Country Spotlight Series, Health Systems Strengthening
FBOs Strengthen Health Systems in Bangladesh
Faith-based organizations LAMB and World Renew make substantial contributions to the health system in Bangladesh through their work in maternal and child health, family planning, nutrition, immunization, water and sanitation, and overall health systems strengthening. They have operated in Bangladesh since 1976 and provide sustainable health care services in rural Bangladesh.
The Role of Faith-Based Organizations (FBOs) in Health Systems Strengthening
Non-governmental organizations (NGOs) play an important role in improving health services in Bangladesh. Globally, Bangladesh is one of the countries with the largest number of NGOs, with 60% of them providing health-care-related services. For decades, Bangladesh has struggled to meet the need for qualified health workers in rural areas, as many health care providers remain concentrated in urban areas.
BANGLADESH COUNTRY PROFILE
Country Population (2019): 163,046,161
Life expectancy: 72 years (as of 2018)
Maternal Mortality Rate: 196 per 100,000 live births
Under-5 mortality rate: 45 deaths per 1,000 live births
Infant mortality rate: 38 deaths per 1,000 live births
Antenatal Care & Skilled Attendance at Birth:
- Less than 18% of pregnant women receive quality care. Quality care is defined as four or more antenatal visits, with at least one visit from a medical provider, measurement of weight and blood pressure, testing of blood and urine, and receipt of information on potential danger signs during pregnancy.
- Slightly more than half of the deliveries (53%) were attended by medically trained personnel.
- 10% of births attended by trained traditional birth attendants
- In 2017, women who reported receiving ANC from a qualified doctor (76%)
- 31% of children under age 5 are stunted
- 22% of children are underweight
LAMB’s contribution to human resources for health systems strengthening includes training clinical personnel as well as those involved in oversight of health facilities in rural areas. Notably, LAMB was involved in developing Bangladesh’s national curriculum for training doctors and health professionals to collect and audit perinatal mortality data. This effort enabled LAMB to create interventions to reduce perinatal mortality. World Renew focuses on a strong monitoring and evaluation system for the communities and centers so that they ensure better data reporting.
According to Nancy TenBroek, Program Consultant for World Renew Bangladesh, “Community ownership in developing and then tracking program results is essential.” In addition, World Renew is increasing trainings for community health workers and advocating for more health resources in remote areas.
“Community ownership in developing and then tracking program results is essential.” -Nancy TenBroek, Program Consultant, World Renew Bangladesh
Our Vision for Sustainability: The Power of the People’s Institute (PI) and Shifting Action to Lay People
World Renew uses the People’s Institute (PI) model, to empower community members at the grassroots level to advocate for resources from the government and promote healthy behaviors in the community. According to TenBroek, “Full participation of community members and leaders is critical to sustainability and the success of our work.”
Similarly, LAMB’s approach to sustainability focuses on helping communities identify and utilize local resources to supplement where the government does not meet people’s needs. One of the ways LAMB and World Renew have achieved this vision is by helping communities establish emergency funds, which are used when government resources are scarce.
LAMB is also determined to shift the idea of responsibility for positive change to the local level by empowering communities to contribute to the common good. This is not limited to distribution of financial resources, but includes watching out for power imbalances and where public services fall short. According to Dr. Kris Prenger, Primary Health Advisor at LAMB, “We want to empower people to see themselves as more than just poor, but as people who are made in the image of God and capable of contributing to the betterment of their own community.”
Improving Maternal, Newborn and Child Health Through Research
Research is important for identifying health challenges and delivering effective interventions. Currently, World Renew manages a nutrition grant from Canadian Food Grains Bank (CFGB) to conduct a cohort study on factors contributing to health in the first 1000 days of life.
The first 1000 days of life spans from conception until a child’s second birthday and are critical to the health and neurodevelopment of a child. LAMB partnered with Infant and Young Child Feeding (IYCF) to conduct research on breastfeeding and complementary feeding, to improve feeding practices for children less than 24 months old.
The LAMB component assessed factors that would help scale up IYCF’s work through community health workers. For example, better feeding practices were observed in areas where CHWs were motivated by financial versus in-kind incentives.
LAMB also conducted a five-year research study on nutrition supplementation for pregnant and lactating mothers to investigate its effect on birth weight and the subsequent growth of babies.
LAMB partnered with Infant and Young Child Feeding to conduct research on breastfeeding and complementary feeding, to improve feeding practices for children less than 24 months old.
Respectful Maternity Care
Many women experience “obstetric violence,” which is abusive and dehumanizing treatment during obstetric care. The World Health Organization (WHO) proposed the term “Respectful Maternity Care,” which seeks to uphold “the right of every woman to the highest attainable standard of health and respectful health care,” especially during her pregnancy, labor and
delivery, and post-natal period. World Renew has trained community volunteers and health providers on how to provide respectful maternity care.
Similarly, in coordination with the government of Bangladesh, LAMB developed Safe Delivery Units at health facilities that are run primarily by delivery attendants trained in obstetric first aid along with diploma midwives. To overcome barriers to obstetric care, LAMB promotes linkages between local community health workers and adolescent and women’s groups.
World Renew has trained community volunteers and health providers on how to provide respectful maternity care.
Technical Working Groups
Participation in country-level health service technical working groups connects LAMB and World Renew to other partners in Bangladesh. World Renew has helped communities address gender- based violence and advocated for services of the poor.
LAMB has been involved in obstetric fistula, kangaroo care, caesarean section, and perinatal working groups. In the c-section technical group, LAMB works with partners to identify ways to reduce unnecessary c-sections. While c-sections are lifesaving interventions, unnecessary c-sections can negatively affect the health of the mother and baby.
In coordination with the government of Bangladesh, LAMB developed Safe Delivery Units at health facilities that are run primarily by delivery attendants trained in obstetric first aid along with diploma midwives.
According to the current BDHS (2017-2018) report, Bangladesh has a Contraception Prevalence Rate (CPR) of 62%. The total demand for family planning is 74%, with unmet demand higher in rural areas than urban areas (13% vs. 9%, respectively).
Although more women are using contraception, the current discontinuation rate is 37%, an increase from 30% in 2014. Since the government of Bangladesh has a strong family planning program, many women easily access family planning services. The most common source for family planning is the private sector (49%), followed by the public sector (44%).
LAMB partners with government health and family welfare centers to provide family planning. Both LAMB and World Renew work closely with community health workers and opinion leaders, such as faith leaders to scale up access and referrals to family planning services. Recently, World Renew has engaged men in family planning counseling.
Family Planning Challenges
While LAMB has observed an increase in family planning uptake, it has also noticed stigma associated with permanent methods of contraception. In some rural Muslims communities, there is a belief that if women have surgery on their bodies, they cannot be buried in a Muslim graveyard.
Currently, only 9% of Bangladeshi women use long-acting or permanent methods (BDHS 2017-2018). The second challenge is stockouts of family planning commodities. As a result, LAMB uses alternative commercial suppliers to restock contraception commodities, while World Renew partners with the People’s Institute to advocate for more commodities from the government.
Bangladesh has one of the most successful vaccination programs, known as the Expanded Programme for Immunization (EPI), launched in 1979. According to the BDHS (2017-2018) 78% of Bangladeshi children receive basic vaccinations by 12 months. An ongoing challenge is disinformation on vaccines.
LAMB works alongside community health workers to deliver immunizations to communities through the government EPI program. World Renew works on community sensitization and engaging faith leaders to promote National Immunization Days (NID). Similarly, volunteers with World Renew work with Government staff to make families aware of vaccination sessions and encourage them to attend.
World Renew has conducted several Positive Deviance Hearth (PDH) trainings and promoted better nutrition for underweight adolescents. In the agriculture sector, World Renew promotes the use of manure during rice planting to increase yield and engages farmers in seed management and regeneration. World Renew works with community volunteers to deliver key health messages, conduct growth monitoring of children, and increase clinic referral for severely malnourished children.
LAMB has a physical rehabilitative program for disabled children, which includes nutritional support for those at high risk for malnutrition. Both World Renew and LAMB engage women’s groups in kitchen gardening to promote better nutrition and work with community volunteers to build latrines and handwashing centers.
Stockouts of family planning commodities is a significant challenge, so LAMB uses alternative commercial suppliers to restock contraception commodities. World Renew partners with the People’s Institute to advocate for family planning commodities from the government.
The Unique Identity of FBOs
“Through our integrated work, we want to demonstrate what it means to be a body with different parts, but unified to promote Christian love and justice to the people we serve,” said Dr. Kris Prenger of LAMB Hospital. “As an FBO, we believe that God is part of the change that we want everyone to experience. We seek to invite Him into the process of change, to see Him as the source of power in the change, and as the reason for change.”
For LAMB, its identity as an FBO has shaped its understanding of best practices. Dr. Prenger says, “We embrace the wholistic Christian perspective that we are to pursue best practices as God’s standards of restorative relational work as we deliver quality technical work.”
World Renew is inspired by value-based stories of positive transformation. According to Ms. Nancy TenBroek of World Renew, “We don’t just do good for the sake of doing good, but we do good because it is God performing his work through us as we promote Christian justice to the people we serve. We believe this is what enables World Renew to serve the needy and see value in everyone.”
“We want to demonstrate what it means to be a body with different parts, but unified to promote Christian love and justice to the people we serve.” -Dr. Kris Prenger, LAMB
The Road Ahead for FBOs in Bangladesh
Many projects are successful when community members are empowered and provided with appropriate tools to manage and take ownership of their own development. In their work in Bangladesh, LAMB and World Renew have modeled this community-centered approach to development by empowering people to see themselves as valuable contributors to the betterment of their community.
World Renew empowers and engages community members through its People’s Institute (PI), which equips people to advocate for community resources at the governmental level.
Through its establishment of the community emergency fund program, which relies on community donations, LAMB is demonstrating how community members can contribute to the common good of their community.
Similarly, World Renew empowers and engages community members through its People’s Institute (PI), which equips people to advocate for community resources at the governmental level.
Ultimately, when community members are part of the positive change, they will see themselves as more than receivers or beneficiaries of aid but also capable givers of resources for their own communities.
The CCIH Country Spotlight Series features Christian health services, including those provided through facilities, communities and churches. The aim of these pieces is to help identify influential Christian health organizations and highlight key partnerships and initiatives that improve health for those in need. These pieces are illustrative and will not represent or reflect the entirety of important Christian contributions to the design and delivery of health services. CCIH is a non profit association based in the United States with members across the globe.
CCIH Intern Patience Mhlanga, MPH conducted research and writing for this report.