Quality of Care in Bangladesh
Maternal and newborn health is a priority in Bangladesh. The 4th Health, Population and Nutrition Sector Program (HPNSP 2016-2022) sets ambitious targets of achieving by 2022:
- MMR of 121 per 100,000 live births
- NMR of 18 per 1000 live births
- Under 5 mortality rate of 34 per 1000 live births
See the Bangladesh poster for the 2nd meeting of the Network for Improving Quality of Care for Maternal, Newborn and Child Health, 12-14 March 2019, Addis Ababa.
To demonstrate learning from which other districts in the country can achieve these targets, Bangladesh has identified two districts – Kurigram and Narsingdhi as the first wave learning districts for the QoC Network. Kurigram has selected as hard to reach and comparatively high maternal mortality and Narsingdhi has selected as good leadership and previously tested QI intervention.
In Kurigram there are total five facilities and in Narsingdhi there are four facilities are included for piloting. In this intervention, Upazilla Health Complexes (Sub-district hospital) are the primary referral center and the District hospitals are the secondary referral for the Patient management. In Kurigram District, total 10 Standards for MNH (EMEN) are tested for piloting and in Narsigdhi district total, 5 set of core standards (RMNCAH) are tested. 10 EMEN standards are already included in the RMNCAH standards for another comprehensive approach. Each district has also set-sub national targets for tracking progress for example. Quality teams in the learning facilities then work together to identify quality problems by using PDCA & Community Participation approach and develop local solutions to address it, in the process contributing to the overall district target. Development of Clinical Mentorship is one of the important approach for the piloting. Assessor team from national level regularly conducted the monitoring activities. Quality Improvement Secretariat (QIS) of Ministry of Health & Family Welfare provides guidance with a package of quality interventions to build a supportive environment, support change in facilities, monitor progress and involve communities in improving care. In DHIS2 , there is a dashboard for monitoring the activities routinely.
Very recently another important approach “Zero Maternal Death Initiative” has started in Moulvibazar district for reduction of maternal & neonatal death. The main feature of this initiative are Go, NGO & DP collaboration and effective MPDSR implementation. The whole district has digital database, each & every pregnancy will be tracked by using TAB/ Smartphone of the field worker.
Photo: Sufia Khatun, 25, with her child at her home in Budhata Union, Ashashuni, Satkhira, Bangladesh, in April 2013. ©UNICEF/Haque