MATERNAL HEALTH PROGRAM IN BANGLADESH

Bangladesh is one of the developing countries in the world. There has been substantial progress
in Bangladesh during the last decades, specially in maternal, neonatal and child health: It has achieved
considerable improvement in social and health indicators, like maternal mortality Ratio(MMR), Neonatal
mortality, Infant mortality and Total fertility rates (TFR),
Despite remarkable changes, and Bangladesh is in track to achieve MDG 4 and number of
initiatives have been taken to achieve MDG 5. Government of Bangladesh has given more emphasis and
priorities on particular issues, like Antenatal Care (ANC), safe delivery with Post Natal Care (PNC) and
neonatal care in HNPSP. Some special and innovative programs are undertaken on reproductive, neonatal
and child health along with other support programs under ESD, DGHS. National and international
agencies are optimistic that Bangladesh will be able to achieve the Governments policies like PRS,
HNPSP and MDG goals.
Present status:
Maternal Health:
• Maternal mortality ratio: 320/100,000 live births (in the year 2001)
• 18% births have been attended by skilled birth attendants
• 60% pregnant women receive at least one ANC.
• 22% mother and newborn receives post-natal care from a trained service provider within six
weeks of delivery
• 15% delivery conducted at the health facility

Newborn:
• Out of 3.8 million babies, 120,000 die within 28 days,
• Approximately, 100,000 babies are stillborn,
• Neonatal death rate 37/1000 LB,

Government’s Commitment and Initiatives:

• Poverty Reduction Strategy Paper (PRSP)
• Health, Nutrition & Population sector Program (HNPSP)
• Sector Investment Plan (SIP) of HNPSP
• Millennium Development goals (MDG) (Health related commitments of the Government).
• Revised Program Implementation Plan (R - PIP)
National Health Policy
• Bangladesh National Strategy For Maternal Health
Millennium Development Goals (MDGs) with Targets

Maternal Under-5 Infant

Mortality Mortality Mortality
3.2 94

66

1.4 31
22

201 201
1999-2000 2015 1999-2000 1999-2000
5 5

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National Programs on Maternal Health Care
EmOC: Obst. first Aid, Basic & comprehensive EmOC
59 District Hospitals
132 Upazila Health Complex (UHC)
70 MCWCs : 60 District level; 8 Upazila level and 2 union level.
Community-based Skilled Birth Attendant Program
Demand Side Financing: Maternal Health Voucher Scheme
• Joint Govt. - UN agencies MNH Program
• Safe Blood Transfusion Program,
• National Nutrition Program,
• Postnatal Care (PNC) with vitamin A supplementation
• Maternal nutrition (through Iron + Folic acid).
• Prevention of unsafe abortion through safe MR services and provision of post abortion
care (PAC),

1) Major activities of EmOC Program

• Provide basic and comprehensive EmOC services
• Development of skilled human resources
• Ensure Quality Care (regular visit by quality assurance team, regular infection
prevention practices)
• Facility Preparedness:
- Creating Readiness
- Formulation/ Review of Hospital Action Plan
- Future Search Conference
- Appreciative Inquiry
• Strengthening of Management Information System (MIS)
• Health Education Program /Social mobilization / Creating awareness against 5 danger
signs,
• Women Friendly Hospital Initiatives

2) Maternal Health Voucher Scheme – Demand Side Financing

The program designed to test the effectiveness and feasibility of using voucher as a way of increasing
demand for maternal health services among the poor/all women.
Target Group / Beneficiaries: poor and vulnerable women, in some cases (9 upazilla) all pregnant
women
Service Components: Three antenatal cares, one safe delivery, one postnatal care, care of
complication, if required, including caesarian section.
Expected out come:
i. Increase uptake of maternal health cares particularly by the poor section of the
community.
ii. Conforming quality care from the designated health centers / institutions.
iii. Improved inter-sectoral collaboration.
iv. Improve collaboration with NGOs and public sectors.

Progress: DSF Maternal Health Voucher Program is being implemented in 35 Upazilla of 33 district and
more than 100,000 vouchers have already been distributed.

3) Skilled birth attendance at delivery.

Competency based six month training on basic midwifery is providing to basic health workers called
Family Welfare Assistant (FWA) and Female Health Assistant (Fe-HA). The SBA becomes able to
provide Basic EOC including ANC, PNC and Essential newborn care at the household level and to early
detect abnormality for prompt referral. The Community based Skilled Birth Attendant training program
has contributed significantly to clean and safe delivery in the community; rural women are increasingly
changing their preference of Traditional Birth Attendants to better Skilled Birth Attendants.

Progress: about 4,000 C-SBA trained in 256 UZ of 42 District.

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 4) Women Friendly Hospital Initiatives:
Objectives of the initiations-
• Ensure availability of services to women (obstetrics care, management of violence
against women, gender equity)
• Create suitable environment for women (quality care, community-hospital partnership)
Goals:
• to create conditions necessary for women
• to reduce maternal mortality by providing essential obstetrics services
• to provide appropriate measure for women affected by violence
• to use hospitals as an opportunity for empowering women
• to eliminate discrimination against women from hospitals
Progress; Implemented in 4 district hospital – Manikgonj, Cox’sbazar, Joypurhat, Rajbari and 3 Upazilla
– Bhairob, Chowgacha and Fatikchari.

5) Joint Govt. UN MNH Program:

Purpose of the program

Improved community maternal and neonatal health (MNH) practices and utilization of quality MNH
services, particularly among the poor and excluded. The Program is being implemented on the basis of
Local Level Planning (LLP) with decentralize approach.
Outputs OF THE PROGRAM
Specifically, the project will achieve the following outputs:
 District and sub-district health MNH plans developed, implemented and monitored by Health
and Family Planning Management Teams with the participation of communities.
 Increased availability and access to sustained quality continuum of MNH care and services.
 Women empowered to uphold and claim their rights to optimal maternal care and ensure
survival rights of their newborns.
 Community support groups participate in management of MNH services and facilitate
women’s access to MNH care
Progress: Maternal and newborn health program is implemented to 4 districts – Thakurgoan,
Jamalpur, Narail and Maulvibazar.

Challenges:
• Deficit in skilled manpower especially in anesthesia
• Retention of skilled manpower especially in peripheral areas,
• Filling up the vacant posts including consultants/specialists both in Obs-Gynae. and Anesthesia)
• Transfer without replacement
• Issues related to carrier planning
• Scarcity of specifically trained nurse midwife
• Inadequate medical audit/Maternal, Neonatal Death Audit

Future Needs and Plans

• A need based National HRH Policy/Strategy for MNCH services needs to be developed and it
will be complementary to the National HRH strategy 2003
• Expansion of Emergency Obstetrics Care services,
• Community Based SBA services and IMCI to cover whole country
• Expansion of DSF program to reach the poor pregnant women

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• Strengthening Inter-program coordination and collaboration in GOB, NGO, private section in
MNCH field