The purpose of the evaluation is to determine the extent to which the Healthy Child and Mother Project that was implemented by the grantee organization and its local Bangladesh partners from 2009-2014 accomplished the intended results and to describe key factors that contributed to what worked or what did not work. The project used a maternal newborn intervention package incorporated into the government community-integrated management of childhood illness (C-IMCI) strategy expanded to include newborns and delivered by a cadre of trained CHWs at household and community levels. The project innovation was the People’s Institution (PI) community mobilization model, adapted to empower the poor and marginalized to collaborate with the public health sector to promote maternal newborn health. The evaluation used a comprehensive participatory approach, including collection and integration of quantitative and qualitative data from a variety of sources.
The evaluation team determined that the project effectively mobilized marginalized women and men for maternal newborn health and involvement with the health system by establishing the PI model. A 3-tiered functional PI system was established within 2-years that served as the foundation for public private partnership (PPP) development, enhanced health services, trained volunteer community-based providers, emergency health funds, and MNC gains. From baseline to endline, 4-ANC visits increased from 5% to 14%, institutional delivery from 8% to 19%, and SBA delivery from 9% to 22%. In addition, the availability of weekly ANC services at health facilities increased from 60% to 90%, and 24/7 delivery services from 3% to 17%. Thermal care of the newborn increased from 10% to 40% and clean cord care from 57% to 69%. The project strengthened PPP system collaboration with MOUs, a referral system, and participatory health committee structures in which the poor are now active MNC advocates with the government and government officials and health workers are meeting with them to make policies and decisions that address community needs. Study findings show that at endline over 60% of women of reproductive age (WRA) in the intervention area were active members of the PI groups and that WRA that were PI group members were significantly more likely to have higher levels of social capital than those who were not PI group members.
Best practice from this project for the global community to consider in promoting maternal newborn health care in marginalized communities include:
- The PI Model delivery platform of community mobilization to promote MNC in partnership with MOH officials and health facilities/providers.
- Community-supported and managed emergency health funds.
- A MNC facility referral system that gives priority to poor mothers and children.
- A volunteer system of trained village-based health providers working in collaboration with health facility providers to promote MNC.
- Community involvement in the management and operations of local clinics.
- HMIS matching meetings between PI and government providers/officials for accurate data to address MNC needs.
Results of the evaluation were disseminated in Netrokona Bangladesh to a stakeholder audience of public officials, NGO representatives, and community members. Government officials expressed appreciation for the gains in maternal newborn health that are occurring due to the public private partnership established by the project and pledged to continue working with the PI groups and CHWs to further MNC health in the district.