1. MCHIP Bangladesh Community Interventions
Jennifer Shindeldecker, Program Officer
on behalf of the MCHIP/Bangladesh team
Courtesy: HIP

2. Presentation Overview
• Background, program scale-up
• Design of MaMoni community approach
• Q & A
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3. Background
• Abhay Bang’s research shows effectiveness of CHWs to reduce
newborn mortality in India (1990)
• Projahnmo shows effectiveness of CHWs to reduce newborn
mortality in Bangladesh (2001-2006)
• ACCESS delivers community based newborn interventions using
CHWs in Sylhet (2006-2009)
• MaMoni works through the public health system to deliver
MNCH/FP/N in Habiganj (a district model) (2009-2014)
• DHSS is an interim expansion of the district model to two new
districts funded by USAID opportunistically in advance of the HSS
procurement (2012-2014)
• MaMoni HSS strengthens national and district health systems to
strengthen delivery and improve utilization of MNCH/FP/N in 7
districts (2013-2017)
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4. Geographic Coverage – Projahnmo
Trial
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Study conducted by:
JHU, ICDDRB, Shimantik
Coverage:
Sylhet District (3 upazilas)
Beneficiary pop: 742,000
2001-2006
SNL and USAID funded
A randomized control trial to
determine effectiveness of
community based intervention

5. Geographic Coverage - ACCESS
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USAID’s ACCESS
preceded MCHIP
Coverage:
Sylhet (7 upazillas)
Beneficiary pop: 3.4 M
2006-2009
$ 5.8 M
Initial USAID investment to
implement community based
program at modest scale

6. Geographic Coverage - MaMoni
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MaMoni Project
(MCHIP in Bangladesh)
Coverage:
Sylhet (7 upazillas), and
Habiganj (district wide)
Beneficiary pop: 5.5 M
2009-2014
$ 13.5 M
An expansion of the package
to include child health and
nutrition.
A switch to working through
and supporting district public
health systems

7. Geographic Coverage – MaMoni &
DHSS
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MaMoni Project
(MCHIP in Bangladesh)
Coverage:
Sylhet (7 upazillas),
Habiganj, Lashmipur,
Noahkhali
Beneficiary pop: 10.4 M
2009-2014
$ 6 M
An expansion of the district
model to two new districts in
anticipation of MaMoni HSS

8. Geographic Coverage – MaMoni HSS
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MaMoni HSS Project
(MCHIP in Bangladesh)
Coverage: (7 districts)
Hobiganj, Lakshmipur,
Noakhali, Bhola,
Brahmanbaria,
Jhalulcathi, Piropur
Beneficiary pop: 14.9 M
2013 - 2017
$ 50 M
A consolidation of MCHIP
investments and an expansion
of district and national HSS

9. MaMoni Results Framework
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Goal: Improved maternal and neonatal outcomes
1. Increase utilization of services
2. Increase knowledge, skill, practice at home
3. Increase family planning acceptance and understanding
4. Mobilize community to support demand
5. Systems strengthening
6. Increase stakeholder leadership, commitment and action

10. Approach from all levels
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National
Division
District
Upazila
Union
Ward
Household/Community

11. MaMoni Integrated MNH-FP Package
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Technical Area MaMoni Interventions
Maternal
health
ANC, TT immunization, IFA, skilled
attendance at birth, referral for EmOC, use
of misoprostol for prevention of PPH,
prevention and management of PE/E
(including calcium supplementation)
Newborn
health
ENC, breastfeeding, managing newborn
complications, ETAT
FP Promotion of modern methods, LAM and
PPFP (inclusion of LAM/PPFP counseling),
referral for LAPM, compliance with USAID
regulations
Handwashing Handwashing (focus on perinatal period)
IYCF (added in
2012)
Immediate and exclusive breastfeeding,
complementary feeding up to 2 years

12. Community Health Workers
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• 257 women trained on
MNH/FP/N, deployed to fill
vacancies or complement
providers in high population
areas
• 43 private community skilled
birth attendants trained and
supported to establish private-
practice delivery services in
their communities (covering
20% of the population)
• 2,000 depot holders (all
women) trained and linked
to local supply chains-
many of whom earn
enough income to support
their families.

13. Community Volunteers
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• Over 14,000 community
volunteers:
• Selected from and by local
communities
• Mobilize communities around
health issues and jump-start
community action group
(CAG) meetings.
• Unpaid
• Receive 8 days of training
• Workload: ~12 hours per
month

14. Community Action Groups (CAGs)
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• 2,132 CAGs formed in Habiganj
• 93% of 2,245 villages in the project area have a CAG
• 100% of CAGs have a health worker as a member
• 98% of CAGs have local government participating
• 100% of CAGs have emergency transport
• 89% of CAGs in Habiganj have a collective
emergency fund available for maternal and newborn
emergencies

15. Community Microplanning
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• Innovative approach to link community members with
frontline health workers to raise health issues and
streamline surveillance data
• Meetings in 396 units in Habiganj, 257 units in Sylhet
• After monthly EPI sessions, health workers and CVs:
• Share MNH/FP information and update health
worker registers
• Update list of pregnant and high-risk mothers
• Update unit map to facilitate service delivery
• Prepare monthly action plan for service delivery,
targeting identified individuals
• Identify problems raised by communities and
jointly develop solutions

16. Typical Microplanning Meeting
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17. Microplanning Meeting Coverage in
MaMoni Project Areas
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50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
2011 2012 2013

18. Engagement of Union Parishads in
MNH/FP/N Activities
Local government engaged by:
 Providing cash or in-kind contributions for MNH/FP/N
services from public funds and human resources
 Supporting birth and death registration, particularly
neonatal deaths
 Overseeing health facility/worker performance to ensure
increased access and quality to services
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19. MCHIP Community Activities
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• Training of CVs and formation of CAGs
• Introduction of community microplanning
• Set up of referral system and emergency funds
• Introduction of supportive supervision and joint
supervision visits
• Engaging local government to support MaMoni
activities
• Orientation of TBAs/depot holders to promote key
behaviors and ensure essential commodities at
village level
• Training of private CSBAs to expand service
coverage in hard-to-reach unions

20. MaMoni Preliminary Results in Sylhet
and Habiganj (2010 - 2012)
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Indicator Sylhet
Dec 2010
Sylhet
Jun 2012
Habiganj
Dec 2010
Habiganj
Jun 2012
A. Percentage of recently delivered mothers who:
Sought care for obstetric
complications during
delivery
55.4% 58.0% 37.7% 47.5%
Sought care for newborn
complications
51.5% 54.2% 42.0% 46.1%
Used an SBA (including
CSBA)
21.0% 25.8% 15% 19.4%
Received early PNC visits
within 24 hours of childbirth
19.5% 23.0% 13.7% 17.7%
B. Percentage of married women who:
Currently use a modern
contraceptive method
34% 40.3% 39.1% 40.6%

21. Sustainability of Community
Activities in Sylhet
Responsibility transferred to MOH&FW in September 2011.
As of 2013:
CHWs: Out of 259 MaMoni CHWs, 14 hired by MOH&FW,
88 employed by other GOB departments/NGOs, 6 elected to
UP positions
CAGs: half of the CAGs continue to meet on a regular basis
Community microplanning: 250 out of 257 community
microplanning meetings and 52 out of 56 union follow-up
meetings held.
UPs: 52 out of 56 UPs allocated budgets for MNH/FP/N
activities in the last fiscal year
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22. Lessons Learned
• Integrated and comprehensive approach is key
to cost effective interventions
• Community can take certain responsibilities in
health care services
• Community interfacing with health systems is
possible
• Local government institutions can play an
important role in facilitating health care services
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23. THANK YOU!