Population Council Research that makes a difference

In rural Bangladesh, maternal and child health services have been given a high level of priority in rural development efforts. As a part of these efforts, the government developed a network of Health and Family Welfare Centers (HFWCs) to provide these services at the union level, the most basic administrative level in Bangladesh, serving populations of approximately 30,000. However, although they are geared toward serving rural populations, services at HFWCs are highly underutilized by these communities, particularly antenatal care and childbirth services; only 19 percent of deliveries occur at health facilities, with the the rest taking place in the home. 

The reasons for this underutilization of services are primarily that most HFWCs do not have the capacity to provide 24-hour normal delivery and newborn care services and have limited availability of female paramedics. These shortcomings are compounded by the fact that pregnant women re often are unwilling to travel long distances to the facilities.

Although development agencies in Bangladesh have striven to implement effective health interventions in rural areas, none of these programs has tested any approaches to strengthen normal delivery services at HFWCs, and there is currently no evidence to support whether or not these union-level facilities can safely and cost-effectively provide normal deliveries. Because of this clear need to undertake a pilot research initiative, the Population Council proposed an operations research study to test the feasibility of strengthening HFWCs and collect concrete evidence to support policy changes to do so.

With the financial support of DFID, the Council conducted this study beginning in February 2011 and ending in August 2011. The immediate goal was to seek evidence and identify mechanisms to strengthen union-level HFWCs to provide maternal and child health services in rural Bangladesh. The long-term goal was to improve maternal and infant health and to reduce maternal and neonatal mortality and morbidity.

The study comprised a three-part design: policy advocacy activities, situation analysis, and a cost-benefit study.

As part of policy advocacy activities, researchers held workshops (including a national-level workshop) and consultative meetings with policymakers, program managers, academics, NGOs, local government representatives, and journalists, to elicit opinions and support for making the necessary policy and programmatic changes.

During the situation analysis, researchers assessed the readiness of randomly selected HFWCs in four districts in terms of their human resources, infrastructure, and referral mechanisms, and also conducted in-depth interviews with program managers and service providers to determine their views on programmatic challenges and opportunities.

Finally, a cost-benefit study was conducted to estimate the costs of inputs required to strengthen HFWCs and to assess the cost-effectiveness of doing so.

Project impact

Study results have been published and disseminated among policymakers, program managers, and development partners to inform policy change and program development. Event-specific reports were published to facilitate future utilization of the findings, advocacy activities were published by daily newspapers in both Bengali and English and broadcast by electronic media to create public awareness, a framework was developed on strengthening HFWCs to provide normal delivery and newborn care services, and a concept note for piloting the effectiveness of strengthening HFWCs was prepared.

This project generated other deliverables as well, including reports on the readiness of union health facilities, cost estimates, and results of the national workshop and policy advocacy workshops.

These products all will play a vital role in formulating new and necessary policies and in the design of future programs to strengthen HFWCs to provide 24-hour normal delivery and newborn care services. These steps in turn will increase the rate of facility-based delivery, and ultimately, will help achieve MDGs 4 and 5 by decreasing maternal and newborn mortality.