1

Strengthening reproductive services by close to community providers: Lessons from REACHOUT, Bangladesh

The REACHOUT project is funded by the European Union

Dr. Mahfuza RifatAssistant Professor, Coordinator REACHOUTJames P Grant School of Public HealthBRAC UniversityJune 12, 2016

Background

• REACHOUT, a five year implementation research project -To understand and strengthen the role of close-to-

community (CTC) health workers

• REACHOUT Bangladesh, focuses on menstrual regulation (MR), a procedure to safely establish non-pregnancy up to 6-12 weeks after a missed menstrual period

Context analysis

• Poor women remain vulnerable to unsafe and uninformed choices

• Inadequate supervision and referral structure: major gaps identified by the partners

• A range of CTC health service providers to provide MR services: formal, Informal

Objective

• To conduct implementation research and strengthen the role of close-to-community (CTC) health workers, focusing menstrual regulation (MR)

Implementing Partners

Marie Stopes Bangladesh (MSB)

Reproductive Health Services Training and Education Program (RHSTEP)

CTC providers

Community

Close-to-Community Providers

Health Centre

Majority female (71%)Education: Secondary and aboveMean age: 31 yearsMean years of service: 2.7 Paid staffVisits community

Interventions

Facilitative referral training for CTC providers

Supportive supervision training for supervisor of CTC providers

Introducing revised, structured referral card

Method

• Combination of quantitative and qualitative methods • Ongoing process documentation• Observations in terms of trainings and supervision• Data collection of first phase ended in November, 2015

Key findings

• CTC providers feel motivated in contributing to well-being, maintaining good relations and gaining positive recognition

• After intervention: more confident, comprehensive information, networking with other providers, and saving clients from clandestine operators

• Positive changes in supervision style of the supervisors

Key findings…

• New referral card helped in documenting activities, tracking referred clients and ensuring referral fees to the referrer

• Many of the CTCs mentioned low pay as a demotivating factor• Commonly faced challenge by the CTCs:

– Access to all households– Insufficient time to engage in discussions

Key findings..

• Implementing organisations were supportive • Perceived benefits were recognised by CTCs and women• Regular meetings and dialogues was critical to avoid

implementation disruption • Joint development of training manuals, involving trainers from

organisations promoted ownership

Lessons learnt

• Implementation research is a continuous process and should be developed and adapted according to context

• Innovative interventions was feasible and acceptable • Strengthening monitoring process, accountability and

recognition of hard work of the CTCs is critical• Intervention targeting multi-layer of supervisors is

necessary for sustainability

Acknowledgement

• Implementation partners– Marie Stopes Bangladesh– Reproductive Health Services Training and Education Program

• The team REACHOUT Bangladesh Sabina, Malabika, Rifat, Sadia, Salauddin, Irin, Riaz, Sumona, Tamanna, Tahmina and Sushama

• All close-to-community providers

Thank you All