Health Program

VERC has been implementing its Health program in four different areas in Bangladesh since 1990, which are 1. Savar under Dhaka district and Lalmohan under Bhola district, Sitakunda and Mirasarai under Chittagong district with the supported by different donors and own fund.

Program Goal:

The goal of the health program is to improve the health status of community people especially the poorest women and their children.

Program Components:

• Maternal and Child Health (MCH), providing antenatal and postnatal check up, advice on adolescent care, nutrition, safe motherhood, counseling to preventing RTI/STD and Immunization services.
• Family Planning (FP), distribution pill & condom, insertion of CT & FP Injection, providing advice on contraceptives including permanent & long-term methods and referral also.
• Behavior Change Communication (BCC): Under the component people were mobilized to promote their hygiene behavior practices, taking quality food maintaining healthy way of processing for balanced diet and receiving medical treatment during their ailments.
• Lobby and Advocacy: These activities conduct to ensure the services available to communities from government and NGO sectors for needed utilization, empower community representatives to negotiate with the service providers and their controller for re-scheduling the services to best suit with communities need and play watch-dog role for the services, so that communities are guaranteed with sustainable services. 

Project wise discussion:
1. Community Led Sustainable Health Program (Second Phase)      
VERC has been implementing Community Led Sustainable Health Program since 2006 with the financial and technical supported by SIMAVI, the Netherlands. At the closed of the CLSHP phase-1 activities, in July 2009, the project was assessed and recommended that the project be continued with revised design, emphasizing community empowerment. Accordingly, the second phase was so designed as to cover the entire upazila with the goal of institutionalizing an effective community managed sustainable health service accessible to all focusing on poor women and children.
Goal
Institutionalizing an effective Community Managed Sustainable Health Service accessible to all sections of people focussing on poor women and children in Lalmohan upazila enjoying better health and attaining improved hygiene practices.
Objectives

• To bring about long-term change in behavioural patterns by raising community awareness on health and hygiene issues and thereby improve the status of public health.
• To provide access to quality, affordable and sustainable healthcare services, responding adequately to the beneficiaries’ needs.
• To ensure that all members of the community, regardless of gender, age, disability or socio-economic situation have full access to the healthcare services available and participate fully and effectively in all community led initiatives.

 

Project Location

District	Sub-district	Unions/ Municipalities
Bhola	Lalmohan	Ramganj
		Lalmohan
		Poshchim Char Umed
		Lord Hardinge
		Dhali Gournagar
		Charvata
		Kolma
		Badarpur
		Farazgonj
		Lalmohan Municipality

Population Coverage

Direct Beneficiaries:
The entire population is expected to be the direct beneficiaries of the project interventions ultimately.  The project presently aims to cover at least 70% of the population, while it emphasises special focus on providing the women and children populations first with the services to be proffered. The demographic statistics indicate that a total 87,030 are females, that is, about 49.24% of the total 252,497 population constitutes females and 70% of the female population means 87,030 heads. Children number 97,729 of the total 252,497 population, of which 112,884 are aged over 18 years and the remainder are under 18, that is, they are all children. Of the children, 70% number 97,729, who are envisaged to be the direct beneficiaries of the VERC project interventions. While earmarking beneficiaries for the project, the poorest of the poor, the most vulnerable, marginalised, disabled, widows, female-headed households will be preferred.

Indirect Beneficiaries:
The male population of 128,168 of the total community population of 252,497 and another 400 government and NGO service providers living as community members will constitute the indirect beneficiaries.

Activities undertaken and accomplished to date

Rapport Building:
As VERC has been working in Lalmohan for a long time implementing safe water, sanitation and health related development activities, the organization has already become very popular with these communities. As the ongoing project is a rights based one and also because it follows and implements a new approach, the project staff have to meet with the Local Government representatives, government officials, NGO personnel and members of the local elite frequently, with a view to keeping close contact and building good working relationship based on cooperation.

CBO Formation:

In order to achieve sustainability, inculcate health seeking behaviour and practices among the community people and to establish easy access to the healthcare services made available at the governmental healthcare facilities and NGOs by their professionals, VERC has formed two types of community based organizations (CBOs), viz. Community Support Groups and  Health Watch Committees. This has been effected for community mobilization involving community members of different age groups, viz. groups of children, adolescent boys and girls and adult males and females.

The group formation is carried out by the local community people and the process is conducted and facilitated by the VERC field staff. All such groups, however, are not identical either in formation or their respective roles and responsibilities. Of the groups formed and envisaged so far, category one is an absolutely formal community based organization, that is, Community Support Group, one is a formal civil society organization, which is, in this case a Health Watch Committee and the remainder groups are informal working groups for performing issue based activities which should form parts of the community mobilization process.

The community based organizations formed under the project are described below.

Community Support Group (CSG): A CSG is by nature a formal community based organization consisting mainly of mothers and members of the community. The responsibilities of the members include carrying out analysis of the existing situation, identification of gaps in the healthcare service delivery system, developing plans of action, creation of supportive environment for accessing the services, breaking the cultural and behavioural barriers and raising an emergency fund for helping out distressed community people during delivery or emergency medical treatment. A CSG will also be responsible for sensitizing and motivating women who are usually victimized in various incidences of different kinds of violence through increasing awareness raising and capacity building initiatives. Each of such groups will comprise of 8-11 community members. A total of 33 community support groups will be formed. In addition to carrying out information dissemination and motivation sessions among the community members so that they are aware of and access the available healthcare services, community support groups will also support the community members to overcome barriers in the utilization of the available services. As a formalized CBO, it will have bylaws and CSG members will prepare yearly plans of actions for providing need based support to the communities with special focus on mothers and children. The details of the Community Support Group (CSG) formation, roles and responsibilities will be explained in the Community Empowerment Strategy. To date, 30 Community Support Groups have been formed. The CSGs are organizing monthly meetings on a regular basis and keeping the meeting minutes.

Health Watch Committee (HWC):  The HWC is a Civil Society Organization (CSO) comprising of local leaders, members of the elite, influential people, religious leaders and representatives from marginalized groups. Each HWC will have 11 members. The main responsibilities of the HWCs include carrying out negotiations with the service providers and their controllers for rescheduling the available healthcare in accordance with the needs of the community people and playing a watchdog’s  role so that the members of the communities are able to access the services as required in a sustainable manner. As a Civil Society Organization, the HWC will have formal bye-laws for guiding these organizations effectively through facilitating the Union Parishad (UP) Health Standing Committee and Upazila Management Committee. The HWC will also adopt a rights based approach through revitalization of the Union Parishad Health Standing Committee and the Upazila Management Committee. Also, for protecting women against violence and proper maintenance and improvement of their Sexual and Reproductive Health (SRH), the HWC will undertake and carry out advocacy programmes through mobilizing the Local Government Institutions both at the Union and Upazila level. The HWC will also lobby the government administration at the sub-district (Upazila) and central level with a view to promoting health and social protection rights of women as well as protecting women against all kinds of violence and violations relating to their health and social protection rights. The HWC will also try to create an environment for improving the existing healthcare services offered at the union and upazila level health facilities through involving the Local Government Institution bodies and concerned government administration and Health Management Committee. The details of the Health Watch Committee (HWC) formation, roles and responsibilities will be explained in the Community Empowerment Strategy.   Under the project, 11 Health Watch Committees have been formed and they are organizing regular meeting and document the meeting minutes.

Mobilization Group Formation:

Adult male and female, adolescent boys and girls and children’s groups: These groups will be treated as informal groups which will be formed for community mobilization and dissemination of health related messages among the community members. They are not to be considered as CBOs; rather they will act as issue based functional groups. These groups do not have any formal structure and bye-laws and will be directed by the team leaders. Adolescent male and female groups should mainly deal with the reproductive health and hygiene issues. In addition, the informal groups will motivate the backward communities to come forward to access the services available at the union and upazila level health facilities. They will also put the members of the community aware of the existing situation if the available services are not based on the needs of the local people. They will also raise a common voice demanding the improvement of the quality of the existing health services. Under the project, altogether 900 mobilization groups will be formed and 150 mobilization groups have been formed to date. These groups are currently engaged in organizing different events such as, the monthly meeting, rallies and marking occasions.

The 10 health messages which have been selected so far for dissemination among the community members cover the following:

1. Sexual and Reproductive Health
2. Family Planning/ Birth Control
3. Maternal Health-- ANC, Birth Planning, PNC
4. New-born care
5. Child Health – Immunization, Diarrhoea, Acute Respiratory Tract Infection
6. Nutrition – Breastfeeding, Supplementary feeding
7. Tuberculosis and Leprosy
8. Water, Sanitation and Environment
9. HIV/ AIDS
10. Information on Available Services at Facilities

 

Linkages between the groups:
Almost all the groups will play befitting roles both individually as well as collectively according to the locals’ needs and nature of intervention. The issues/ concerns are common to all but their degrees and dimensions vary with the variegated contexts/ groups/ actors. The mobilization group will be responsible for community ignition, awareness and mobilization. Community Volunteers will supervise and facilitate the mobilization groups directly.  The Community Support Group will function under the direct facilitation of a Health Motivator and in close collaboration with the Health Watch Committee. The HWC will play the key coordination role as the watchdog actor establishing and monitoring operational linkages between the Community Support Groups, other non-formal groups and the Local Government. Along with monitoring various practices promotion, activities such as carrying out campaigns, rallies and marking various days will be executed by the children’s groups will be overseen by the HWC. The HWC will act as an umbrella organization for all groups. It will also provide effective back-up to all groups while they carry out their respective roles and functions. The Health Watch Committee will be facilitated by a Program Organizer.

Capacity Building
Review and updating Training Module/ Manual:
A daylong meeting was organized for reviewing and updating the project training module/ manual by a team of nine professionals from among the VERC Training Cell personnel and senior staff members of the Community Led Sustainable Health Programme. Before finalization of the training module and manual, relevant training materials were gathered  from various different sources. The team reviewed and modified the existing training module and developed the course outline. At the same time, the team has set the time for oraganising and conducting the training during March-June 2010. The outlines of the following training programmes are given below:

1. Training in community mobilization and motivation techniques
2. ToT on prevention and promotion of healthcare issues

Project Orientation-cum-Training:
Health rights for all and ensuring access of all to the existing health services are the leitmotifs of the project titled “Community Led Sustainable Health Program (Second Phase)” which VERC is implementing in Lalmohan sub-district under Bhola district. In order to implement the project successfully, a 2-day project orientation-cum-training was organized during 3-4 February 2010. The project works on a wholly rights based approach. Therefore, the training sessions were designed and developed in such a way that both theoretical as well as group work were integral components of the training. The theoretical sessions discussed the conceptual aspects of the project such as the project goal, objectives, strategies, exit strategies and so on. The group work sessions mainly focused on sharing ideas about the formation of the CBOs, ways of achieving entries into and interaction with the communities and establishing and maintaining linkages between the groups.
Summing it all up, the training sessions seemed quite successful, as all the participants appeared to have received the messages about the project strategies and interventions clearly. 

Training in Community Mobilization:

VERC is recognized as a pioneering developer and innovator of new techniques for promoting sustainable development, particularly focusing on participatory methods whereby the community people are empowered through awareness raising to be able to take decisions on their own and implement actions themselves. VERC believes that only through community people taking up responsibilities for the improvement of their lot and situation, development initiatives can be made sustainable in the long term. VERC firmly believes that its dedicated staffmembers and community catalysts are the key actors in all its community-centred activities and achievements. In this regard, VERC has been continuously active in exploring and enhancing human potentialities through offering training and holding workshops, orientation and experience sharing sessions within the organization as well as consolidating learning from the community. VERC conducted a 5- day training course on “Community Mobilization” for Programme Organizers, Paramedics and Health Motivators during 21-25 March 2010 at Lalmohan, Bhola. A total of 30 project staff participated in the training. The objectives of the training course were to enhance

knowledge, skills and attitudes of the “Community Led Sustainable Health Program” project staff so that they should be able to act meaningfully and effectively promoting the leitmotifs of the new approach. The specific objectives of the training were to enable the trainees understand the community and community analysis, ways to communicate effectively, the importance of motivation, history and strategies of participation, CBO formation and facilitation and participatory monitoring, among other things. Ms. Laila Ishrat Jahan, Assistant Coordinator, Health Programme of VERC coordinated the programme from the headquarters. The training course was so designed as it earmarked 2 days for field practices and the remainder days were spent in in-house discussions and demonstrations. Mr. Subash Chandra Saha, Coordinator, Training and Communication Section of VERC and Khandoker Faisal, Assistant Coordinator facilitated the 5-day training course. 

Health Service Delivery
As per the new approach adopted, VERC will provide healthcare services through satellite clinics in the areas where governmental or NGOs services are hard to reach. The existing gaps in healthcare services are being located following enquiries and inventorying. It is expected that from April 2010 onward, the project will be able to set up and hold satellite clinics in the areas already earmarked. During the immediate past quarter, satellite clinics were held regularly in the previously selected areas. The description of satellite clinics commissioned is given below. 

-Satellite clinic
The project established 09 satellite clinics in different places of Dhali Gournagar, Char Vata and Ramganj unions of Lalmohan upazila. The project is committed to putting in its best efforts in establishing required number of satellite clinics in the areas. A satellite clinic provides health services from 10am to 4pm daily.

It is understood from the field experience accounts that all the satellite clinics are functioning properly and there is huge demand for services offered which asks for establishment of more satellite clinics for providing more services to the communities. The staff are working on identifying and finding out acceptable ways and means to increase their services in the project areas.

Under each satellite clinic, one paramedic and one health assistant are now effectively serving the community members. In order to make the satellite clinics more effective and operational, two more health motivators and five volunteers are mobilizing the local community of each catchment area under a satellite clinic. The work force is found to be providing adequate health services among the people in the community. From the current evaluation, it is perceived that people of the community expressed their full satisfaction about the quality of service provided by the team. But the beneficiaries require more and more health care services from the satellite clinics.

The satellite clinics are movable establishments and they are used to providing health services in most cases from the premises of some socially enlightened community leaders or some member of the local elite. Local elite consider it a symbol of prestige to serve the people in the community by offering to house the satellite clinic within the premises of their establishments. Therefore, finding a suitable place for establishing or operating satellite clinics is not a problem in the area. Therefore, the expansion of the service through commissioning more satellite clinics is not a problem and full utilization of the available limited resources is also ensured as the needs are great and pronounced.

During the period under review (October 2009 to March 2010), various types of services were provided to a total 2628 beneficiaries. The types of treatment and services received by the people through the programme are described below:  
From October 2009 to June 2010

SL	Services	No. Of Clients
1.	Antenatal checkup (ANC)	2053
2.	Postnatal checkup (PNC)	219
3.	Pelvic Inflammatory Diseases (PID)	50
4.	Fever, common cold and general weakness	293
5.	Gastric ulcer	217
6.	Skin diseases	21
7.	Diarrhea and dysentery	21
8.	Children under-5 (Acute Respiratory Infection)	05
9.	Children under-5 (diarrhoea)	04
10.	Family Planning method acceptance	-
11.	Counseling	18
12.	Other diseases	147
13.	Diagnostic services	434
Total		3482

Information regarding safe delivery:
From October 2009 to June 2010

Number of pregnant mothers			Delivery and others					Total no of pregnant mothers at the end of March 2010         (1-2)
At the end of October 2009	Newly detected during the period	Total pregnant mothers (1)	Delivery conducted by			Others	Total (2)
			Hospital, clinic, doctor, nurse	Trained TBA	Un-trained person
1198	1773	2971	216	531	751	02	1500	1471

 (*) Abortion  

Clients referred to Government health centres
VERC has developed good working relationship with the governmental hospital as well as NGOs active locally. In case the VERC staff come across any critical case which they are not able to handle or manage, they readily refer the mother to the government hospital and/ or NGOs, as appropriate. The records of all such referrals are maintained in specific registers. On the other hand, VERC is also used to practiseng resource sharing, seeking assistance from other NGOs.

Client Contribution
Although client contribution is a complementary as well as supplementary factor for achieving sustainability of the health programme, the initiation of the process has been kind of hampered as health cards distribution among the clients could not be accomplished during the reporting period because the task of new site selection for the satellite clinics has not been completed yet. Free treatment has been provided to 12 hardcore poor patients. The chart below depicts the client contribution picture at a glance during the period under review.

From October 2009 to June 2010

SL	Particular	October 2009 to June 2010
		Clients	BDT
1	Service charge	3032	30320
2	Pathological test charges	434	20622
3	Sale of medicine	--	74,694
4	Providing treatment without services	16	--
Total		3482	125,636

 
Advocacy
Advocacy constitutes the key activity carried out by VERC for ensuring everybody’s access to healthcare services. The major advocacy activities envisaged and undertaken by the organization are given below.

Collaboration and Coordination with Local Government & GO-NGO:
VERC continuously collaborate and coordinate with the local government and GO-NGOs for ensuring the health service delivery and improved access of the poorest communities.  Such lobbying is done in collaboration with CBOs (CGS, HWC) so that the targeted population get quality health services at free/ affordable cost. Besides, VERC regularly conducts GO-NGO collaboration workshops with a view to addressing the preventive and curative health service needs of people of the catchments areas. The project staff regularly hold meetings with government officers and other concerned officials and people as part of the lobby and advocacy activities. VERC also lobbies the local government institutions for ensuring the services for the poorest in collaboration with the CBOs in a sustainable manner. Marking various special days and occasions such as the World/ National Immunization Days, World AIDS Day, Environmental Days etc also form part of VERC’s advocacy work.   

Launching Workshop:
VERC has successfully organized the district level workshop cum Launching Workshop of Community Led Sustainable Health Project (second phase) at National Press Club on 16 June 2010 . The Chief Guest of the workshop was Mr. M Hafizuddin Khan, Advisor of the former Caretaker Government of Bangladesh. Mr. Mahamudul Kabir, Country Director, TDH-Netherlands and Dr. Dibalok Singh, Executive Director, DSK were present as special guests. The purpose of the workshop was to disseminate the project activities and how VERC hard to reach the hardcore people for health care services. More than 100 participants covering donors, International NGOs, NGOs, doctors and journalist participated in the workshop. Ten daily newspapers were published the news and 2 TV channels telecasted the news of the workshop. This workshop was highly appreciated by health practitioner, NGO personnel, civil society and donor communities.

Union Level workshops:
The project orientation workshop was organized at Ramganj union parishad office on 30 March 2010 with the former chairman of Ramganj Union Parishad as the chief guest. Around 60 people attended the workshop. The purpose of the workshop was to share the aim and objectives of the project, the role of the Community Support Groups and the Health Watch Committees and how these groups supplement and complement the Governmental Health Committees activities both at the Union and Upazila level envisaged to meet the basic community health needs.

A Case study

My savings are my support

Paschim Ramganj is a tiny village of Ramganj union under Lalmohan sub-district of Bhola district. It is 3 km away from Ramganj Bazar. Shahanaz is a 23 years old married woman who lives in this village with her husband Jashim, an electrician. When she conceived for the seventh time, it was settled at the family level that one of their neighbours would help deliver her baby. But when the time for her delivery neared, she started having pain and she was seen suffering from labour pain for three long days. Despite unbearable pain, there was no move for transferring her to the hospital as her financial condition was acutely distressful. Her husband was also working as a day labourer and could not afford to take Shahanaz to any health facility. In fact, they had no practical preparation or arrangements made for delivery of the baby. Suffering excruciating pain for three days, she suffered a stillbirth, that is, she gave birth to a dead child.

Having experienced all the pains and the sad losses, Shahanaz’s mind-set should have changed but unfortunately she was not so much changed because she was prejudiced and believed that it was what the almighty had kept in store for her and so it was irreversible. Shahanaz, however, was persuaded and motivated to attend the meetings organised and facilitated by the VERC staff, where she came to know about ANC, PNC, nutrition, sexual and reproductive health and preparatory arrangements for delivery etc. Eventually, she became a regular attending all the meetings. As an active group member, she started putting in 30 taka every week in a piggy bank (locally called ‘matir bank’, that is earthen bank). Her savings now stand at 800 taka. She has in the meantime conceived again and her expected day of delivery is in June. Shahanaz hopes that she will be able to deposit a good amount of money by June which will help her meet the emergency and other expenses during the child. Following her example and resolve, other pregnant women in the same village are also resorting to raise a little savings for the purpose.

VERC staff replicate these good practices throughout the project area. Shahanaz says she is grateful to VERC and she wishes VERC activities all success.

 

Md. Shahabuddin
Health Motivator
Ramganj

 

Significant document developed:  

Under the project period the there important documents were developed which are as follows:

1. Develop and share a detailed community empowerment strategy including the strategy on right based approach (see the detailed report-- annexure-A)
2. Develop and share community IEC/ BCC strategy including KAP and community monitoring tools (see the detailed report-- annexure-B)
3. Share baseline survey (see the detailed report-- annexure-C).

Constraints
The constraints experienced by the project personnel while initiating the project interventions in the area may be summarized as follows:

• While VERC has been awaiting NGO Bureau’s approval and clearance as regards the project’s funding, the organisation’s workers in the field bore the brunt of the delays as all planned activities could not be implemented as scheduled.
• Since to many project staff and the community volunteers, the project’s ‘rights based approach’ is a ‘new approach’, relevant motivational tools and training are a requirement to orientate and familiarize the field level implementers better with the ‘new’ concepts. 
• As the sites for the satellite clinics have not yet been finalized, health card distribution among the beneficiaries could not be accomplished.
• Due to widespread ignorance and religious prejudices,  people do not seem so willing to listen to, accept and practice the health messages and tips on sexual and reproductive health, safe sex etc.

 

Lessons Learnt
The lessons learnt by the project workers and the realizations dawned on the directing staff while implementing the initializing activities have been encapsulated as follows:

• Receiving health care services at the government healthcare facilities from the government employed medical professionals is among the basic rights of the people recognized by our constitution.
• It is a fact that most of the grassroots are not even aware of this ‘right’ and hence the widespread popular nonchalance and lack of interest in obtaining information about the available facilities and the services and tips on ways of accessing the same. The project, therefore, is moving in the right direction while it provides the communities assistance in establishing their ‘health rights’.
• Health services delivery centres being introduced under the project have to be so meticulously planned and carefully run that they may serve as models for other such service providers in the project area .
• It is imperative that in pursuance of the project’s the right based approach, the project workers carry on with their rapport building activities and hold motivation meetings regularly without fail, as such interventions are crucial to effect positive changes in the mindset of the community people.
• Project Community Support Groups and Health Watch Committees have proved effective in playing significant roles in the process of rendering the community people aware of their health rights and establishing people’s access to the healthcare services.

 

2. Maternal and Reproductive Health Project

Project Background
VERC and IDRF have worked in long-term partnership on projects related to community-led water and sanitation, health and hygiene promotion, emergency relief and rehabilitation, micro credit programs, women’s empowerment, disaster preparedness and in particular maternal child health. Community involvement through community training has been a key component of all programming. The issue of maternal health and infant mortality in Bangladesh has been of longstanding concern to VERC and IDRF.  Bangladesh’s maternal mortality rate continues to be unacceptably high. For each woman who dies due to complications from pregnancy and childbirth many more suffer injuries, infections and sometimes disabilities brought about by conditions like obstetric fistula.  This project builds on VERC’s success with a four- year community based Maternal and Child Health Project (MCH) in the Savar area of Dhaka district. In 1988 the then ODA (as DFID used to be called at that time) initiated an ODA-funded NGO project for health services delivery in which VERC joined as a partner in 1990. The project was then re-named as the Bangladesh Population and Health Consortium, of which CIDA also funded some components. Due to changes in DFID’s policy around the funding of health in Bangladesh, BPHC was closed in 2005. Throughout BPHC, each member NGO was assigned a geographical area, in which they provided basic primary health care, particularly maternal, child health and family planning services through static and satellite clinics. They also were engaged in demand creation and health promotion to ensure better utilization of services. A socio-economic survey followed by distribution of cards indicating well ranking allowed the project to segregate utilization by well rank and ensured that particular initiatives were taken to reach the very poor. The project was very successful in delivering services at a local, grassroots level with a high rate of utilization resulting marked decrease in neonate, infant, child and maternal deaths as published in Health Policy and Planning; 19(4): 187-198.  VERC approached IDRF with the suggestion of replicating this model and utilising lessons learned in Chittagong where the maternal death rate is high.

Project Purpose: Improvement of maternal and newborn health outcomes through interventions, focused on medical, cultural, and social factors, addressing the Maternal Child Health challenges facing the population of 100 villages in two sub-districts of Chittagong District in Bangladesh.

Project Goal: To contribute to reductions in maternal mortality by providing holistic sustainable social development in selected poor rural communities of Bangladesh.
Project Duration:       36 months        (2010-2013)

 

Working Areas:

Name of District	Name of Upazilas	Name of Unions
Chittagonj	Sitakunda	Saidpur
		Muradpur
		Barabkunda
	Mirsarai	Ichakhali
		Katachara
		Mithanala

 

 

Project Beneficiaries:
Direct:   Pregnant and Postnatal Mothers – 10,000
Children under five years – 20,000
Adolescent Boys and Girls – 20,000
Couples – 10,000
TBAs – 100
Peer Educators/Community Catalysts – 200
Health Centre and Outreach Professionals - 40

Indirect:
Population of the 100 villages within the target two Upazlas: 150,000

Project Activities:

• Maternal child health surveys repeated, recorded, analysed, disseminated for both sub-districts;
• Two community based health centres in operation attending to health needs of women and their children;
• Increased, expanded, and enhanced direct MCH health care services for women and children in the clinics, coupled with comparable levels of MCH health promotion/community outreach activities;
• Medical training of traditional birth attendants in safe home birthing techniques;
• Training in health promotion and education techniques in maternal child health issues and approaches for community peer educators;
• Community based health promotion activities in mother and child health, integral infant-child development, family planning, sexual health issues and strategies, especially around sexually transmitted diseases (STDs);
• Community animation, community organization, leadership development among community women to ensure empowerment of women around issues of reproductive, maternal and child health;
• Information sharing and dissemination of information among MCH health workers in Bangladesh and in Canada;
• Holistic consideration of day to day health and hygiene practices, with health education by example through ICS, organic demonstration gardens, water point and latrine provision, in cooperation with the local communities

Activities done so far
1. Office Set-up (clinic):
Two offices have been hired for project office cum clinic at Sitakunda and Mirasharai. The required office furniture will be purchased by the middle of octaber/2010. It is expected that the clinical services will be started from Octaber/2020.

Staff Orientation:
A formal staff orientation meeting was held on 11 July 2010 at VERC Head Quarter. Ms. Jespal Panesar and Mr. Motahar Hossain from IDRF side, VERC management and project staff were attended in the meeting. There were 15 participants participated in the orientation session. The aim of the orientation session was to orient about the project purpose, target, activities and timeline to be met with the project criteria.

Work Plan Development:
In the presence of Ms. Jespal Panesar, the detailed work plan has been developed. However, later we also developed monthly work plan with the help of Mr. Motahar Hossain which is being attached with this email.

General Information collection:
Some basic information of the union parisahd has been collected for developing the union profile. The information are: number of clinics and government hospital,  population(male/female/child), how many Local government bodies, Agriculture/Health/Family planning situation, types of NGOs  service available in the community,  GOB & NGOs Health & Family Planning Service Provider list Collection, how many TBA & SBAs existed in the community etc. We have documented all the mentioned information for future reference.

Rapport Building:
As VERC has been working in Sitakunda for a long time implementing safe water, sanitation and health related development activities, the organization has already become very popular with these communities. As the ongoing project is a integrated based one and also because it follows and implements a new approach, the project staff have to meet with the Local Government representatives, government officials, NGO personnel and members of the local elite frequently, with a view to keeping close contact and building good working relationship based on cooperation.

Collaboration and Coordination with Local Government & GO-NGO and other stakeholders:
VERC continuously collaborate and coordinate with the local government and GO-NGOs for ensuring the health service delivery and improved access of the poorest communities. The following stage VERC continuous maintain the collaboration and coordination     
a. Upazila level:

1. Upazilla Chairman, Vice chairman
2. UNO
3. Upazila Health & Family Planning  Department
4. Upazila Family Planning Department
5. Upazila Social welfare/Statistics/Public health
6. Different NGOs officials.

b. Union level:

1. Local Government bodies.
2. Different NGOs official
3. Union level heath service provider
4. Union level Family Planning service     provider.
5. Union based health facility center identify.

c. Community level:

1. Community leader, stakeholder, catalyst identify.

.
Review and updating Training Module/ Manual:
A daylong meeting was organized for reviewing and updating the project training module/ manual by a team of nine professionals from among the VERC Training Cell personnel and senior staff members of the Maternal and Reproductive Health Project. Before finalization of the training module and manual, relevant training materials were gathered from various different sources. The team reviewed and modified the existing training module and developed the course outline.

Formation of CBOs and Committees:
Under the project, two formal CBOs (i.e. Health Watch Committee & Mothers Club) will be formed. All necessary preparation have been completed to form the groups and it is expected to be formed all the groups by Octaber/2010.
The Health Motivator mobilizes the communities and rapport building with them. Different types of committees will be formed under the project. At the same time they are identifying as well as selecting the community people for the committee who are interested and acceptable by the community. We will be started to forming the committees from the early Octaber/2010.

Satellite Clinic site selection:
As per the selection criteria, we have 18 places for conducting the satellite clinic of which 09 for Sitakunda and 09 for Mirsarai. The health services through satellite clinic will be started soon.

Baseline survey:
The baseline survey was conducted during 21 July to 22 August 2010 with the facilitated as well as technical supported by Deanna Duplises, Project Development Consultant, IDRF. For the baseline survey, 1500 households selected for data collection.  Initially the whole process of baseline survey, methods and questions were shared with VERC management and concerned project staff and the draft four types of survey questionnaires (adult male, adult female, youth male & youth female) were prepared. The draft questionnaires were tested at project areas for finalization. Six survey facilitators hired for data collection, however the date was collected jointly by survey facilitators as well as project staff. Before data collection from the field, a 2-day long survey orientation training organized for survey facilitators and project staff. This training was based on practical as well as demonstration session. All the project staff and survey facilitators participated in the training session. The training helped the participants in many ways such as the purpose of survey, how to speak with community people, how to ask question, how to fill in the survey format etc. At the same Ms. Deanna taught to Mr. Anowar and Mr. Motahar the process of entry the data. In this way data was collected from the 1500 households and   no obstacle was arisen during data collection at field level. A person hired temporary for data entry and we hope data entry will be completed by this month.  

 

Constraints
The constraints experienced by the project personnel while initiating the project interventions in the area may be summarized as follows:

• While VERC has been awaiting NGO Bureau’s approval and clearance as regards the project’s funding, the organisation’s workers in the field bore the brunt of the delays as all planned activities could not be implemented as scheduled.
• The staff salary is inadequate to recruit quality staff at this present time, however to minimize the gap we have revised the budget without changing the bottom line of the budget which is still in sufficient.
• It is imperative to recruit qualified survey facilitator to conduct the survey smoothly and the survey facilitator should have good skill to bring all health related information from the participant. During our survey it is found that female especially unmarried female feel shy to speak about menstruation problem and unwanted pregnancy due to social and family condition. As a result, the unknown voice will never be revealed.
• Due to widespread ignorance and religious prejudices,  people do not seem so willing to listen to, accept and practice the health messages and tips on sexual and reproductive health, safe sex etc.

Conclusion
Bangladesh cannot boast any dependable and systematic health care provision network countrywide. A number of expensive health care providing medical centres of international standards have cropped up of late in the large cities like the capital and the port city of Chittagong all right; but they cater to the needs of only a counted few who are more prone to flying out to distant shores on the smallest pretexts of being afflicted by the slightest physical discomfort. The widespread governmental health care provision networks too fail to attract the multitudes because of the nonchalance of their attending professionals which include doctors, nurses and technicians. As a result, over 80 percent of the grassroots compulsively turn to the informal health services providers, who include all types of uncharted quacks, fakes, faith healers and all, when sick.

Under the project, two types of CBOs—Mothers Clubs and HWCs have been formed who will regularly reach the communities all required information regarding the available health services, explain to people the ways and means of utilizing them when required and ensure the improvement and provision of the health services to benefit the communities through organizing and holding dialogues and negotiations between the government and private service providers and the community people. With proper formation and effective functioning of the Mothers Club and HWCs in the project areas established, availability and accessibility of services both from governmental and non-governmental sources are envisaged and expected to improve substantially, which will eventually be utilized by all segments of the communities through the facilitation and support of the Mothers Club duly. As a result, people’s health is expected to improve considerably, enabling and supporting them in leading an economically productive and meaningful life. As both the CBOs comprise of the active members of the local communities, they are expected to remain functional beyond the project life, thus ensuring sustainability of the achieved ways to ensuring the overall integrated wellbeing of people and environment.