Health & Nutrition
With the support of donor agencies and Bangladesh Government, Resource Integration Centre (RIC) is playing role in the health sector of Bangladesh. Health-based programme implemented by the organization such as Mamoni project at Hatia Upazilla in Noakhali District for Child and Mother healthcare, urban primary healthcare and national TB control at 10 wards of Rajshahi City Corporation is being implemented. Homecare and health services are providing for the older people under ENRICH programme at Arial Baligaon union in Munshigonj District. RIC is organizing education programme along with the health and nutrition programme. Education and health programme is implementing at the Lauhajong Upazilla in the same district, Janjira Upazilla of Shariatpur and Shibchor Upazilla of Madaripur District for affected people of Padma Multipurpose Bridge Area. Sanitation development project “MILIS” is being implemented at the 6 Upazilas of Gazipur, Narsinghdi, and Naryangonj Districts. The goal of these project is to increase the capacity to access health and education services to the poor by growing resources and capacitance, development of mother-child health, fetching the affected people of the PMBP area under the government’s health and education policy, reducing the morbidity by TB. Outcomes of these each are creating accessibility to the government services and increasing demand for captivating health services.
1. Ma-Moni Health System Strengthening Project: RIC has been engaged in Strengthening District
Health and Key Service Delivery Systems (DHSS) project with an objective to ensure that, all essential components of Upazilla, union-level health systems are efficient to support MNH-FP-Nutrition service delivery in an integrated and sustainable manner in Hatiya Upazila. Other objectives of the project are to ensure that critical and lifesaving MNH interventions are available and delivered at optimal quality of care at the community based service delivery points and from the strategically located facilities, to ensure that, through systems strengthening, meaningful community and local government engagement is engendered at the all levels to improve demand and supply for MNH-FP-Nutrition care and finally to ensure that, a conducive national environment at policy and strategic level is advocated to ensure effective implementation of evidence-based MNHFPN interventions.
To achieve the project objectives RIC is implementing flowing major activities: Developing capacity of Ministry of Health and Family Welfare (MOH & FW) managers on HR planning, LLP, budget, Work Plan and DIP and Technical support towards local resource mapping and optimum utilization of local and community resources to complement HR gap.
Improving the quality of care
- Development of a comprehensive QA system for community-level-services.
- Support for Training on supportive supervision.
- Introduction of joint supervisory visits and development of tools
- Adaptation of Standard Operating Procedures (SOP) for each level of service delivery and for all conditions. SOPs to be used as standards for SBMR
Strengthening Health Management Information System (HMIS)
- Training of Community Volunteers (CV), Community Health Worker (CHW), Family Welfare Assistant (FWA) and Health Assistant (HA) on Community Micro Planning
- Introduce community micro planning system at unit and ward levels to collect community data through volunteers.
- Link birth and death data with UP registration systems.
- Automation of the (HMIS) at the union, upazila
Enhancing MOH ownership, engagement and coordination
- Development and introduction of a mechanism to ensure optimum coordination between MOH and MOLG particularly at upazilla and union levels.
Capacity building of field workers and service providers
- Basic MNHFPN training for field workers, supervisors, paramedics, CHCPs
- Paramedic training for ANC and PNC
- Mass BCC activities to raise awareness
- Display key MNHFPN messages in public places
Critical gap management to ensure service in low performing areas
- Identification of key positions at strategically located service delivery points
- Deploy temporary staffs at key positions and trained them
- Strengthening of strategically located facilities
- Strengthening vital registration system through Local Government
- Develop and implement a comprehensive vital registration system and Link and synchronize the vital registration system with MOH HMIS so that a single source is used to keep accounts of births and deaths.
Strengthening oversight of LG for MNH –FP Nutrition
- Advocacy with Upazila and Union Parishads for promoting MNH-FP-Nutrition.
- Activation of Health and Family Planning Standing Committees
- Support to select, involve and promote CVs to engage in MNH-FP-Nutrition promotion, mobilization and care to seek
Budgeting and local problem solving by Union Parishad (UP)
- Advocacy towards allocation of budget and local funding for MNH-FP-Nutrition activities
- Capacity building of UP to allocate budget towards priority local MNH-FP-Nutrition issues and to ensure and monitor appropriate expenditure.
Community engagement with a health system
- Selection of community volunteers (CV) through Union Parishads, the formation of community action groups (CAG) by CVs and linked with each community clinics
- Development of referral network by CAGs
2. Urban Primary Health Care Service Delivery Project (UPHCSDP): RIC has started the implementation of the Second Urban Primary Health Care Service Delivery Project (UPHCSDP) in Rajshahi City Corporation under the agreement with the Ministry of Local government and rural development. Earlier RIC implemented the same project in Madhabdi Municipality of Narsingdhi district
Health services are providing through Public Health Center (PHC) with clinical facilities and Comprehensive Reproductive Health Care Centre (maternity center) with Operation Theatre (OT) and a Laboratory for Pathological testing services and through outreach/community/households. Following services are providing under the project:
Reproductive Health: Maternal Care: Safe Motherhood, Antenatal Care, safe delivery (including by Skilled Birth Attendants), Emergency Obstetric Care (EOC), peri-natal and post-natal including essential newborn care, prevention of unsafe abortion through safe MR services and maternal nutrition;
Family Planning: Provision of contraceptive commodities (oral contraceptives, condoms, injectable, and IUDs), Information and services for other options such as Norplant, vasectomy, tubectomy, menstrual regulation, and natural family planning, and side effects information and how to deal with them.
Maternal Nutrition: Maternal nutrition services, including pregnancy weight gain monitoring and targeted supplementation of underweight (BMI<18.5) pregnant women and lactating mothers, nutrition education and micronutrient supplementation as well as nutrition education and micronutrient supplementation for female adolescents and newly-wed.
Assistance for women who are survivors of violence: Health workers will be able to properly refer survivors of violence to the appropriate legal assistance, counseling, and crisis management services and provide immediate psychological support. Health workers will also detect cases of assault and increase community awareness of the issue. At each health center, there will be at least one staff member capable of using the “rape investigation kits”
Adolescent Health Care: Information and health care services for adolescent boys and girls between the age group of 10 to 19 years.
Prevention of RTI, STI and HIV/AIDS: Information on preventing HIV/AIDS and other STDs, and treatment using both standard and syndromic approach.
Child Health Care: Immunization: Immunization against diphtheria, tetanus, measles, polio, tuberculosis, hepatitis B, and immunization of mothers with tetanus toxoid.
Control of Diarrhea and other childhood diseases: Case management using the Integrated Management of Childhood Illness (IMCI) approach and essential newborn care within public-sector health services and to facilitate its introduction at NGO facilities.
Control of Acute Respiratory Infections: Treatment of acute otitis media, pneumonia, and asthma through appropriate case management, and educating mothers how to identify the warning signs of pneumonia, appropriate treatment with antibiotics, control of asthmatic attacks, etc.
Control of Micronutrient Deficiency: High-dose Vitamin A capsules for children 12 to 59 months and increase the coverage of therapeutic supplementation for children with night blindness, measles, persistent diarrhea and severe malnutrition. iron for young children suffering from iron deficiency anemia, and promotion of the use of iodized salt. Introduction of growth monitoring system for children under 5 will be expanded.
Communicable Disease Control: TB, Malaria, Dengue, SARS, Kala-Azar, filariasis and leprosy: Treatment, linkage, Preventive motivation, and campaign.
Limited Curative Care: First aid for injuries: Includes treatment of cuts, burns, and fractures.
Emergency care: Treatment and care for pain, snake bite, poisoning, shock and drowning
Treatment of minor infections: Treatment of ear, eye and skin infections
Behavior Change Communications (BCC): Strengthened interpersonal communication raises awareness on existing ESP services, promote healthy lifestyle behavior and minimize gender inequalities
To develop client-oriented positive attitudes on part of service providers, to enhance health-seeking behaviors on part of users, promote healthy lifestyle behaviors, and to promote informed decision-making regarding the use of private-sector health care especially ESP, diagnostic services and therapeutic drugs.
Management and Prevention/ Control of STIs, RTIs & HIV/AIDS: Counseling, Awareness education: Establish VCT center: RIC operate one VCT center under the UPHCP II in Madhabdi. VCT and provide confidential counseling to enable people to make informed decisions about their HIV status and to take necessary actions accordingly. If a person decides to take the HIV test, VCT enables confidential testing. Counseling for VCT consists of the pre-test, post-test, and follow-up counseling. VCT is benefiting individuals and society as a whole by helping prevent HIV/AIDS and STI. Under the Project, VCT follows the national policy established by the National STD/AIDS Committee and maintain functional linkages with other agencies/organizations providing HIV/AIDS-related services.
STI and RTI Control: Services are provided as a distinct component with following interventions (i) training of service providers and field workers on STI and RTI prevention and control; (ii) diagnosis and management of STIs, and female and male RTIs; and (iii) counseling, treatment, and motivating clients to bring their partners for treatment and counseling.
Behavior Change Communication and Marketing (BCCM) for HIV/AIDS and STI Control: Behaviour Change Communication and Marketing (BCCM) component for HIV/AIDS-related activities is done to (i) improve the vulnerable population’s knowledge, attitudes, and behavior related to HIV and its economic impact; (ii) promote condom use, harm reduction strategies and safe sex; (iii) encourage voluntary counselling and HIV testing; (iv) encourage care-seeking for STIs; (v) increase knowledge of the link between TB, STIs and HIV/AIDS; (vi) empower vulnerable people to control their lives; and (vii) enable exertion of rights, tolerance and care toward people living with HIV/AIDS. Activities will help households prevent adult and child infectious diseases through changes in knowledge, attitudes, and practices.
Mainstreaming of HIV/AIDS component: Mainstreaming of activities are (a) training on HIV/AIDS awareness building and HIV/AIDS prevention planning to the staff at all level and (b) integrate HIV/AIDS issues into behavior change communication and marketing activities supported by the Project.
Other activities on HIV/AIDS and STI management:
- Supply condoms
- Refer for complaints of vaginal discharge, lower abdominal pain, genital ulcers, swellings in growing in men
- Follow syndrome approach
- Partner management
3. Enhancing Health and Nutrition Services for the Urban Poor People of Selected Municipality of Bangladesh (EHNSMP): RIC is implementing the project in 06 selected Municipalities i.e Chapai Nawabganj, Kaliakair, Narshingdi, Naogaon, Tarabo and Tangail of the six districts. The project aims to increase utilization of primary health care and nutrition services in targeted areas (60 wards of the 6 municipalities) for 110,249 poor households by reimbursing the healthcare costs through a health card scheme in partnership with private clinics, diagnostic centers to ensure that essential services are available and accessible. By strengthening the local government institutions, RIC will establish an oversight and accountability mechanism between the elected representatives and private enterprises, so that the local government mechanisms can support the clinics in continuing to provide essential services beyond the life of the project. Through stakeholder consultations, a sustainability model will be developed in partnership with different stakeholders for these urban communities.
Under this project RIC will also develop 2,000 volunteers (one for every 60 poor households) and 1,800 community groups to maintain a passive surveillance and mobilize collective action to identify health problems and respond to them, and link these groups and volunteers with the ward infrastructure to ensure that the basic vital statistics (births, deaths, etc.) are entered into the Civil Registration and Vital Statistics system.
The project is a 33 months’ project financed by European Union for the period from February 2018 to October 2020.