The story of Mrs. Nadira Banu from rural Bangladesh.
How Mrs. Nadira Banu regained confidence in her skills
By Shohel Rana & Mariam Aktar Sheli and
Dr. Dhiman Dutt & Dr. Nurun Naher
Shiro Noti Union Center is a rural health facility in Noagoan district in the North-West of Bangladesh, with a mandate to provide primary health care services along with normal delivery care to approximately 29,078 of population. It is situated almost 5km away from the Shapahar Upazila Health Complex, the nearest higher referral center at sub-district level.
Unfortunately, from August 2019 the center’s key health staff, Mrs. Nadira Banu, Family Welfare Visitor suffered from a severe physical illness and had to stop working. Due to the shortage of adequate human resources in the official human resource pool of the Government, it was challenging for the local health authority to arrange for a temporary replacement.
As a result, the center lost its capacity to provide services to the pregnant mothers. The affluent community members were availing services from private facilities around, but it was not affordable and accessible to most families. The situation was leading to unsafe home deliveries and its consequences. After almost one year, Mrs. Nadira rejoined her duty station. She provided essential services like antenatal care and family planning services, but due to the long practice gap, she was lacking confidence to conduct normal deliveries. During a monthly Open Platform meeting between the local Health Facility Management committee, the local health authorities and the health providers, they discussed how to help Mrs. Nadira to overcome her fears.
After almost one year, Mrs. Nadira rejoined her duty station. She provided essential services like antenatal care and family planning services, but due to the long practice gap, she was lacking confidence to conduct normal deliveries.
Together with the mentoring team they delivered a healthy baby
The committee sought for technical assistance from the “Public Health Improvement Initiative in Rajshahi” project, supported by the Swiss Red Cross. The project employs a mentoring team (a trained doctor and a senior staff nurse), who during the next two weeks visited Mrs. Nadira repeatedly at her workplace. When an expectant mom with delivery pain arrived, they stood by her side and guided her through the whole process. Even when Mrs. Nadira felt she could not do it, they encouraged her and helped her through to lead and practice the delivery, including good surveillance and documentation such as the partograph.
Together they delivered a healthy baby without any complications. This was an exciting and very joyous moment for her and for the mentoring team. After a long practice gap, Mrs. Nadira was elated as she got her confidence back. She mentioned that the smiling new mom and the precious sleeping baby were the most satisfying part of her work. In the aftermath of this, the number of deliveries and also other antenatal, postnatal and family planning services steadily raised, making the facility an essential health hub in the community.
The local Health Facility Management Committee members are happy about the development. This incident also strengthened the ties between the committee and the health provider, and led to more constructive discussions and actions how the health center can be improved. The social accountability mechanism through a holistic community engagement through open forum discussion resulted in a positive solution. (Shohel Rana and Mariam Aktar Sheli, DASCOH Foundation compiled the story of Mrs. Nadira)
Background
While working towards the 2030 SDG target, Bangladesh’s has achieved remarkable progress. The goals for the Under 5 mortality rate (U5MR) (31/1000 live births) and neo-natal mortality rate (NMR) (17/1000 live births) have already surpassed or reached their 2020 milestone targets (U5MR-34 and NMR-17) ahead of time. However, the maternal mortality ratio (MMR) has stalled; from 181/100,000 live birth in 2015 (BBS 2015) to 172/100,000 live birth in 2017. The number of deliveries with skilled attendance at birth has increased from 9.5% in 1994 to 42% in 2014 (World Bank 2014), to 53% in BDHS, 2017 (BMMS 2016), and is targeted to increase to 65% by 2020. However, with the slow decline in maternal mortality over the past years, to reach the target of MMR of 105/100,000 live birth may not be possible. Quality of care, skills and abilities, supportive supervision on the job to create confidence are important measures to bring the maternal mortality rate down.
The Swiss Red Cross along with DASCOH Foundation are working together with the Ministry of Health and Family Welfare of Bangladesh to strengthen maternal, neonatal and child health services at the Primary Health Care Centre level and thus contribute significantly to reach the SDG targets in the northern districts of Rajshahi and Naongaon. With a “whole of upazila approach”, the different levels of the complex Primary health care system in Bangladesh are strengthened and interlinked (including a link to private providers), focusing on quality of care through supervision and mentorship on the job and timely and functional referral in case of emergencies. On the community side, the project facilitates different social accountability mechanism who support quality performance and patient rights.
The “Public Health Improvement Initiative Rajshahi” (PHIIR) project is being implemented in five upazilas of Rajshahi and Naongaon district in Bangladesh. The mentor team is assigned to provide supportive supervision and mentorship support along with all necessary on the job training to the health service providers of the assigned 42 union level health facilities and thus improving their skill and competency for continued provision of quality services. Though these may seem to be a small intervention in terms of human resource allocation and time, but combination of these along with relevant support and strong social accountability mechanism can contribute significantly towards the larger goal.
The project advocates with the Ministry of health and family Welfare for the assignment of mentors from Government staff. Infrequently they join the PHIRR mentor team. Lack of funds for transport and lack of time are reasons given by the Government why these duties are not fulfilled. The project is collecting further evidence to prove the effectiveness of supervision in terms of health outcomes.
Shohel Rana and Mariam Aktar Sheli, DASCOH Foundation compiled the story of Mrs. Nadira
Dr. Dhiman Dutt, Health Manager from Swiss Red Cross and Dr. Nurun Naher, Deputy Director, Health and Environment from DASCOH Foundation reviewed the article, added the required references, and prepared for submission.
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