Marie Stopes was awarded a project called “Scale for Continuing Operations and Programme Expansion” (SCOPE) by Marie Stopes International (MSI). Since 2007, the project is contributing towards significant reductions in unplanned pregnancies, unsafe abortions and maternal mortality rates in Bangladesh. Services are being provided through 10 referral clinics, 68 upgraded mini clinics and 4 mini clinics under this project in 55 districts. In addition to providing normal services from the clinics, the project provides long term family planning methods through its 8 IUD Roving Teams. It conducts other outreach activities including serving the homeless people.

The purpose of this project is to improve the health of the urban poor, especially women and children by improving access and changing the way in which health services are provided. The project is funded by the Government of Bangladesh (GoB), Asian Development Bank (Lead Development Partner), Department for International Development UK (DFID), Swedish International Development Agency (SIDA), United Nations Population Fund (UNFPA) and ORBIS International. The beneficiaries of the project are the poor & ultra poor slum dwellers and low income families.

Marie Stopes has been implementing the project in Mohammadpur area of Dhaka City through Dhaka City Corporation since 2000. The second phase of the project has a duration of six and a half years, and started in July 2005. Under this second phase, MSB was also awarded two additional locations, one in Barisal and another in Comilla being served from July 2006.

These projects provide services such as reproductive health care, child health care, communicable disease control, limited curative care, behavioral change communication, eye care, nutrition support, tuberculosis care, HIV/AIDS care and action against “violence against women”. Marie Stopes Bangladesh ( MSB ) provides the services through 3 Comprehensive Reproductive Health Care Centres (CRHCC) and 13 Primary Health Care Centres (PHCC), 9 mini clinics, 6 drop in centres, 3 primary eye care centres, 3 VCT centres and 120 satellite clinics in partnership areas of Dhaka, Barisal and Comilla. Besides, health services are also being provided to school children and garment workers.

MSB has been implementing this project titled “NGO Co-financing Community contribution to Actions in Bangladesh implemented by non governmental organisations since March 2006. This 54-month project is funded by the European Commission through MSI, UK. The project aims to contribute towards the poverty and maternal mortality related MDGs by improving the health status, particularly SRH of the poor and underserved women, men and young people in Shariatpur, Bhola and Barisal districts of Bangladesh.

The project addresses their basic need by increasing the availability of services leading to an improved quality of life. To avoid duplication and to maximise resources, the project developed strong linkages with government health providers and other health services providers to ensure maximum integration with existing services, prevent the creation of parallel systems; and to facilitate referral to related services (safe delivery services).

The project aims to achieve this through:

» Establishing Service Delivery Points (SDP) - SRH centres, mini clinics and a strong outreach (satellite clinics) component for quality and affordable SRH service provision to increase availability and access to these services.
» Targeted Behaviour Change Communication (BCC) strategy - awareness pertaining to SRH issues including FP, Birth Spacing, Contraceptives, STI, RTI, ANC, PNC, Menstrual Regulation (MR), HIV/AIDS and other related issues of women, men, young people and other community stakeholders to create an enabling environment in which these services can be delivered. Ensuring these populations have knowledge of, and can avail SRH services is central to alleviating poverty.
» Developing a participatory methodology to ensure local ownership of the project.
» Building linkages with the district government hospitals and other providers to ensure an effective response when referring cases to them (especially safe delivery services).
» Developing a replicable model for SRH service delivery in the hard to reach areas.

One of the innovative activities of the EC financed project was the introduction of a "Voucher Scheme” to facilitate increased access to and utilization of safe delivery services, empower poor pregnant women to procure safe delivery services from qualified service providers, start creating sustained demand for institutional obstetrics care and improve quality of maternal health services in selected centers.

Under this scheme, poor and under-served pregnant women are provided normal and cesarean delivery services by qualified attendants of the local designated clinics/hospitals which have a MoU with Project. The project launched this initiative in all the three project districts in January 2007.

How does the Voucher Scheme work ?
» Marie Stopes Volunteers (MSVs) who are from the local community are the focal point for selecting eligible clients
» MSVs list all ANC clients from their area; those who meet selection criteria are referred to the nearby MS clinic
» Voucher is given to the client after reconfirmation of her financial status during a field visit by MS staff

The government of the People’s Republic of Bangladesh received a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) for prevention and control of HIV among high risk population and vulnerable young people in Bangladesh, thus creating the opportunity to work with the garments industries of the country. Beginning January 2008, the project is being implemented by Marie Stopes’ consortium in collaboration with the Bangladesh Garment Manufacturers and Exporters Association (BGMEA). The aim of the project is to equip factory workers with knowledge regarding HIV/AIDS and ways to prevent being infected.

Approach
» Partnership
» Coordination with BGMEA, factory managements to ensure worker availability with least impact on production
» Life Skill Education to help sustain impact


Project Implementation

‘Strengthening Adolescent Reproductive Health in Bangladesh’ a five year project was awarded to Plan Canada and its ally Plan Bangladesh, by the Canadian International Development Agency (CIDA). Marie Stopes Bangladesh was awarded one of the components commencing January 2008. It will reach out to 200,000 adolescents as direct beneficiaries and 500,000 indirect beneficiaries in remote rural and urban areas of Bangladesh over 4½ years.

Project Goal:
To improve the reproductive health of vulnerable and underserved adolescents in selected areas of Bangladesh and to increase their access to services.

Project Purpose:
1. To create an enabling environment to meet the sexual and reproductive health needs of adolescents in selected areas of Bangladesh
2. To increase availability, accessibility and utilization of quality and gender sensitive SRH information and services
3. To develop partnerships with Government, UN and other stakeholders for implementation of ARH strategy within the HNPSP framework

The project focuses on-
» Adolescent Friendly Health Service (AFHS)
» Counseling
» Providing a safe and supportive environment
» Providing information
» Capacity development (life skills, peer education, counseling, leadership, gender training etc)

Adolescents, both girls and boys of Bangladesh have generally remained outside the purview of GO services, so far. This project aims at improving the reproductive health of poor and vulnerable adolescents in selected areas of Bangladesh following the national ARH strategy. The project will complement implementation of the national ARH strategy.

The project envisions to improve the sexual and reproductive health of vulnerable and underserved adolescents through developing capacity at the social, health provider and policy levels to meet their reproductive health needs in selected areas of Bangladesh through partnerships with the Government of Bangladesh, UN agencies, NGOs and Communities following a participatory approach.

Indirect project beneficiaries like parents, teachers, community and religious leaders are involved so as to guide and support Adolescents in taking appropriate decisions related to reproductive health issues. Adolescents are being organized and their capacity to deal with reproductive health issues developed through direct participation in decision making using various innovative approaches.

Gender sensitiveness is a key strategy for the Project beneficiaries and to achieve this, service providers and social supporters of the project will be oriented and coached to be gender sensitive.

This project aims to create an enabling environment to meet the reproductive health needs of adolescents in selected city corporation areas of Dhaka and Chittagong through implementing the national ARH strategy within the HNPSP framework. The project will be implemented in 4 and ½ years, from January 2008 to June 2012 in two phases in 4 wards (wards # 42 and 43 of Zone 6 of Dhaka City Corporation, and wards # 40 and 41 of Chittagong City Corporation) targeting 35,000 adolescents. In addition, 5,000 adolescent garment workers of Dhaka and Chittagong will also be targeted as direct beneficiaries of the project and this is being implemented in collaboration with the BGMEA.

The project has mainly three service components for the adolescents: a) providing ASRH information b) making linkages with existing GoB health centers for referring adolescents for clinical services and c) counseling.

Title of the project: Public-Private Partnership in Improving Safe MR Services
Location(s) of the project: All of Narayanganj district
Total duration: 23 months starting from June 2009.

Objectives of the project: The overall objective of the project is to increase access to and utilization of MR services in public-NGO-private service delivery facilities in a selected district of Bangladesh. The Specific objectives are - (a) to increase awareness on prevention of unwanted pregnancy and unsafe MR services and (b) to improve quality of safe MR services in the public-NGO-private service delivery outlets.
Target group: 371 women representatives from the community; 120 micro-credit NGO workers; 18 micro-credit managers/supervisors; 45 female locally elected representatives; 100 female teachers; 50 key decision makers, formal and informal leaders, 500 health and FP field workers, NGO field workers and BA/SBA; 200 service providers.
Final beneficiaries: Directly109,000 married women of reproductive age including adolescents and indirectly- 409,023 eligible couples of Narayanganj district.

Major Activities:
• Form community support groups and develop capacity to create awareness among community people on SRH issues including prevention of unwanted pregnancy and safe MR services
• Sensitize micro-credit NGOs to deliver messages on prevention of unwanted pregnancy and safe MR services to their female group members
• Sensitize local elected female representatives and school/college teachers on safe SRH practices
• Sensitize key decision makers, formal and informal leaders to ensure a supportive role from male household members in prevention of unwanted pregnancy and promotion of safe MR
• Mobilize HAs, FWAs, NGO field workers and SBA/TBA on prevention of unwanted pregnancy and promotion of safe MR services.
• Sensitize public/private and NGO service providers to deliver SRH services through a framework of Rights Based Approach (RBA)
• Develop capacity of the service providers on Infection Prevention to ensure quality MR services
• Develop and introduce technical and non-technical guidelines to improve quality of MR services
• Establish effective referral system with GO-NGO-Private service delivery outlets to ensure management of post MR complications
• Document and disseminate lessons learnt and best practices