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Role of Marie Stopes Bangladesh in Social Development challenges and way forward

• Dr. Reena Yasmin
• Sr. Director Programmes

• Marie Stopes was founded in 1988 as a not

for profit organization

• Affiliated with Marie Stopes International,

London, UK

• Is one of the foremost SRH service delivery
• rganization
• We are contributing towards two important

Social Development Goals NO ONE SHO HOULD BE BE LE LEFT BE BEHIND

Extensive Network of Clinics and Outreach Services

MS Referral Clinic MS Clinic LAPM RT & IUD RSP Public Sector Support MS Maternity Clinics

Our Our Spr Spread ead

Network of Clinics:

• Marie Stopes Clinics

: 41

• Marie Stopes Referral Clinics

: 60

• Maternity Clinics (DFID)

: 15

Extensive Network of Outreach:

• LAPM Roving Teams : 11
• IUD Roving Service Providers : 28
• Strengthening GoB health facilities

for LAPM services : 25

FP Service (Cafeteria approach) ANC/PNC RTI/STI Safe MR Service Post Abortion Care Neonatal & Child Health Post Abortion contraception Limited General Health

Satellite Once per week Services including

• FP

ANC/PNC CH STI/RTI Post Abortion Care follow-up Limited GH  FP  ANC/PNC; Safe Delivery  Breast-feeding  Unsafe abortion  Post Abortion Care  Post abortion FP  VAW  Nutrition

• Newly-wed counseling

Women-based community support group Male involvement Participation of local formal/informal leaders Participation of GoB field workers Participation of local NGOs Linking with UPPR

Community participation

BCC

GO Collaboration Community Participation Quality Assurance Private sector involvement Safety Net for the Poor Capacity Development M & E Documentation

Safe Delivery services Management of minor OBG/GYN operations FP Service (Cafeteria approach) ANC/PNC RTI/STI Safe MR Service Post Abortion Care Neonatal & Child Health Post Abortion contraception Limited General Health Selective Male RH services (NSV) Primary management of Infertility & Referral linkage

MCH Post Urban Area - VSC Roving Team IUD Roving Team

Maternal & Child Health Referral Centre NGO Partnerships Peri-Urban Area

Urban Area- Close to community Satellite

Access: Access: Multi Multi Tier Ser Tier Service vice Deliv Deliver ery y Model Model

Af Affor

• rda

dabili bility: ty: Pr Pro-po poor T

• r Tar

arge geting ting no one is denied services for want of money

At least 40% of services to be ensued free of cost to the poor Baseline Survey (Based on SES) Opportunity Card distribution based on poverty grading criteria Annual Review

PROVIDER % of Failed MR % of Incomplete Quality Score Client Satisfaction Doctors 0.02 0.16 Both types

• f clinics

scored equally in quality indicators 97% satisfied with the service Paramedics 0.004 0.05

Comparative outcome of MR services

• Cost of Providers do have a significant impact on service costing
• Where ever possible task shifting//sharing
• Getting and retaining doctors in small towns and remote locations
• Or they do not want to work in slums

Ava vail ilabili bility ty of

• f Ser

Service vice Pr Provide viders: s: Par ara-medicaliz medicalization tion

more than 1.1 million unsafe abortions/MRs every year

Decision Decision Making: MR Making: MR & P & Post

• st MR FP

MR FP

384,000 Women suffered from Abortions complications in 2014 48% of all pregnancies are unintended

Total MR conducted 52,000 Post MR FP (%) 97% Short term FP acceptors 71% LARC acceptors 26% Permanent method 0%

MSB: Up to Quarter 3 (2017)

Only 14% of women can take decisions alone on their health issues

Collective initiative of men and women in awareness activities on family planning

Male Involvement

Jah Jahanara, is is 30 30, was as marrie ied at t 12 12 & had ad th the fir first of

• f se

seven ch child ildren sh shortly aft fter

“I say to my daughter, I was a child when I gave birth to a child; have only two kids. I do not want you to go through the same miserable life as mine.” TFR Stagnated: Low uptake of LAPM

• A unique collaboration with DGFP
• Mostly in remote an

and har ard to

• reach loc

locations, where there are –

 Lack of trained and skilled service providers  Low performances  Inadequate demand creation

Lo Low Up w Uptak take of e of LAPM: LAPM: Colla Collabor boration tion

• 17 Teams (each team consisting of 1 Doctor

and 1 Field Worker): based regionally.

• Move to GoB health facilities to provide

LAPM services

TFD show in a school to prevent child marriage

Adolescent SRHR

• A large cohort of

adolescents (10 - 19 years) entering the RH life every year

• Adolescent Bir

irth Rate is is 113 per 1000

• teenage pregnancy is

is th the number one causes of f mortality for gir irls aged 15 – 19 years

1 in 3 (36.84%) married Bangladeshi men reported physically and/or sexually abusing their wives in the past year About 48% of workers report current illness/symptoms

Female Factory Workers

Annually around 1.8 million clients walk through Marie Stopes blue door

Thank You

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