Demand-based Reproductive Health Commodity Project
Bangladesh is a densely populated country with 1099.3 persons per square kilometer (2009 estimates). One of the greatest challenges in Bangladesh is population control and to bring the fertility level down to 2.1 children per woman. To achieve this, there must be an increase in the use of permanent and semi-permanent contraceptive methods. Traditionally, family planning and reproductive health programmes in Bangladesh have been supply-oriented. From the 1980’s until the mid 1990’s, this strategy was remarkably successful and the total fertility rate declined rapidly. In the recent years however, the total fertility rate is declining very slowly. Slow decline in the total fertility rate remained to be one major challenge in the family planning program of Bangladesh.
In July 2005, the National Institute of Population Research and Training (NIPORT) under the Ministry of Health and Family Welfare (MoHFW) of the Government of Bangladesh launched the three-year Demand- Based Reproductive Commodity Project (DBRHCP) financed by CIDA through UNFPA. The study, which focused on four wards of Dhaka City Corporation and two rural sub-districts, was implemented by NIPORT in partnership with ICDDR,B, the Population council, Research Training and Management International, and John Snow International/Deliver Bangladesh.
Under the DBRHCP project, existing government service providers were trained in quality service provision. Behavioural change materials were developed and community volunteers trained to act as health promoters and to build referral linkages between community and providers. It was anticipated that the entire chain of service provision would be improved within the project period, including service delivery, follow-up and counseling, record keeping, reporting and monitoring, as well as logistics and supplies.
Researchers from ICDDR,B conducted both baseline and endline household surveys in three areas: four slum areas of Dhaka city with a population of 141,912; one rural sub-district in Sylhet Division in the north-east of the country with a population of 323,357; and lastly another rural sub-district in Chittagong Division in the south-east of the country with a population of 260,983. Respondents were selected by simple random sampling in all three project sites. They included currently married women of reproductive age from 10-49 years, their husbands, and their adolescent daughters, aged 13-19 years. A total of 19,671 married women of reproductive age, 2,433 husbands and 3,196 adolescent girls were interviewed for the baseline survey. To capture the changes in selected reproductive health indicators within the project period, 19,637 married women of reproductive age, 3,340 husbands and 2,457 adolescent girls were interviewed in the end line survey. Researchers found improvements in some reproductive health indicators. The urban slum area had the highest contraceptive prevalence rate for all methods among the three areas — 59% in the baseline and 65% at the endline survey. The contraceptive prevalence rate for any modern method increased significantly from baseline to endline in Dhaka from 51% to 58% and in Nabiganj from 20% to 30%. However, there was little change in contraceptive prevalence rate in Raipur, which was 43% to 44%. In all areas, significantly higher proportions of women used injections at endline compared to baseline and the most commonly used contraceptive method was the oral pill.
In rural areas, a significantly higher proportion of women obtained contraceptive methods from the public sector at the endline compared to the baseline. In Raipur, use increased from 37% to 50% while in Nabiganj it was 41% to 50%. In urban areas however, more women obtained contraceptives from the NGO sectors at the endline compared to the baseline survey. In Nabiganj, women obtaining antenatal care (ANC) rose from 43% to 57% and in Raipur from 78% to 81%, but such changes were not observed in the urban slums. In all areas women received higher proportion of post-natal care (PNC) at endline compared to baseline.
The intention of DBRHCP was to assess family planning user perspectives and changes in key indicators including the contraceptive prevalence rate, ANC, PNC and health care utilization from public sector. Evaluation of the results revealed improvements in several important reproductive health indicators, suggesting that the efforts to positively improve services affected selected outcomes in the community, most importantly through increased contraceptive prevalence rates and more frequent ANC and PNC visits. With these findings, appropriate strategies for improved reproductive health service delivery could be developed which could be demand-based, effective and replicable in the national programme. Without considerable modification to make reproductive health a client-oriented service, Bangladesh is unlikely to achieve replacement level fertility in the near future.
The Project Steering Committee (PSC) meeting of the “Demand Based Reproductive Health Commodity Project” was held on 13 April 2010 at 2.00 pm at the conference room of the Ministry of Health and Family Welfare to share the results within the Health Ministry. A wider dissemination seminar will be held on 21 September 2010 in the presence of policy makers and stake holders. The Honourable Health Minister, Dr AFM Ruhal Haque, will be the Chief Guest of the seminar.http://www.icddrb.org/media-centre/news/2167-demand-based-reproductive-health-commodity-project