-every-year-study-1316227


Preterm birth main barrier to cutting under-5 child mortality httpwwwthedailystarnetcitypreterm-birth-main-barrier-cutting-under-5-child-mortality-1316542


Ending premature child deaths httpwwwthedailystarnethealthending-premature-child-deaths-1317316

Daily Prothom Alo

November 13 2016

(Editorial) httpwwwprothom-alocomopinionarticle1019549E0A6B6E0A6BFE0A6B6E0A781E0A6AEE0A783E0A6A4E0A78DE0A6AFE0A781E0A6B0-E0A689E0A69AE0A78DE0A69A-E0A6B9E0A6BEE0A6B0

Daily Star December 8 2016

Prevent Deaths from Preterm Births Experts comments on world prematurity Day httpepaperthedailystarnetindexphpopt=viewamppage=11ampdate=2016-12-08

Daily Prothom Alo

November 18 2016

৪ ৩৮

httpwwwprothom-alocombangladesharticle1023277E0A7AA-E0A6B2E0A6BEE0A696-E0A7A9E0A7AE-E0A6B9E0A6BEE0A69CE0A6BEE0A6B0-E0A6B6E0A6BFE0A6B6E0A781-E0A685E0A695E0A6BEE0A6B2E0A787-E0A69CE0A6A8E0A78DE0A6AE-E0A6A8E0A6BFE0A69AE0A78DE0A69BE0A787



Daily Prothom Alo

March 2 2017

নবজাতেকরনািভরযতন

httpwwwprothom-alocomlife-stylearticle1094761E0A6A8E0A6ACE0A69CE0A6BEE0A6A4E0A695E0A787E0A6B0-E0A6A8E0A6BEE0A6ADE0A6BFE0A6B0-E0A6AFE0A6A4E0A78DE0A6A8

Daily Prothom Alo

February 12 2017

াযেসবা েথেক বহzwjদের চর ও ীেপর মানষ

httpwwwprothom-alocombangladesharticle1079687E0A6

Daily Prothom Alo

February 26 2017

২৩ শতাংশ িশশzwj জাে কম ওজন িনেয়

httpmprothom-alocombangladesharticle1090540E0A7A8E0A7A9-E0A6B6E0A6A4E0A6BEE0A682E0A6B6-E0A6B6E0A6BFE0A6B6E0A781-E0A69CE0A6A8E0A78DE0A6AEE0A6BEE0A69AE0A78DE0A69BE0A787-E0A695E0A6AE-E0A693E0A69CE0A6A8-E0A6A8E0A6BFE0A79FE0A787

Daily Ittefaq

February 28 2017

েয়াজন অপিিবেরাধী সমিত অিভযান

httpwwwittefaqcombdprint-editioneditorial20170228179065html

Daily Kaler Kantho

March 4 2017

ব েহাক অেয়াজনীয় িসজািরয়ান অপােরশন

httpwwwkalerkanthocomonlineprescription20170304470638

Daily Prothom Alo

March 6 2017

সবরজনীন াযসরায় সমিত উেদযাগ দরকার

httpwwwprothom-alocombangladesharticle1098991E0A6B8E0A6B0E0A78DE0A6ACE0A69CE0A6A8E0A780E0A6A8-E0A6B8E0A78DE0A6ACE0A6BEE0A6B8E0A78DE0A6A5E0A78DE0A6AF-E0A6B8E0A781E0A6B0E0A695E0A78DE0A6B7E0A6BEE0A79F-E0A6B8E0A6AEE0A6A8E0A78DE0A6ACE0A6BFE0A6A4-E0A689E0A6A6E0A78DE0A6AFE0A78BE0A697-E0A6A6E0A6B0E0A695E0A6BEE0A6B0

Sylhettoday24com

May 16 2017

ও পথ

Link httpwwwsylhettoday24comnewsdetailsSylhet41474

BDnew24com May 29 2017

lsquoMaMoni HSSrsquo brings local level solutions to ensure safe motherhood in Bangladesh



httpbdnews24comhealth20170529MaMoni HSS-brings-local-level-solutions-to-ensure-safe-motherhood-in-bangladesh

Currentnewscombd

May 28 2017

httpwwwcurrentnewscombdbnnews245107

Newsgallerybd24com

May 28 2017

র ও

Link httpnewsgallerybd24comE0A6B9E0A6ACE0A6BFE0A697E0A69EE0A78DE0A69CE0A787-E0A6ACE0A6BFE0A6B6E0A78DE0A6AC-E0A6A8E0A6BFE0A6B0E0A6BEE0A6AAE0A6A6-E0A6AEE0A6BE

Sylhettoday24com

May 28 2017

httpwwwsylhettoday24comnewsdetailsSylhet41884

Daily Observer May 29 2017

World Safe Motherhood Day observed in districts

httpwwwobserverbdcomdetailsphpid=76107

Daily Deshjamin May 29 2017

Offline only

Daily Protidiner Bani

May 29 2017

এক ও ও

Offline only

Newsgallerybd24com

May 30 2017

Link httpnewsgallerybd24come0a6aee0a6bee0a6a7e0a6ace0a6aae0a781e0a6b0e0a787-e0a6a8e0a6bfe0a6b0e0a6bee0a6aae0a6a6-e0a6aee0a6bee0a6a4e0a783e0a6a4e0a78de0a6ac

Daily Observer June 02 2017

29 women die in Laxmipur in 12 months while giving birth

Link httpwwwobserverbdcomdetailsphpid=76794

Daily Khowai July 09 2017

httpwwwdailykhowaicomnews2017071061476

Korangi News 24 July 09 2017

ও

httpkoranginews24comp=4158

Habiganj Express July 09 2017

ও



httpwwwhabiganjexpresscomp=69926

News Gallery Bd 24

July 09 2017

httpnewsgallerybd24comE0A6B8E0A78DE0A6ACE0A6BEE0A6B8E0A78DE0A6A5E0A78DE0A6AF-E0A6ACE0A78DE0A6AFE0A6ACE0A6B8E0A78DE0A6A5E0A6BEE0A79F-E0A6B8E0A6AEE0A6A8E0A78DWWJZzG_z2mIfacebook


APPENDIX 7 FORUMS WHERE MAMONI HSS LESSONS WERE DISSEMINATED

Title Forum Month Type of Dissemination

Leveraging results from a Nationwide

Service Readiness Facility assessment

To Prioritize Investments to establish 247 delivery services at peripheral level health Facilities in Bangladesh

Global Symposium on Health Systems Research

Vancouver Canada

Nov 2016 Oral Presentation

Integrated mother‐ newborn registers and interface with community structures at peripheral level facilities enables real time population level estimates on key maternal health indicators


Vancouver Canada

Nov 2016 Poster Presentation

Strengthening peripheral health facilities to increase skilled attendance at birth in rural Bangladesh


Vancouver Canada Nov 2016 Poster

Presentation

Establishing an automated routine health information system to improve tracking of clients across the continuum of care


Vancouver Canada

Nov 2016 ePoster Presentation

National scale-up of a clinical skills based training innovation Bangladeshrsquos experience with improving neonatal resuscitation using the Helping Babies Breathe curriculum


Vancouver Canada


Quality of LAPM Services RH Scientific Days Save the Children

Nairobi Kenya Nov 2016 Oral

Presentation

Overcoming health system bottlenecks in implementing Kangaroo Mother Care at district and sub-district level health facilities in Bangladesh

11th Congress of the International Network on KMC

Trieste Italy Nov 2016 Poster

Presentation



Management of infection of the 0-59 days infants at union level facilities

Ramgonj upazila Lakshmipur district Bangladesh

Meeting of Principal Investigators for PSBI Implementation Research

Lagos Nigeria Nov 2016 Poster

Presentation

Technology readiness of peripheral and community level service delivery systems in rural Bangladesh to introduce electronic health information systems

Global Digital Health Forum

Washington DC USA Dec 2016 Oral

Presentation

Community Micro Planning (cMPM) - an innovative approach of MaMoni Health Systems Strengthening (HSS) project to strengthen public sector Community Health Workers (CHW) service delivery in Bangladesh

CHW Symposium Kampala Uganda Feb 2017 Oral

Presentation

Recruiting training and retaining of Community Volunteers Experience from rural Bangladesh


Presentation

Making a difference community volunteers contributing to increasing use of effective family planning in Bangladesh


Presentation

Development of community skilled birth attendants in hard-to-reach areas of Bangladesh


Presentation


APPENDIX 8 LIST OF PROCESS DOCUMENTATION ACTIVITIES

MaMoni HSS will contribute to the following learning priorities over the life of the project Learning Item Study Type Lead

Partner Expected Time Line

Progress made in Y4 and current status

1 CHX Scale-Up Implementation Case Study Documentation of process results and lessons of national scale-up by all partners and stakeholders including MOHFW NGOs and the private sector

Prospective Ambispective Documentation Multiple sources routine implementation data stakeholder meetings and reviews Newborn and Child Health Cell records tracer surveys

MaMoni HSS with JHUIIP

FY 2018 Qualitative and quantitative data (training and monitoring) collection ongoing stakeholder workshop in January

2 Changes in Skilled Birth Attendance rates as a result of improvements at the UHFWCrsquos - To what extent and how did the

approach of advocacy and assessment lead to improvements at UHFWC through sector plans and local government budget allocations

- Did improved service provision at UHFWC lead to increased utilization of UHFWC for delivery and increased coverage of SBA (MaMoni Areas)

Prospective Ambispective Documentation Source of Data Tracer surveys HFSSPA District Planning outputs Routine program data on UP budget utilization

MaMoni HSS

FY 2018 Data collection ongoing

3 Case Study of the PCSBA Program and their income viability

Retrospective Documentation of Habiganj and Prospective Documentation in Noakhali IRB required

MaMoni HSS in collaboration with JHUIIP

A documentation on pCSBA completed in FY 2016 but scope expanded to include the new PCSBAs expected to be completed by early FY18

Study protocol approved by JHU IRB data collection completed data analysis ongoing

4 Case Study of MaMoni Program Retrospective MaMoni FY 2018 Six rounds of


Learning Item Study Type Lead Partner

Expected Time Line


Impact on Service Equity - ANC SBA and PNC in Habiganj

ndash geographic and social equity - Coverage of MNH FP and

nutrition across program districts

Documentation tracer indicator surveys

HSS tracer survey conducted final endline survey to be completed in February 2018

5 Quality of service delivery for Permanent Sterilization Methods of Family Planning

Cross-sectional Mixed Method Study

MaMoni HSS with icddrb

Data analysis completed Manuscripts FY 2018

Data analysis completed Two manuscript ongoing

6 Quality Improvement Document the QI framework

(process) outputs (improvement in performance standards) and overlay that data with quality performance indicators (health outcomes)

Routine Documentation through project MIS Data from QI sentinel sites

Mamoni HSS

FY 2018 First draft prepared Documentation ongoing

7 Newborn Sepsis (PSBI) Management in MaMoni Supported Areas Hashow has the community

platform improved care-seeking How are upazilas maintaining

records for newborn sepsis cases Can outcomes be traced

Routine Documentation Data source Routine implementation data Tracer surveys KII with SACMOs pharmacists village doctors FGD with community members

JHUIIP MaMoni HSS

FY 2018 Data collection ongoing Writing workshop planned in October 2017

8 Misoprostol Implementation in MaMoni HSS Supported Areas

Update MaMoni HSS is piloting a new model packaging misoprostol and CHX together in Lakshmipur district

Whether an integrated distribution increases coverage

What are the barriers in service delivery and demand side

Routine Documentation Data source Tracer Surveys Routine implementation data (DGFP reports) KII with service providers

MaMoni HSS

FY 2018 Two rounds of tracer survey completed with additional questions Endline survey to be completed in Feb 2018

9 Nutrition Update Scope limited to Jhalokathi district where MaMoni HSS strengthened 82 community clinics to identify malnutrition How is growth monitoring and

promotion implemented Did the intervention result in

improved screening referral and case management for MAM and SAM

Routine Documentation Source of Data Routine Implementation (including training) data Key Informant interview (KII)

MaMoni HSS

FY 2018 Data collection complete Data analysis ongoing expected in Dec 2017

10 Postpartum Family Planning Routine Documentation MaMoni FY 2017 Data



Expected Time Line


What has been the contribution of MaMoni at community level to increasing demand for LAPM

Did PPFP uptake increase in project areas

Source of data Training data Routine utilization data from DGFP KII of service providers FGD with communities

HSS collection ongoing

11 Local Government Documentation of process and

outputs with standing committee meetings open budget meetings spending data

Stories of how MaMoni achieved success in increased government engagement and MNCH spending

Routine Documentation MaMoni HSS

FY 2017 Data for FY 15 and FY 16 already collected Analysis framework being developed

12 Leadership Management Did decentralized district

planning help managers be more proactive and efficient for planning other managerial practices

How has the program management practices ndash data-driven planning supervision program reviews functional integration and collaboration ndash changed

Routine Documentation Routine implementation data Record review of planning process and review meetings Key Informant Interview FGD of providers in three upazilas

icddrb MaMoni HSS icddrb

FY 2017 Conceptual framework developed Data collection initiated

13 PEE Management at union level facilities using loading dose magnesium sulfate

Update Scope limited to 30 unions in 4 districts Prospective documentation of whether FWVs can properly screen and identify women with SPE

Prospective documentation Source of data Record review at referral facilities

icddrb MaMoni HSS

FY 2018 Protocol finalized Data collection ongoing

14 Quality of ANC at Satellite Clinics Assessing the physical preparedness of satellite clinics

Source of Data Structured assessment of facilities Direct observation of ANC at SC Key informant interviews

MaMoni HSS

FY 2018 (data collection complete)

GOB approval received Study completed Program brief drafted

15 Use of partograph to inform referral decision-making Were partograph effective in identifying complications

Record review KII

MaMoni HSS

FY 2018 Program brief completed Manuscript drafted

16 Introducing Special Care Units in 3 district hospitals

KII Record review

MaMoni HSS icddrb

FY 2018 Data analysis completed Program brief being drafted

17 Introduction of KMC in 14 facilities Record Review KII FGD of MaMoni FY 2018 Data



Expected Time Line


mothers HSS icddrb

collection ongoing

18 Intervention to reduce discontinuation of Implant and IUD

Record review Follow-up with clients KII of providers

MaMoni HSS icddrb

FY 2018 DGFP permission received Data collection ongoing

19 Use of Antenatal Corticosteroid in two district hospitals

- Are providers able to administer a complete dose of dexamethasone (12 hour)

- Estimation of gestational age

Routine documentation Record review KII FGD with community

MaMoni HSS icddrb

FY 2018 Data analysis ongoing

20 Effect of strengthening IPWaste management at union level facilities

KII MaMoni HSS icddrb

FY 2018 Routine documentation

21 Evolution of community mobilization model in ACCESS MaMoni ISMNC and MaMoni HSS project

Record review KII

JHU MaMoni HSS

Fy 2018 Routine documentation

22 Use of WISN tools to estimate workload of government health workers

WISN tools Record review Stakeholder consultation

MaMoni HSS

FY2018 Study completed by BUHS and draft report circulated

Annual Report

October 01 2016ndash September 30 2017

Submitted

TABLE OF CONTENTS

ABBREVIATIONS

Cover photo credits Photo A ndash Unknown Photo B ndash Mr Sarwar Hossain BSMMU 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 (USAIDBangladesh) 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 Photo Story

A Most Beautiful Cry How Tayeeba Survived Her Day of Birth

Tayeeba the second child of Rikta Begum and Md Tara Mia is now five years old They live in a remote village of Ganibyaparir dangi of Sadarpur Upazila Faridpur district Tayeeba is not going to school yet but she has grown like a normal child of her age There was a chance that this asphyxiated babyrsquos cognitive development could have been compromised nevertheless she has memorized the Bangla alphabets numbers and rhymes and plays with her friends It is now incredible to imagine what this child went through in the first few hours of her life

It was March 9 2012 Tayeeba was not crying and had difficulty breathing after birth She could not move Fortunately Sakhina Begum a Community Skilled Birth Attendant (CSBA) who had just completed her Helping Babies Breathe (HBB) training was around Following the training Sakhina also received HBB kits to provide delivery-related assistance at home

When Rikta experienced labor pains her husband Tara Mia quickly called Sakhina Begum to their home Sakhina Begum first tried to clean the meconium from the mouth and nose of the newborn using a Penguin Sucker She then attempted to stimulate the baby by rubbing the babyrsquos back near its spinal cord However the baby did not cry so she started artificial ventilation using a bag and mask She managed to get through 40 rounds of artificial breathing per minute when all of a sudden the baby moved and cried

ldquoIf I hadnrsquot received HBB training I couldnrsquot imagine how I would have helped the baby survive such a serious condition at homerdquo Sakhina said with pride and joy

Tayeebarsquos mother Rikta Begum is grateful to Sakhina ldquoHad Khala (Sakhina Begum) not been around my child would not have survivedrdquo Rikta said For her third pregnancy Rikta has already ensured that Sakhina will be beside her when she delivers

Sakhina Begum has worked as a Health Assistant (HA) in her area since 2007 She received CSBA training for six months In February 2012 she received HBB training that was organized by the Integrated Management of Childhood Illnesses unit supported by the MaMoni HSS Project and funded by USAID She was promoted to the role of an Assistant Health Inspector (AHI) in the same year for her good performance


TABLE OF CONTENTS


















EXECUTIVE SUMMARY
















































INTRODUCTION




Number of

Unions

Population (2017

Projection)






226 6662456 4 7 20 213 619



Pirojpur-2)



151 4870933 2 5 14 126 488

Total 40 377 10718274 6 12 34 339 1107











Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

CHW

)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

Para

med

ic)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni

(Nur

se)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni












37

64 60

51

73

66 61

53

65

81

70 70 68 69

81

74 71

66

75 80

76 75 72 74

83 82 77

74 72

85 83 77

87

71 70

73 70

67 70

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge

2012 2013 2014 (Round-I)



9

22

14 12

34

42

19 15

30

40 35

25 26

36 39 39

21 23

38 41

44

30 26

37

44 43

31

43

36

45 46

32

49

40

26

50

26 26

36

0

10

20

30

40

50

60





3

49

72 65

94

0102030405060708090

100

Y3-Q4 Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber

Quarter











Source MIS-4 DGFP



3871

0

6363

1923

4 3487

3

7148

3595

6

5207

1717

5

2855

0

1052

4

81060

23714

62788

106004

37722

0

20000

40000

60000

80000

100000

120000


Num

ber





68 172

385 938

600

94 145

24

870

8

89 90

77 620

68

69 183 117 603

87

58 110 152 501

86 211 338 212 1016

93

0102030405060708090

100







35 34

14 19

42

23

3 8

21

43

3 8

14

2

33

11 8 10

22 32

17

5

16 25 28 26

5

15

27

38

25

14

25 23

50 55

30 30

45

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge




85 91 91

98 96

0

20

40

60

80

100


Perc

ent

6 0

519 308

635 558 671

143 64 146

1041 1283 1342

1201 1441 1402

2148

1081

1335 1247 1049

1409 1333

1644

0

500

1000

1500

2000

2500





Source MIS-2 DGFP















Source DGFP MIS-3

2073

4

5376

1872

2 2513

1

8318

1384

2

2718

4

7793

2090

0

3695

8

1104

2

1845

3

51415

15041

39826

67237

23927

40500

0

10000

20000

30000

40000

50000

60000

70000


Num

ber


41 54 75 94

4678

8117

11738

15466

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0102030405060708090

100


Num

ber








19

30 34

28 29

45

36

26

43

28

51

39 32

47

32

51

37 35

51

36

52

37 35

50

36

58

39 40

51

39

52

43 48 49

40

53 45

40

50

0

10

20

30

40

50

60

70





52 52

91 89 64 71 68 68

147 112

158

246 276 288

309 314

0

50

100

150

200

250

300

350


Num

ber



Source Project MIS










Total 87 49 81 7 76 14 2811

Training Types n n


















127 37

7

352

100

215

113 43

6

208

1081

989

547

281 50

2

449

479

1694

1958

646

369 64

4

704

502

1798

2886

1232

676

737 13

48

1316

4950

6185

2525

1541 1996

2937

0

1000

2000

3000

4000

5000

6000

7000


Num

ber

Q1 Q2 Q3 Q4 Total







59486 59486 59486 59486

32882 28689 31301 29458

15709 16571 22786 22411

0

10000

20000

30000

40000

50000

60000

70000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber







3 0 4 2 0 4 1 1 1 2 10

1 1 2 1 10

2 10 13

4

16 8

24 29

5 20 10

25 30

10

0102030405060708090

100


Perc

enta

ge



19 12 11

4

24 19 7 3

15 29

20 6

28 19

39

7 11

34 22

42

25 34 38

27

48 34 32

41 31

48 36

48 41

32 33 20 20 18

0

20

40

60

80

100


Perc

ent




12

4 10

10

16

19

23

3 4 8 3 3 28

34

21

29

20

27

39

22

27

19

25

23

164 21

0

133 19

0

172

175

124

112

112

102 12

5 145

216

148

104

91 11

0

90 13

1

100

76

80

93

97

299

244

179

174

168 186 22

7

194

157 21

5

196

204

719

640

447 494 486 497

544

431 376

424 442 472

0

100

200

300

400

500

600

700

800


Num

ber




Source Project MIS


CI 115 5

CSI 314 14

IFB 1764 81


Source Project MIS


Source DHIS-2


273 310

875 900

0

100

200

300

400

500

600

700

800

900

1000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber


Source DHIS-2




142 133 134 140 141 132 140 128 139 126 133 125

0102030405060708090100

0100020003000400050006000700080009000

Perc

enta

ge

Num

ber





























1179

1785

205

581

0

500

1000

1500

2000

2500

Year-3 Year-4

HI HSCS







5567

9200

11528

3754

6414

10951

6015

8805

12614

3078

6365

11431

0

2000

4000

6000

8000

10000

12000

14000


Year-3 Year-4

3888

8064

9353

3230

5600

9474

4369

7817

10709

2607

5710

9886

0

2000

4000

6000

8000

10000

12000


Year 3 Year 4


Source MIS-4 DGFP


Source MIS-4 DGFP



Source MIS-4 DGFP


1679

1136

2175

524

814

1477 1646

988

1905

471 655

1545

0

500

1000

1500

2000

2500


Year 3 Year 4




121d Nutrition

41 41 48 47

42

53 51 50 52

40

56 52 53 54

45

56 54 55 53

42

57 49 49

57

47 56

50 53 55

44

61 52 53 56

48

58 55 53 58

0

20

40

60

80

100


Perc

ent



18

24

82

76

0 10 20 30 40 50 60 70 80 90 100

Year-3

Year-4






























ToT on HRIS





470 518 497

07 23 17

456

553 513

27

135 91

0

20

40

60

80

100



o

f dat

a co

mpl

eten

ess

May 17 Sep 17




2844 3106

4887

3140

3913

3023

6513

3629

1189 1368

2912

1902 2397

1639

4283

2278

495 630

1804 1156

1526 861

2571

1574

186 257 962

570 803 404

1274 937

0

1000

2000

3000

4000

5000

6000

7000



ANC1 ANC2 ANC3 ANC4









22

63

41

78

102030405060708090

Diastolic gt= 90 PE










2














developed

Chittagong 11 11 11

Sylhet 4 4 4

Barisal 6 6 6

Khulna 10 10 10

Dhaka 13 13 12

Rajshahi 8 8 8

Rangpur 8 8 8

Mymensingh 4 3 2

Total 64 63 61






















Barisal 6 Bhola



Dhaka 12 Tangail

Rangpur 13 Kurigram




District


Target Actual









Percent












5 5 0 0 0

31 16 9 6 0

36

16 8 8 4

97

34

14

39

10

0

20

40

60

80

100

120











100 100 100 100 99 95 96 100

76 84

64

91

50 54

100 88 92

82 95

73 75

0

20

40

60

80

100

120



measured




pregnancy


duringpregnancy


of four ANC





100 100 98 97 97 96 93 100 100 100

53 39 39

52

14

100 100 100

76 68 68 74

53

100

0

20

40

60

80

100

120





procedure


negative impact


Used job aidduring

counseling









































































Sl No

Name of the store

Jan

16

Feb

16

Mar

16

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

17

1 Sadar

2 Lakhai

3 Bahubal

4 Madhabpur

5 Chunarughat

6 Nabiganj

7 Baniachang

8 Ajmeriganj


















Habiganj 77 57 74 7298945 4449311 61

Jhalokathi 32 21 656 3080069 1009640 33

Lakshmipur 58 42 724 6035208 5887871 98

Noakhali 44 38 864 4518000 6260098 139

Total 211 158 749 20932222 17606920 841































Number of CVs

Target of CAG with


Achievement

Number Percentage






Name of

Union



Nurpur union of

Habiganj (4 CSA)

4894 4729 1189




Lakshmipur (5 CSA)

9729 12545 12027


Charkakra Union of

Noakhali (5 CSA)

8730 7580 8970


23353 24854 22186


1668 1775 1584 Net

Profit

15-20
































High Health System







Assessment Type






Sentinel survey


Twice in a year




Twice in a year


Newborn revisit




Routine MIS MOHFW








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018






HSCS areas







HSCS areas



Noakhali 21 NA 21


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





HSCS areas







HSCS areas








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018







HSCS areas



Noakhali 35 NA 10





Pirozepur 18 41 41

HSCS areas





Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks rate




HSCS areas






235128

209600

217475



110200

113933

Bhola 263795 221407 229711







Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks

Pirozepur 90 NA 90


HSCS areas







Pirozepur 50 NA 70







Pirozepur 95 NA 95


HSCS areas






Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018











2149 8701 16519



200 425 0



75 119 119


Noakhali 25 25


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018


Jhalokathi 16 16













2015


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

















Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks











Noakhali 5 80 5





4 4 4



Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





Pirozepur 12148 8621 12148 Bhola 1982 18453 18453





Pirozepur 44612 43826 43826 Bhola 68546 73961 73961



Women 95784 Men 83507

Noakhali 145556 1290879 109167


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018



Men 7556 Jhalokathi 115587 11459 86690

Women 9373 Men 2086


28371

23929

23929





24355

20229

20229







Achievement 2017

Target 2018 Remarks






Total 326 326 165 Barisal 42 42







Total 130 157





Achievement 2017

Target 2018 Remarks






Habiganj

Ajmiriganj



Baniachong




Habiganj Sadar




Nabiganj





Jhalokathi

Jhalokathi Sadar






Nalchity



Lakshmipur

Lakshmipur Sadar



Ramganj


Ramgati




Roypur




Noakhali Begumganj




Companiganj



Hatiya





Daily Kaler Kantho

October 2 2016


Daily Kaler Kantho

October 12 2016

শত শত


Daily Kaler Kantho

November 18 2016

এ পথ










Daily Prothom Alo

November 13 2016




Daily Prothom Alo

November 18 2016

৪ ৩৮




Daily Prothom Alo

March 2 2017



Daily Prothom Alo

February 12 2017



Daily Prothom Alo

February 26 2017



Daily Ittefaq

February 28 2017



Daily Kaler Kantho

March 4 2017



Daily Prothom Alo

March 6 2017



Sylhettoday24com

May 16 2017

ও পথ







Currentnewscombd

May 28 2017


Newsgallerybd24com

May 28 2017

র ও


Sylhettoday24com

May 28 2017






Offline only


May 29 2017

এক ও ও

Offline only

Newsgallerybd24com

May 30 2017








ও



ও




News Gallery Bd 24

July 09 2017









Vancouver Canada




Vancouver Canada





Presentation



Vancouver Canada




Vancouver Canada




Presentation




Presentation







Presentation




Presentation



Presentation



Presentation



Presentation



Presentation














MaMoni HSS










Expected Time Line















Mamoni HSS






JHUIIP MaMoni HSS







MaMoni HSS






MaMoni HSS





Expected Time Line




















icddrb MaMoni HSS




MaMoni HSS




Record review KII

MaMoni HSS



KII Record review

MaMoni HSS icddrb





Expected Time Line


mothers HSS icddrb

collection ongoing



MaMoni HSS icddrb






MaMoni HSS icddrb






Record review KII

JHU MaMoni HSS




MaMoni HSS


Annual Report


Submitted

TABLE OF CONTENTS

ABBREVIATIONS


TABLE OF CONTENTS


















EXECUTIVE SUMMARY
















































INTRODUCTION




Number of

Unions

Population (2017

Projection)






226 6662456 4 7 20 213 619



Pirojpur-2)



151 4870933 2 5 14 126 488

Total 40 377 10718274 6 12 34 339 1107











Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

CHW

)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

Para

med

ic)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni

(Nur

se)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni












37

64 60

51

73

66 61

53

65

81

70 70 68 69

81

74 71

66

75 80

76 75 72 74

83 82 77

74 72

85 83 77

87

71 70

73 70

67 70

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge

2012 2013 2014 (Round-I)



9

22

14 12

34

42

19 15

30

40 35

25 26

36 39 39

21 23

38 41

44

30 26

37

44 43

31

43

36

45 46

32

49

40

26

50

26 26

36

0

10

20

30

40

50

60





3

49

72 65

94

0102030405060708090

100

Y3-Q4 Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber

Quarter











Source MIS-4 DGFP



3871

0

6363

1923

4 3487

3

7148

3595

6

5207

1717

5

2855

0

1052

4

81060

23714

62788

106004

37722

0

20000

40000

60000

80000

100000

120000


Num

ber





68 172

385 938

600

94 145

24

870

8

89 90

77 620

68

69 183 117 603

87

58 110 152 501

86 211 338 212 1016

93

0102030405060708090

100







35 34

14 19

42

23

3 8

21

43

3 8

14

2

33

11 8 10

22 32

17

5

16 25 28 26

5

15

27

38

25

14

25 23

50 55

30 30

45

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge




85 91 91

98 96

0

20

40

60

80

100


Perc

ent

6 0

519 308

635 558 671

143 64 146

1041 1283 1342

1201 1441 1402

2148

1081

1335 1247 1049

1409 1333

1644

0

500

1000

1500

2000

2500





Source MIS-2 DGFP















Source DGFP MIS-3

2073

4

5376

1872

2 2513

1

8318

1384

2

2718

4

7793

2090

0

3695

8

1104

2

1845

3

51415

15041

39826

67237

23927

40500

0

10000

20000

30000

40000

50000

60000

70000


Num

ber


41 54 75 94

4678

8117

11738

15466

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0102030405060708090

100


Num

ber








19

30 34

28 29

45

36

26

43

28

51

39 32

47

32

51

37 35

51

36

52

37 35

50

36

58

39 40

51

39

52

43 48 49

40

53 45

40

50

0

10

20

30

40

50

60

70





52 52

91 89 64 71 68 68

147 112

158

246 276 288

309 314

0

50

100

150

200

250

300

350


Num

ber



Source Project MIS










Total 87 49 81 7 76 14 2811

Training Types n n


















127 37

7

352

100

215

113 43

6

208

1081

989

547

281 50

2

449

479

1694

1958

646

369 64

4

704

502

1798

2886

1232

676

737 13

48

1316

4950

6185

2525

1541 1996

2937

0

1000

2000

3000

4000

5000

6000

7000


Num

ber

Q1 Q2 Q3 Q4 Total







59486 59486 59486 59486

32882 28689 31301 29458

15709 16571 22786 22411

0

10000

20000

30000

40000

50000

60000

70000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber







3 0 4 2 0 4 1 1 1 2 10

1 1 2 1 10

2 10 13

4

16 8

24 29

5 20 10

25 30

10

0102030405060708090

100


Perc

enta

ge



19 12 11

4

24 19 7 3

15 29

20 6

28 19

39

7 11

34 22

42

25 34 38

27

48 34 32

41 31

48 36

48 41

32 33 20 20 18

0

20

40

60

80

100


Perc

ent




12

4 10

10

16

19

23

3 4 8 3 3 28

34

21

29

20

27

39

22

27

19

25

23

164 21

0

133 19

0

172

175

124

112

112

102 12

5 145

216

148

104

91 11

0

90 13

1

100

76

80

93

97

299

244

179

174

168 186 22

7

194

157 21

5

196

204

719

640

447 494 486 497

544

431 376

424 442 472

0

100

200

300

400

500

600

700

800


Num

ber




Source Project MIS


CI 115 5

CSI 314 14

IFB 1764 81


Source Project MIS


Source DHIS-2


273 310

875 900

0

100

200

300

400

500

600

700

800

900

1000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber


Source DHIS-2




142 133 134 140 141 132 140 128 139 126 133 125

0102030405060708090100

0100020003000400050006000700080009000

Perc

enta

ge

Num

ber





























1179

1785

205

581

0

500

1000

1500

2000

2500

Year-3 Year-4

HI HSCS







5567

9200

11528

3754

6414

10951

6015

8805

12614

3078

6365

11431

0

2000

4000

6000

8000

10000

12000

14000


Year-3 Year-4

3888

8064

9353

3230

5600

9474

4369

7817

10709

2607

5710

9886

0

2000

4000

6000

8000

10000

12000


Year 3 Year 4


Source MIS-4 DGFP


Source MIS-4 DGFP



Source MIS-4 DGFP


1679

1136

2175

524

814

1477 1646

988

1905

471 655

1545

0

500

1000

1500

2000

2500


Year 3 Year 4




121d Nutrition

41 41 48 47

42

53 51 50 52

40

56 52 53 54

45

56 54 55 53

42

57 49 49

57

47 56

50 53 55

44

61 52 53 56

48

58 55 53 58

0

20

40

60

80

100


Perc

ent



18

24

82

76

0 10 20 30 40 50 60 70 80 90 100

Year-3

Year-4






























ToT on HRIS





470 518 497

07 23 17

456

553 513

27

135 91

0

20

40

60

80

100



o

f dat

a co

mpl

eten

ess

May 17 Sep 17




2844 3106

4887

3140

3913

3023

6513

3629

1189 1368

2912

1902 2397

1639

4283

2278

495 630

1804 1156

1526 861

2571

1574

186 257 962

570 803 404

1274 937

0

1000

2000

3000

4000

5000

6000

7000



ANC1 ANC2 ANC3 ANC4









22

63

41

78

102030405060708090

Diastolic gt= 90 PE










2














developed

Chittagong 11 11 11

Sylhet 4 4 4

Barisal 6 6 6

Khulna 10 10 10

Dhaka 13 13 12

Rajshahi 8 8 8

Rangpur 8 8 8

Mymensingh 4 3 2

Total 64 63 61






















Barisal 6 Bhola



Dhaka 12 Tangail

Rangpur 13 Kurigram




District


Target Actual









Percent












5 5 0 0 0

31 16 9 6 0

36

16 8 8 4

97

34

14

39

10

0

20

40

60

80

100

120











100 100 100 100 99 95 96 100

76 84

64

91

50 54

100 88 92

82 95

73 75

0

20

40

60

80

100

120



measured




pregnancy


duringpregnancy


of four ANC





100 100 98 97 97 96 93 100 100 100

53 39 39

52

14

100 100 100

76 68 68 74

53

100

0

20

40

60

80

100

120





procedure


negative impact


Used job aidduring

counseling









































































Sl No

Name of the store

Jan

16

Feb

16

Mar

16

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

17

1 Sadar

2 Lakhai

3 Bahubal

4 Madhabpur

5 Chunarughat

6 Nabiganj

7 Baniachang

8 Ajmeriganj


















Habiganj 77 57 74 7298945 4449311 61

Jhalokathi 32 21 656 3080069 1009640 33

Lakshmipur 58 42 724 6035208 5887871 98

Noakhali 44 38 864 4518000 6260098 139

Total 211 158 749 20932222 17606920 841































Number of CVs

Target of CAG with


Achievement

Number Percentage






Name of

Union



Nurpur union of

Habiganj (4 CSA)

4894 4729 1189




Lakshmipur (5 CSA)

9729 12545 12027


Charkakra Union of

Noakhali (5 CSA)

8730 7580 8970


23353 24854 22186


1668 1775 1584 Net

Profit

15-20
































High Health System







Assessment Type






Sentinel survey


Twice in a year




Twice in a year


Newborn revisit




Routine MIS MOHFW








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018






HSCS areas







HSCS areas



Noakhali 21 NA 21


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





HSCS areas







HSCS areas








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018







HSCS areas



Noakhali 35 NA 10





Pirozepur 18 41 41

HSCS areas





Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks rate




HSCS areas






235128

209600

217475



110200

113933

Bhola 263795 221407 229711







Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks

Pirozepur 90 NA 90


HSCS areas







Pirozepur 50 NA 70







Pirozepur 95 NA 95


HSCS areas






Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018











2149 8701 16519



200 425 0



75 119 119


Noakhali 25 25


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018


Jhalokathi 16 16













2015


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

















Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks











Noakhali 5 80 5





4 4 4



Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





Pirozepur 12148 8621 12148 Bhola 1982 18453 18453





Pirozepur 44612 43826 43826 Bhola 68546 73961 73961



Women 95784 Men 83507

Noakhali 145556 1290879 109167


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018



Men 7556 Jhalokathi 115587 11459 86690

Women 9373 Men 2086


28371

23929

23929





24355

20229

20229







Achievement 2017

Target 2018 Remarks






Total 326 326 165 Barisal 42 42







Total 130 157





Achievement 2017

Target 2018 Remarks






Habiganj

Ajmiriganj



Baniachong




Habiganj Sadar




Nabiganj





Jhalokathi

Jhalokathi Sadar






Nalchity



Lakshmipur

Lakshmipur Sadar



Ramganj


Ramgati




Roypur




Noakhali Begumganj




Companiganj



Hatiya





Daily Kaler Kantho

October 2 2016


Daily Kaler Kantho

October 12 2016

শত শত


Daily Kaler Kantho

November 18 2016

এ পথ










Daily Prothom Alo

November 13 2016




Daily Prothom Alo

November 18 2016

৪ ৩৮




Daily Prothom Alo

March 2 2017



Daily Prothom Alo

February 12 2017



Daily Prothom Alo

February 26 2017



Daily Ittefaq

February 28 2017



Daily Kaler Kantho

March 4 2017



Daily Prothom Alo

March 6 2017



Sylhettoday24com

May 16 2017

ও পথ







Currentnewscombd

May 28 2017


Newsgallerybd24com

May 28 2017

র ও


Sylhettoday24com

May 28 2017






Offline only


May 29 2017

এক ও ও

Offline only

Newsgallerybd24com

May 30 2017








ও



ও




News Gallery Bd 24

July 09 2017









Vancouver Canada




Vancouver Canada





Presentation



Vancouver Canada




Vancouver Canada




Presentation




Presentation







Presentation




Presentation



Presentation



Presentation



Presentation



Presentation














MaMoni HSS










Expected Time Line















Mamoni HSS






JHUIIP MaMoni HSS







MaMoni HSS






MaMoni HSS





Expected Time Line




















icddrb MaMoni HSS




MaMoni HSS




Record review KII

MaMoni HSS



KII Record review

MaMoni HSS icddrb





Expected Time Line


mothers HSS icddrb

collection ongoing



MaMoni HSS icddrb






MaMoni HSS icddrb






Record review KII

JHU MaMoni HSS




MaMoni HSS


Annual Report


Submitted

TABLE OF CONTENTS

ABBREVIATIONS








EXECUTIVE SUMMARY
















































INTRODUCTION




Number of

Unions

Population (2017

Projection)






226 6662456 4 7 20 213 619



Pirojpur-2)



151 4870933 2 5 14 126 488

Total 40 377 10718274 6 12 34 339 1107











Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

CHW

)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

Para

med

ic)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni

(Nur

se)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni












37

64 60

51

73

66 61

53

65

81

70 70 68 69

81

74 71

66

75 80

76 75 72 74

83 82 77

74 72

85 83 77

87

71 70

73 70

67 70

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge

2012 2013 2014 (Round-I)



9

22

14 12

34

42

19 15

30

40 35

25 26

36 39 39

21 23

38 41

44

30 26

37

44 43

31

43

36

45 46

32

49

40

26

50

26 26

36

0

10

20

30

40

50

60





3

49

72 65

94

0102030405060708090

100

Y3-Q4 Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber

Quarter











Source MIS-4 DGFP



3871

0

6363

1923

4 3487

3

7148

3595

6

5207

1717

5

2855

0

1052

4

81060

23714

62788

106004

37722

0

20000

40000

60000

80000

100000

120000


Num

ber





68 172

385 938

600

94 145

24

870

8

89 90

77 620

68

69 183 117 603

87

58 110 152 501

86 211 338 212 1016

93

0102030405060708090

100







35 34

14 19

42

23

3 8

21

43

3 8

14

2

33

11 8 10

22 32

17

5

16 25 28 26

5

15

27

38

25

14

25 23

50 55

30 30

45

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge




85 91 91

98 96

0

20

40

60

80

100


Perc

ent

6 0

519 308

635 558 671

143 64 146

1041 1283 1342

1201 1441 1402

2148

1081

1335 1247 1049

1409 1333

1644

0

500

1000

1500

2000

2500





Source MIS-2 DGFP















Source DGFP MIS-3

2073

4

5376

1872

2 2513

1

8318

1384

2

2718

4

7793

2090

0

3695

8

1104

2

1845

3

51415

15041

39826

67237

23927

40500

0

10000

20000

30000

40000

50000

60000

70000


Num

ber


41 54 75 94

4678

8117

11738

15466

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0102030405060708090

100


Num

ber








19

30 34

28 29

45

36

26

43

28

51

39 32

47

32

51

37 35

51

36

52

37 35

50

36

58

39 40

51

39

52

43 48 49

40

53 45

40

50

0

10

20

30

40

50

60

70





52 52

91 89 64 71 68 68

147 112

158

246 276 288

309 314

0

50

100

150

200

250

300

350


Num

ber



Source Project MIS










Total 87 49 81 7 76 14 2811

Training Types n n


















127 37

7

352

100

215

113 43

6

208

1081

989

547

281 50

2

449

479

1694

1958

646

369 64

4

704

502

1798

2886

1232

676

737 13

48

1316

4950

6185

2525

1541 1996

2937

0

1000

2000

3000

4000

5000

6000

7000


Num

ber

Q1 Q2 Q3 Q4 Total







59486 59486 59486 59486

32882 28689 31301 29458

15709 16571 22786 22411

0

10000

20000

30000

40000

50000

60000

70000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber







3 0 4 2 0 4 1 1 1 2 10

1 1 2 1 10

2 10 13

4

16 8

24 29

5 20 10

25 30

10

0102030405060708090

100


Perc

enta

ge



19 12 11

4

24 19 7 3

15 29

20 6

28 19

39

7 11

34 22

42

25 34 38

27

48 34 32

41 31

48 36

48 41

32 33 20 20 18

0

20

40

60

80

100


Perc

ent




12

4 10

10

16

19

23

3 4 8 3 3 28

34

21

29

20

27

39

22

27

19

25

23

164 21

0

133 19

0

172

175

124

112

112

102 12

5 145

216

148

104

91 11

0

90 13

1

100

76

80

93

97

299

244

179

174

168 186 22

7

194

157 21

5

196

204

719

640

447 494 486 497

544

431 376

424 442 472

0

100

200

300

400

500

600

700

800


Num

ber




Source Project MIS


CI 115 5

CSI 314 14

IFB 1764 81


Source Project MIS


Source DHIS-2


273 310

875 900

0

100

200

300

400

500

600

700

800

900

1000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber


Source DHIS-2




142 133 134 140 141 132 140 128 139 126 133 125

0102030405060708090100

0100020003000400050006000700080009000

Perc

enta

ge

Num

ber





























1179

1785

205

581

0

500

1000

1500

2000

2500

Year-3 Year-4

HI HSCS







5567

9200

11528

3754

6414

10951

6015

8805

12614

3078

6365

11431

0

2000

4000

6000

8000

10000

12000

14000


Year-3 Year-4

3888

8064

9353

3230

5600

9474

4369

7817

10709

2607

5710

9886

0

2000

4000

6000

8000

10000

12000


Year 3 Year 4


Source MIS-4 DGFP


Source MIS-4 DGFP



Source MIS-4 DGFP


1679

1136

2175

524

814

1477 1646

988

1905

471 655

1545

0

500

1000

1500

2000

2500


Year 3 Year 4




121d Nutrition

41 41 48 47

42

53 51 50 52

40

56 52 53 54

45

56 54 55 53

42

57 49 49

57

47 56

50 53 55

44

61 52 53 56

48

58 55 53 58

0

20

40

60

80

100


Perc

ent



18

24

82

76

0 10 20 30 40 50 60 70 80 90 100

Year-3

Year-4






























ToT on HRIS





470 518 497

07 23 17

456

553 513

27

135 91

0

20

40

60

80

100



o

f dat

a co

mpl

eten

ess

May 17 Sep 17




2844 3106

4887

3140

3913

3023

6513

3629

1189 1368

2912

1902 2397

1639

4283

2278

495 630

1804 1156

1526 861

2571

1574

186 257 962

570 803 404

1274 937

0

1000

2000

3000

4000

5000

6000

7000



ANC1 ANC2 ANC3 ANC4









22

63

41

78

102030405060708090

Diastolic gt= 90 PE










2














developed

Chittagong 11 11 11

Sylhet 4 4 4

Barisal 6 6 6

Khulna 10 10 10

Dhaka 13 13 12

Rajshahi 8 8 8

Rangpur 8 8 8

Mymensingh 4 3 2

Total 64 63 61






















Barisal 6 Bhola



Dhaka 12 Tangail

Rangpur 13 Kurigram




District


Target Actual









Percent












5 5 0 0 0

31 16 9 6 0

36

16 8 8 4

97

34

14

39

10

0

20

40

60

80

100

120











100 100 100 100 99 95 96 100

76 84

64

91

50 54

100 88 92

82 95

73 75

0

20

40

60

80

100

120



measured




pregnancy


duringpregnancy


of four ANC





100 100 98 97 97 96 93 100 100 100

53 39 39

52

14

100 100 100

76 68 68 74

53

100

0

20

40

60

80

100

120





procedure


negative impact


Used job aidduring

counseling









































































Sl No

Name of the store

Jan

16

Feb

16

Mar

16

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

17

1 Sadar

2 Lakhai

3 Bahubal

4 Madhabpur

5 Chunarughat

6 Nabiganj

7 Baniachang

8 Ajmeriganj


















Habiganj 77 57 74 7298945 4449311 61

Jhalokathi 32 21 656 3080069 1009640 33

Lakshmipur 58 42 724 6035208 5887871 98

Noakhali 44 38 864 4518000 6260098 139

Total 211 158 749 20932222 17606920 841































Number of CVs

Target of CAG with


Achievement

Number Percentage






Name of

Union



Nurpur union of

Habiganj (4 CSA)

4894 4729 1189




Lakshmipur (5 CSA)

9729 12545 12027


Charkakra Union of

Noakhali (5 CSA)

8730 7580 8970


23353 24854 22186


1668 1775 1584 Net

Profit

15-20
































High Health System







Assessment Type






Sentinel survey


Twice in a year




Twice in a year


Newborn revisit




Routine MIS MOHFW








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018






HSCS areas







HSCS areas



Noakhali 21 NA 21


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





HSCS areas







HSCS areas








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018







HSCS areas



Noakhali 35 NA 10





Pirozepur 18 41 41

HSCS areas





Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks rate




HSCS areas






235128

209600

217475



110200

113933

Bhola 263795 221407 229711







Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks

Pirozepur 90 NA 90


HSCS areas







Pirozepur 50 NA 70







Pirozepur 95 NA 95


HSCS areas






Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018











2149 8701 16519



200 425 0



75 119 119


Noakhali 25 25


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018


Jhalokathi 16 16













2015


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

















Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks











Noakhali 5 80 5





4 4 4



Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





Pirozepur 12148 8621 12148 Bhola 1982 18453 18453





Pirozepur 44612 43826 43826 Bhola 68546 73961 73961



Women 95784 Men 83507

Noakhali 145556 1290879 109167


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018



Men 7556 Jhalokathi 115587 11459 86690

Women 9373 Men 2086


28371

23929

23929





24355

20229

20229







Achievement 2017

Target 2018 Remarks






Total 326 326 165 Barisal 42 42







Total 130 157





Achievement 2017

Target 2018 Remarks






Habiganj

Ajmiriganj



Baniachong




Habiganj Sadar




Nabiganj





Jhalokathi

Jhalokathi Sadar






Nalchity



Lakshmipur

Lakshmipur Sadar



Ramganj


Ramgati




Roypur




Noakhali Begumganj




Companiganj



Hatiya





Daily Kaler Kantho

October 2 2016


Daily Kaler Kantho

October 12 2016

শত শত


Daily Kaler Kantho

November 18 2016

এ পথ










Daily Prothom Alo

November 13 2016




Daily Prothom Alo

November 18 2016

৪ ৩৮




Daily Prothom Alo

March 2 2017



Daily Prothom Alo

February 12 2017



Daily Prothom Alo

February 26 2017



Daily Ittefaq

February 28 2017



Daily Kaler Kantho

March 4 2017



Daily Prothom Alo

March 6 2017



Sylhettoday24com

May 16 2017

ও পথ







Currentnewscombd

May 28 2017


Newsgallerybd24com

May 28 2017

র ও


Sylhettoday24com

May 28 2017






Offline only


May 29 2017

এক ও ও

Offline only

Newsgallerybd24com

May 30 2017








ও



ও




News Gallery Bd 24

July 09 2017









Vancouver Canada




Vancouver Canada





Presentation



Vancouver Canada




Vancouver Canada




Presentation




Presentation







Presentation




Presentation



Presentation



Presentation



Presentation



Presentation














MaMoni HSS










Expected Time Line















Mamoni HSS






JHUIIP MaMoni HSS







MaMoni HSS






MaMoni HSS





Expected Time Line




















icddrb MaMoni HSS




MaMoni HSS




Record review KII

MaMoni HSS



KII Record review

MaMoni HSS icddrb





Expected Time Line


mothers HSS icddrb

collection ongoing



MaMoni HSS icddrb






MaMoni HSS icddrb






Record review KII

JHU MaMoni HSS




MaMoni HSS


Annual Report


Submitted

TABLE OF CONTENTS

ABBREVIATIONS










































INTRODUCTION




Number of

Unions

Population (2017

Projection)






226 6662456 4 7 20 213 619



Pirojpur-2)



151 4870933 2 5 14 126 488

Total 40 377 10718274 6 12 34 339 1107











Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

CHW

)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni (

Para

med

ic)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni

(Nur

se)

Vaca

nt P

osts

Vaca

ncy

fille

d up

G

OB

Vaca

ncy

fille

d up

by

MaM

oni












37

64 60

51

73

66 61

53

65

81

70 70 68 69

81

74 71

66

75 80

76 75 72 74

83 82 77

74 72

85 83 77

87

71 70

73 70

67 70

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge

2012 2013 2014 (Round-I)



9

22

14 12

34

42

19 15

30

40 35

25 26

36 39 39

21 23

38 41

44

30 26

37

44 43

31

43

36

45 46

32

49

40

26

50

26 26

36

0

10

20

30

40

50

60





3

49

72 65

94

0102030405060708090

100

Y3-Q4 Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber

Quarter











Source MIS-4 DGFP



3871

0

6363

1923

4 3487

3

7148

3595

6

5207

1717

5

2855

0

1052

4

81060

23714

62788

106004

37722

0

20000

40000

60000

80000

100000

120000


Num

ber





68 172

385 938

600

94 145

24

870

8

89 90

77 620

68

69 183 117 603

87

58 110 152 501

86 211 338 212 1016

93

0102030405060708090

100







35 34

14 19

42

23

3 8

21

43

3 8

14

2

33

11 8 10

22 32

17

5

16 25 28 26

5

15

27

38

25

14

25 23

50 55

30 30

45

0

10

20

30

40

50

60

70

80

90

100


Perc

enta

ge




85 91 91

98 96

0

20

40

60

80

100


Perc

ent

6 0

519 308

635 558 671

143 64 146

1041 1283 1342

1201 1441 1402

2148

1081

1335 1247 1049

1409 1333

1644

0

500

1000

1500

2000

2500





Source MIS-2 DGFP















Source DGFP MIS-3

2073

4

5376

1872

2 2513

1

8318

1384

2

2718

4

7793

2090

0

3695

8

1104

2

1845

3

51415

15041

39826

67237

23927

40500

0

10000

20000

30000

40000

50000

60000

70000


Num

ber


41 54 75 94

4678

8117

11738

15466

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

0102030405060708090

100


Num

ber








19

30 34

28 29

45

36

26

43

28

51

39 32

47

32

51

37 35

51

36

52

37 35

50

36

58

39 40

51

39

52

43 48 49

40

53 45

40

50

0

10

20

30

40

50

60

70





52 52

91 89 64 71 68 68

147 112

158

246 276 288

309 314

0

50

100

150

200

250

300

350


Num

ber



Source Project MIS










Total 87 49 81 7 76 14 2811

Training Types n n


















127 37

7

352

100

215

113 43

6

208

1081

989

547

281 50

2

449

479

1694

1958

646

369 64

4

704

502

1798

2886

1232

676

737 13

48

1316

4950

6185

2525

1541 1996

2937

0

1000

2000

3000

4000

5000

6000

7000


Num

ber

Q1 Q2 Q3 Q4 Total







59486 59486 59486 59486

32882 28689 31301 29458

15709 16571 22786 22411

0

10000

20000

30000

40000

50000

60000

70000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber







3 0 4 2 0 4 1 1 1 2 10

1 1 2 1 10

2 10 13

4

16 8

24 29

5 20 10

25 30

10

0102030405060708090

100


Perc

enta

ge



19 12 11

4

24 19 7 3

15 29

20 6

28 19

39

7 11

34 22

42

25 34 38

27

48 34 32

41 31

48 36

48 41

32 33 20 20 18

0

20

40

60

80

100


Perc

ent




12

4 10

10

16

19

23

3 4 8 3 3 28

34

21

29

20

27

39

22

27

19

25

23

164 21

0

133 19

0

172

175

124

112

112

102 12

5 145

216

148

104

91 11

0

90 13

1

100

76

80

93

97

299

244

179

174

168 186 22

7

194

157 21

5

196

204

719

640

447 494 486 497

544

431 376

424 442 472

0

100

200

300

400

500

600

700

800


Num

ber




Source Project MIS


CI 115 5

CSI 314 14

IFB 1764 81


Source Project MIS


Source DHIS-2


273 310

875 900

0

100

200

300

400

500

600

700

800

900

1000

Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4

Num

ber


Source DHIS-2




142 133 134 140 141 132 140 128 139 126 133 125

0102030405060708090100

0100020003000400050006000700080009000

Perc

enta

ge

Num

ber





























1179

1785

205

581

0

500

1000

1500

2000

2500

Year-3 Year-4

HI HSCS







5567

9200

11528

3754

6414

10951

6015

8805

12614

3078

6365

11431

0

2000

4000

6000

8000

10000

12000

14000


Year-3 Year-4

3888

8064

9353

3230

5600

9474

4369

7817

10709

2607

5710

9886

0

2000

4000

6000

8000

10000

12000


Year 3 Year 4


Source MIS-4 DGFP


Source MIS-4 DGFP



Source MIS-4 DGFP


1679

1136

2175

524

814

1477 1646

988

1905

471 655

1545

0

500

1000

1500

2000

2500


Year 3 Year 4




121d Nutrition

41 41 48 47

42

53 51 50 52

40

56 52 53 54

45

56 54 55 53

42

57 49 49

57

47 56

50 53 55

44

61 52 53 56

48

58 55 53 58

0

20

40

60

80

100


Perc

ent



18

24

82

76

0 10 20 30 40 50 60 70 80 90 100

Year-3

Year-4






























ToT on HRIS





470 518 497

07 23 17

456

553 513

27

135 91

0

20

40

60

80

100



o

f dat

a co

mpl

eten

ess

May 17 Sep 17




2844 3106

4887

3140

3913

3023

6513

3629

1189 1368

2912

1902 2397

1639

4283

2278

495 630

1804 1156

1526 861

2571

1574

186 257 962

570 803 404

1274 937

0

1000

2000

3000

4000

5000

6000

7000



ANC1 ANC2 ANC3 ANC4









22

63

41

78

102030405060708090

Diastolic gt= 90 PE










2














developed

Chittagong 11 11 11

Sylhet 4 4 4

Barisal 6 6 6

Khulna 10 10 10

Dhaka 13 13 12

Rajshahi 8 8 8

Rangpur 8 8 8

Mymensingh 4 3 2

Total 64 63 61






















Barisal 6 Bhola



Dhaka 12 Tangail

Rangpur 13 Kurigram




District


Target Actual









Percent












5 5 0 0 0

31 16 9 6 0

36

16 8 8 4

97

34

14

39

10

0

20

40

60

80

100

120











100 100 100 100 99 95 96 100

76 84

64

91

50 54

100 88 92

82 95

73 75

0

20

40

60

80

100

120



measured




pregnancy


duringpregnancy


of four ANC





100 100 98 97 97 96 93 100 100 100

53 39 39

52

14

100 100 100

76 68 68 74

53

100

0

20

40

60

80

100

120





procedure


negative impact


Used job aidduring

counseling









































































Sl No

Name of the store

Jan

16

Feb

16

Mar

16

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

17

1 Sadar

2 Lakhai

3 Bahubal

4 Madhabpur

5 Chunarughat

6 Nabiganj

7 Baniachang

8 Ajmeriganj


















Habiganj 77 57 74 7298945 4449311 61

Jhalokathi 32 21 656 3080069 1009640 33

Lakshmipur 58 42 724 6035208 5887871 98

Noakhali 44 38 864 4518000 6260098 139

Total 211 158 749 20932222 17606920 841































Number of CVs

Target of CAG with


Achievement

Number Percentage






Name of

Union



Nurpur union of

Habiganj (4 CSA)

4894 4729 1189




Lakshmipur (5 CSA)

9729 12545 12027


Charkakra Union of

Noakhali (5 CSA)

8730 7580 8970


23353 24854 22186


1668 1775 1584 Net

Profit

15-20
































High Health System







Assessment Type






Sentinel survey


Twice in a year




Twice in a year


Newborn revisit




Routine MIS MOHFW








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018






HSCS areas







HSCS areas



Noakhali 21 NA 21


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





HSCS areas







HSCS areas








Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018







HSCS areas



Noakhali 35 NA 10





Pirozepur 18 41 41

HSCS areas





Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks rate




HSCS areas






235128

209600

217475



110200

113933

Bhola 263795 221407 229711







Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks

Pirozepur 90 NA 90


HSCS areas







Pirozepur 50 NA 70







Pirozepur 95 NA 95


HSCS areas






Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018











2149 8701 16519



200 425 0



75 119 119


Noakhali 25 25


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018


Jhalokathi 16 16













2015


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

















Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018

Remarks











Noakhali 5 80 5





4 4 4



Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018





Pirozepur 12148 8621 12148 Bhola 1982 18453 18453





Pirozepur 44612 43826 43826 Bhola 68546 73961 73961



Women 95784 Men 83507

Noakhali 145556 1290879 109167


Indicator

Target (October

2016-September

2017)


2016-September

2017)

Target 2018



Men 7556 Jhalokathi 115587 11459 86690

Women 9373 Men 2086


28371

23929

23929





24355

20229

20229







Achievement 2017

Target 2018 Remarks






Total 326 326 165 Barisal 42 42







Total 130 157





Achievement 2017

Target 2018 Remarks






Habiganj

Ajmiriganj



Baniachong




Habiganj Sadar




Nabiganj





Jhalokathi

Jhalokathi Sadar






Nalchity



Lakshmipur

Lakshmipur Sadar



Ramganj


Ramgati




Roypur




Noakhali Begumganj




Companiganj



Hatiya





Daily Kaler Kantho

October 2 2016


Daily Kaler Kantho

October 12 2016

শত শত


Daily Kaler Kantho

November 18 2016

এ পথ










Daily Prothom Alo

November 13 2016




Daily Prothom Alo

November 18 2016

৪ ৩৮




Daily Prothom Alo

March 2 2017



Daily Prothom Alo

February 12 2017



Daily Prothom Alo

February 26 2017



Daily Ittefaq

February 28 2017



Daily Kaler Kantho

March 4 2017



Daily Prothom Alo

March 6 2017



Sylhettoday24com

May 16 2017

ও পথ







Currentnewscombd

May 28 2017


Newsgallerybd24com

May 28 2017

র ও


Sylhettoday24com

May 28 2017






Offline only


May 29 2017

এক ও ও

Offline only

Newsgallerybd24com

May 30 2017








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News Gallery Bd 24

July 09 2017









Vancouver Canada




Vancouver Canada





Presentation



Vancouver Canada




Vancouver Canada




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Presentation




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MaMoni HSS










Expected Time Line















Mamoni HSS






JHUIIP MaMoni HSS







MaMoni HSS






MaMoni HSS





Expected Time Line




















icddrb MaMoni HSS




MaMoni HSS




Record review KII

MaMoni HSS



KII Record review

MaMoni HSS icddrb





Expected Time Line


mothers HSS icddrb

collection ongoing



MaMoni HSS icddrb






MaMoni HSS icddrb






Record review KII

JHU MaMoni HSS




MaMoni HSS


Annual Report


Submitted

TABLE OF CONTENTS

ABBREVIATIONS

mamoni health systems strengthening activity

Documents