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Modern healthcare for mother and child

Tk 24.5 billion project to build 700 mother and newborn care hospitals


Published : 07 Sep 2019 09:19 PM | Updated : 07 Sep 2020 12:55 PM

Considering sustainable health for mother and child, the government has planned to provide and create modern facilities across the country.
In view of this an estimated Tk 24.5 billion project has been planned to build 700 more mother and newborn care hospitals to further improve child deliveries in the rural settings.

The project, entailing the services that meet human needs and crucial to the society, is first of its kind to reconstruct and replace some selected family planning healthcare buildings and substantially improve rural childbirth delivery facilities. A comprehensive 3-year plan has been submitted to the Ministry of Health last month in regard to preventing death and reducing complications during childbirth. The key challenge of the project is to provide 24-hour normal delivery services from the healthcare delivery service centres.

Quazi A K M Mohiul Islam, Director General of Family Planning Directorate told The Bangladesh Post, “Bangladesh already made remarkable achievements in reducing maternal mortality rates (MMR) and infant mortality rates (IMR). To continue this trend it is important to further strengthen childbirth facilities in the rural areas.”

He said, “We are already leading in many vital health indicators in family planning among the developing countries and the new constructions of hospital buildings would certainly contribute to further development of healthcare deliveries.” A recent survey shows that in rural areas, about 59 percent of deliveries occur at home assisted largely by unskilled or traditional birth attendants (TBAs, 64%). This means that Union Health Family Welfare Centres (UHFWCs) and Family Welfare Visitors (FWVs) are not optimally utilized to increase the rate of institutional deliveries.

The study found the poor shape and conditions of the existing human resources and the physical infrastructures. It was found that existing human resources are neither adequate for performing delivery services at the UHFWC, nor providing round-the-clock services. The study also said that the FWVs did not have adequate training to provide normal delivery services. Only half of the FWVs had training on midwifery and a few FWVs were trained on active management of the third stage of labor.

There is a serious deficiency in knowledge and skills of basic newborn (neonatal) care of FWVs. Training on ‘essential newborn care’ and professional monitoring from higher level are the possible avenues to address inadequacy in FWVs’ knowledge and skills on newborn care.
Dr Mohammad Sharif, Director, Maternal and Child Health of Family Planning Directorate told this correspondent, “This new project is intended to drastically reduce maternal and newborn deaths and also encourage institutional deliveries.

 We already have more trained manpower and proposed for better support of medical equipment, including air-conditioned hospital delivery rooms and modern ambulances to carry pregnant women.” “It would be a milestone in rural child delivery system in Bangladesh once the hospitals are fully in operation expected in 3 years,” said Sharif.

He said that the family planning department has significantly achieved promoting deliveries in hospitals instead of the traditional home deliveries. “In the early 1990s over 95 percent of the deliveries took place at home in the hands of untrained dyes where death rates of both mothers and the newborns were quite high.”

The maternal mortality rate or MMR was 574 per 100,000 live births in 1990 which fell to 169 in 2017 while infant mortality rate or IMR was over 140 deaths per 100,000 live births in 1990 against about 38 in 2017, according to UNICEF Bangladesh. Noted Scientist Dr Shams El Arifeen also Senior Director, Maternal and Child Health department of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) told this correspondent, “I agree that the IMR and MMR have been declining which are largely contributed by overall development of the nation including improved road networks, increased education opportunities and huge investments in the national economy.”

Dr Arifeen, however, said, “There is no single factor that contributed to the declines in the MMR and IMR although I wish to refrain from commenting on the government’s latest claims on the IMR and MMR figures.” Bangladesh is well on track and striving hard to attain the target of SDGs. According to BDHS 2014, Bangladesh has achieved substantial success to increase in use of contraceptives (CPR) to 62 percent and reduction of total fertility rate or TFR to 2.05 per woman in last 10 years. Despite this progress, unmet need for family planning is still 12 percent among currently married woman.

The United Nations Population Fund, UNFPA has been playing a key role in improving maternal and child health in Bangladesh. The new construction would require skilled manpower on which UNFPA has significant contributions. Dr Abu Sayed Mohammad Hasan, Programme Specialist-SRH, UNFPA Bangladesh told the Bangladesh Post, “UNFPA has already trained midwives and nurses to ensure quality care for marginalized and vulnerable groups across the country. This work has increased the numbers of facilities providing family planning and delivery services and improved the overall uptake of services.”

Regarding the new constructions of UHFWCs Dr Hasan said, “UNFPA is ready to support to deploy midwives in those facilities, building capacity of service providers and ensure uninterrupted supply of life saving commodities.” Professor Farhana Dewan, a senior gynaecologist who has vast experiences in training midwives and nurses, said, “Our challenges are huge if we are to achieve the SDG 2030 goals (maternal & child health). We have good infrastructures but must strengthen services on eclampsia – a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure and haemorrhage (bleeding) during deliveries.

Referring to a study Bangladesh Demographic and Health Survey (BDHS) Dr Dewan said, “About 20 percent women die from eclampsia and 31 percent die from haemorrhage. If such problems are not addressed adequately we may fall behind in attaining the SDG targets.” Appreciating the declines in MMR she said, “Among many factors women’s education, empowerment and health seeking behaviour and of course healthcare facilities contributed to the decline.”