Before I get into the details of the project that I am evaluating, a few details about the country. Bangladesh, part of what is called “South Asia” or the Indian Subcontinent, is the 12th most densely populated nation in the world; approximately 2½ times more densely populated than India. On the list of nations from richest to poorest it is 151st out of 184 (purchasing power parity). Administratively the country is divided into 7 divisions and 64 districts. Each of these districts is then divided into sub-districts or upazilas; there are a total of 485 upazilas in Bangladesh. The Netrokona district (shown in dark red in the map below), bordering India in the north, has 10 upazilas (similar to counties) two of which are the location of the project; two other upazilas were used as comparison areas.
Netrokona district is one of the poorly performing areas of Bangladesh in relation to maternal and newborn child health (UNICEF MICS, 2007). Some of this can be attributed to a familiar mix of health practices of mothers and of poorly functioning health care systems, including a lack of trained providers and operational clinics.
Against this backdrop the project proposed an innovation that is an application of a community mobilization approach to maternal newborn health called “People’s Institutions,” originally developed in Bangladesh by World Renew, the U.S. NGO receiving this grant. A People’s Institution is a community-based organization composed of several smaller village-based groups or “Primary Groups” that has democratic governance characteristics. The Peoples Institution model utilizes a 3-tiered structure that consciously coincides with the administrative structure of the country described above. At the base are village-level groups called Primary
Groups; at the middle tier are groups of villages—called Central Cooperative Committees. Finally at the peak of the pyramid at the sub-district level are People’s Institutions. Each of the tiers “feeds” representatives up the ladder so that the sub-district level has representation from all the villages. At the core of the function of this system are trained village health volunteers who are the primary touchpoint between the mothers and children with the health delivery system. Formation of People’s Institutions is a deliberate process that follows developmental stages starting with training in the villages and progressively forming higher tiers as the primary groups become functional. During the period of this project in the 2 upazilas 541 Primary Groups were formed in 505 villages; an amazing accomplishment.