A new health sector approach focusing on the quality of care is set to unveil by the government and the donor on Thursday. The USAID’s MaMoni Health Systems Strengthening Project or MaMoniHSS will be named as MaMoni Maternal and Newborn Care Strengthening Project or MNCSP for the next five years. “Quality of care is going to be the major focus area during the new project,” Joby George, who leads the project as Chief of Party, told Bangladesh has come to a long way in cutting maternal and newborn death. But last year the results of the Bangladesh Maternal Mortality and Health Care Survey came as a surprise.
It found that despite an increasing trend among women seeking maternal care at health facilities during the survey period, the death rate did not decline as expected. Public health experts point to the low quality of care at the facilities for that startling fact.
“We have a new partner called Institute of Healthcare Improvement (IHI) which is a global expert in quality of care. They will bring their global expertise to Bangladesh so that some models can be established,” Joby said.
The new project will focus on managing cases at facilities according to minimum expected standards.
“Standards are already known. Our intention is to establish few good models,” said Joby, adding that they will follow the new WHO Quality of Care framework on maternal and newborn care which was launched in 2016.
The journey of USAIDs MaMoni has a long history. It started with remote home based intervention two decades ago from Habiganj district from where a model has been developed that community home based intervention can reduce newborn mortality.
Then they focused on strengthening district and union government facilities. A model widely known as Habiganj Model of maternal and newborn care in the health sector has been established.
Then came to the next phase of MaMoni HSS where the USAID was replicating the Habiganj model in five more districts.
“But while doing that HSS, we realised that we cannot just replicate district by district. There are certain health system issues we need to solve at national level, especially things like facilities are not ready to offer services, staff is not in place, supply in not available, or information system is not appropriate,” Joby said.
“So these kind of central health system issues need to be addressed at the national level. We cannot just solve it at district level. We started working also at the national level so that right intervention are prioritised, and at the same time we are able to solve some of the health system issues – facility readiness, staffing, procurement, distribution of commodities, heath intervention, central level staff training, and capacity building,” he said.
“We moved from just being district focus to also focusing at the national level, so that we can also address the national health system.”
“MaMoni HSS was kind of balance of addressing problems at the national level, helping the government to prioritise and then implementing at the district level in those districts.”
Joby said the new phase is the advancement of the next type of programme where they will help the government to scale up things that have already established.
There will be three main components of the project - expand things which are already proven, continuing trying out new things as well as innovations, and addressing some of the bigger health system and policy related issues such as work on quality of care, human resources for health, health information system, and supply chain management.
“We are going to focus more on maternal and newborn side,” he said, adding that family planning and nutrition will come automatically as those are linked with maternal and neonatal health.
The programme will be expanded to 10 districts in Sylhet, Barishal, Chottogram, Dhaka and Khulna divisions.
“We are taking a whole district approach. Unlike, MaMoni, when we had a very strong emphasis on direct implementation and community mobilisaiton, now the focus is more on helping the government for 24/7 delivery services at facilities,” he said.
“That is an experienced model. We will be helping the new districts to replicate the same model where we will be engaging the local government, local union managers, and local communities.”
“Our aim will be to have most of the union facilities to become 24/7 delivery facility. Then Union alone is not sufficient. We will be working with the upazilla and district facilities so complications can be better managed when referred.”
“We are looking at three tier system – union, upazilla and district. But the major layer of maternal and newborn should be happening at the primary level,” he said.
Health Minister Mohammed Nasim will formally launch this new project at the Bangabandhu International Conference Centre.