Abstract
BackgroundMANOSHI, an integrated community-based package of essential Maternal, Neonatal and Child Health (MNCH) services is being implemented by BRAC in the urban slums of Bangladesh since 2007. The objective of the formative research done during the inception phase was to understand the context and existing resources available in the slums, to reduce uncertainty about anticipated effects, and develop and refine the intervention components.MethodsData were collected during Jan-Sept 2007 in one of the earliest sites of programme intervention in the Dhaka metropolitan area. A conceptual framework guided data collection at different stages. Besides exploring slum characteristics, studies were done to map existing MNCH service providing facilities and providers, explore existing MNCH-related practices, and make an inventory of community networks/groups with a stake in MNCH service provision. Also, initial perception and expectations regarding the community delivery centres launched by the programme was explored. Transect walk, observation, pile sorting, informal and focus group discussions, in-depth interviews, case studies, network analysis and small quantitative surveys were done to collect data.ResultsFindings reveal that though there are various MNCH services and providers available in the slums, their capacity to provide rational and quality services is questionable. Community has superficial knowledge of MNCH care and services, but this is inadequate to facilitate the optimal survival of mothers and neonates. Due to economic hardships, the slum community mainly relies on cheap informal sector for health care. Cultural beliefs and practices also reinforce this behaviour including home delivery without skilled assistance. Men and women differed in their perception of pregnancy and delivery: men were more concerned with expenses while women expressed fear of the whole process, including delivering at hospitals. People expected 'one-stop' MNCH services from the community delivery centres by skilled personnel. Social support network for health was poor compared to other networks. Referral linkages to higher facilities were inadequate, fragmentary, and disorganised.ConclusionsFindings from formative research reduced contextual uncertainty about existing MNCH resources and care in the slum. It informed MANOSHI to build up an intervention which is relevant and responsive to the felt needs of the slum population.
Highlights
MANOSHI, an integrated community-based package of essential Maternal, Neonatal and Child Health (MNCH) services is being implemented by BRAC in the urban slums of Bangladesh since 2007
This paper describes how information gathered from different streams of formative research was used to understand the context and existing resources, and thereby develop and refine MANOSHI intervention
A participatory rural appraisal (PRA) was conducted with these key informants and slum-dwellers from different corners of the slum to prepare a health resource map identifying the location of the healthcare providers and facilities
Summary
MANOSHI, an integrated community-based package of essential Maternal, Neonatal and Child Health (MNCH) services is being implemented by BRAC in the urban slums of Bangladesh since 2007. MANOSHI (acronym for mother, neonate and child in Bangla) is being implemented by an indigenous nongovernment organization (NGO), BRAC (http://www/ brac.net), since 2007 and funded by Gates Foundation for five years [4] It aims to reduce the morbidity and mortality of the mothers, newborns, and children in urban slums of Bangladesh through development and delivery of an integrated, community-based package of essential health services. The programme seeks to create demand for services in the community through increasing knowledge, building capacity of the service providers (including capacity for homebased delivery and neonatal care), and develop effective referral linkages for emergency obstetric care (EmOC) To sustain these activities, the programme in the medium-term seeks to strengthen and sustain referral linkages with local health facilities in public and/or private sectors, involve and strengthen all stakeholders for effective participation, and develop a support network in the community to facilitate and sustain post-grant activities. These activities with different time perspectives are undertaken within the broader framework of the three “Ds": Delay in decision-making to seek emergency obstetric service, Delay in transportation, and Delay in receiving services at place of referral [5]
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