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RHSTEP Experience

Combating maternal mortality

Md Ashiqul Islam
Bangladesh is one of the developing countries where maternal r mortality due to pregnancy and childbirth complications is estimated at 3.2/1000 live births, is many times higher than that of the rates in developed countries. From such complications more women die in less than 12 hours in Bangladesh.
One of the complications has been identified as induced abor tion. It has been estimated that 780.000 induced abortions are done every year Ironically, most of those induced abortions are done by untrained, traditional and indigenous abortion practi tioners. Consequently, 7,800 women die annually from the procedure and these deaths account for approximately 26 percent of the maternal mortality.
Many of these deaths could be prevented if safe, early pregnancy termination was done by trained providers using a procedure called menstrual regulation (MR).
Among the few specialised non government organisations that are devotedly promoting 1 safe MR. RHSTEP (Reproductive Health Services Training and Education Programme) began the Menstrual Regulation Training and Services Programme (MRTSP) in October 1983. It was a special project of Ministry of Health and Family Welfare of Bangladesh (MoHFW).
Considering the need of get-ung involved in the GoB programme for reducing MMR, MR and TFR and taking into •gnizance of the decision of ICPD in 1994, RHSTEP broad-ened its objective towards achieving improved reproductive health status along with MR Service delivery and MR training.
RHSTEP began to receive funds from Sida after the agency conducted both programmatic and financial evaluation of all MR NGOs. Based on the findings, Sida decided to select a management agency for channeling the fund to two other NGOs for better functioning and efficient management of the ongoing programme. RHSTEP has been selected as a lead agency and in the current programme it will play pivotal role to coordinate all the following activities with the donor and other two organisations namely BWHC and BAPSA.
•Training of Trainers (TOT) on Reproductive Health Care (RHC) for both GO / NGO personnel
-Comprehensive RHCTtaining
for Nurses/paramedics of both Govt, and NGOs
■Comprehensive Menstrual Regulation (MR) Training for doctors of both Govt, and NGOs
Comprehensive Menstrual Regulation (MR) Training for nurse/paramedics of both Govt, and NGOs
•Capacity building training for service providers of RH STEP
■RTI/STI cases Management Training for doctors / FWVs / SACMOs / nurses and other services providers of both GO/NGO
•Refreshers MR training for nurses/paramedics of both GO/NGO
Infection Prevention Training to Health workers and service providers (Doctors / Paramedics / Medical /Xssistants) for 07 days Strengths and uniqueness This is indeed a unique example
of GO-NGO collaboration since centres are located in GOB hospitals where GOB officials act as Project and Technical advisors. They also act as resource person in the training programmes. Training are provided to both GO and NGO service providers and GoB is providing reproductive health kits and FP commodities; supervising quality of training and services and ensuring gender friendly environment within the organisations.
The programme envisions expansion of training e.g. RTI/STI, infection prevention, violence against women (VAW) and adolescent reproductive health (ARH) etc. Also special awareness programme on ASRH and prevention of HIV/AIDS will be there.
Further expansion of community based programmes on safe motherhood, ARH, nutrition and
HIV/AI DS establishment of laboratory for IIPV virus detection by PCR (HIV/AIDS) will be undertaken.
The programme will be expanded in hard to reach areas like Chittagong Hill Ttacts with establishment of 3 new RHSTEP centres in Rangamati, Khagrachari and Banderban district hospitals. Service centers including organisation of satellite clinics; expansion of community based programme on MR, safe motherhood, ARH, nutrition and HIV/AIDS (10 satellites at borders) will be done.
Strength of RHSTEP as Management agency
It pioneered MR Service delivery and training in Bangladesh through supplementing and complementing MR Service delivery programme of GOB.
At present it is performing 50 percent of national MR service delivery; it has committed and expert wok force consisting of 451 persons and wide network of service facilities all over Bangladesh (18) centers. It has integrated with GOB programmes, having centers in GOB hospitals. Context of SRHR programme Poor awareness of Bangladeshi women about their sexual and reproductive health and rights (SRHR) aggravate the condition of sexual and reproductive ill health.
In a male dominated society they have little or no scope to decide freely and responsibly on matters related to sexuality, sexual and reproductive health including the number, spacing and timing of their children and fail to exercise such rights free of discrimination, coercion and violence.
Even the service providers at different levels of health service delivery facilities have traditional perception about SRHR and are not sensitive to the rights of women. Only recently, GoB has undertaken countrywide orientation programme to sensitize to health service personnel about women’s SRHR in a very limited scale.
Even then, it will take years for the health personnel to change their old mind set and repeated effort and frequent reorientation will be necessary so that they regularly ensure proper counseling to make women aware of their rights by providing adequate and appropriate information related to sexual and reproductive health and rights.
Every year millions of Bangladeshi women experience extreme life threatening risks related pregnancy, chronic and other serious reproductive health problems.
In this backdrop, the consortium of three organisations RHSTEP BWHC and BAPSA has started new project titled Comprehensive Reproductive and Sexual Heath Programme including MR Services, Training and BCC (Comprehensive RSH programme) since July 2007 and will end in June 2010. The Consortium will create a broad community supported network for better dissemination of SRHR and strong referral system for meeting the emergency need of the population and providing services with utmost care.
The writer is an official fo RHSTEP