Tag Archives: Bangladesh

Bangladesh | Rolling out MPDSR across the country

Following a successful pilot in Thakurgaon district in 2010 by UNICEF1,2,3, the Ministry of Health and Family Welfare (MoH & FW) of Bangladesh has taken the lead and made a commitment to gradually scale up maternal and perinatal death surveillance and response (MPDSR) across the entire country by 2021.

The national guideline for MPDSR has been approved and the Quality Improvement Secretariat of the Health Economics Unit at the MOH & FW is working with key stakeholders including Directorate General of Health Services, Directorate General of Family Planning, UNICEF, UNFPA, WHO, The Centre for Injury Prevention and Research, Bangladesh and other partners to plan for the roll out in a phase wise manner.

To date, MPDR/ MPDSR is being implemented in 17 out of Bangladesh’s 64 districts with support from UNICEF in 13 districts and, Save the Children in four districts, with implementation due to take place in   two more districts supported by UNFPA in 2016. A series of planning meetings are being conducted by the MoH & FW with the experts to finalise the roll out plan, determining training modalities, review processes, etc. UNICEF, Bangladesh has been providing technical and implementation support to the Ministry of Health and Family Welfare for rolling out MPDSR in collaboration with UNFPA and WHO.

Recent activities include:

  • A six-member team comprising representatives from the MOH & FW, professional societies, UNICEF and WHO attended the regional MPDSR Meeting organised by the WHO’s South East Asia Regional Office in February 2016, where progress on MPDSR in Bangladesh to date and plans for the country wide phase wide scale up by 2020.
  • National MPDSR tools (death notification, community verbal autopsies, facility death reviews) have been simplified by MOH & FW. Key variables incorporated in District Health Information System software of Management Information System of Directorate General of Family Planning which will enable real time data tracking
  • MPDSR national guideline sharing workshop was organized by the Health Economics Unit, MOH & FW in Chittagong division in May 2016 with support from UNICEF. Participants included health and family planning managers from division, district and upazila level, health officers of the City Corporation, obstetricians and neonatologists from the teaching hospitals and other related stakeholders. News of the workshop can be seen by clicking here.
  • A case study on social autopsy titled ‘Social autopsy triggered community responses for averting maternal and neonatal death in Bangladesh’ was published in WHO global website in April which was prepared jointly by UNICEF Bangladesh, MOH&FW and the Centre for Injury Prevention and Research2. Click here to read this.

Upcoming events: July – September 2016

  • A dissemination workshop on the newly developed national guideline on MPDSR will be organized by the Quality Improvement Secretariat, HEU, MOH&FW with support from UNICEF
  • An experience sharing meeting on MPDSR with 17 districts will be organised by Director General of Health Services, MOH&FW with support from UNICEF.
  • A dissemination workshop of the newly developed national guideline on MPDSR will soon be held by the Quality Improvement Secretariat of the ministry. Seven divisional sharing and orientation workshops are in the upcoming plans of the ministry.

Acknowledgements: This update was prepared by Dr Riad Mahmud, Health Specialist (MNH), UNICEF, Bangladesh, and reviewed by Dr. Md. Aminul Hasan, Deputy Director, Health Economics Unit, Ministry of Health & Family Welfare; Dr. Lianne Kuppens, Chief Health section, UNICEF Bangladesh; Dr. Abu Sadat Md. Sayem, Health Officer, UNICEF; Dr. Shayma Khorshed, Consultant, Health Economics Unit, Ministry of Health & Family Welfare and Dr Animesh Biswas, Senior Scientist, Reproductive and Child Health Unit of CIPRB, Bangladesh.

References

  1. Biswas A.; Rahman F.; Halim A.; Eriksson C;  Dalal K. (2014). Maternal and Neonatal Death Review (MNDR): a useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh. Health, 6: 1669-1679
  2. Mahmud R.; Sohel HA.; Sharif M.; Kuppens L.; Rakhimdjanov S.; Sayem ASM.; Khan M.; & Biswas A. (2016). Social autopsy triggers community response for averting maternal and neonatal death in Bangladesh: Experience from ‘Maternal and Perinatal Death Review in 10 Districts’. World Health Organization. p.1-5. Available here>
  3. Biswas A. (2016). Maternal and perinatal death review (MPDR): experiences in Bangladesh. World Health Organization. Cited on 15 June 2015. Available here>
Lao-PDR

Social autopsy as an intervention tool in the community to prevent maternal and neonatal deaths: experiences from Bangladesh

Social autopsy in maternal and neonatal health

Social autopsy (SA) is an innovative strategy whereby a trained member leads a group within a community through a structured, standardised analysis of the root causes of a death or serious, non-fatal health event. Continue reading

Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh

This article by Animesh Biswas and colleagues, published by Health in September 2014, presents findings from a mixed-method study examining the process, feasibility, and acceptance of community death notification in Thakurgaon district, Bangladesh. The study found that community death notification was achievable and acceptable at the district level.

Verbal autopsy in Bangladesh

This case study by Helen Smith and colleagues, published by the World Health Organization in October 2015, describes the process in introducing verbal autopsy in four regions in Bangladesh in 2010. The authors describe the verbal autopsy model implemented, key findings from an analysis of verbal autopsies carried-out over two years,  and key implementation lessons.

Scaling-up Maternal and Perinatal Death Reviews in Bangladesh

The Maternal and Perinatal Death Review (MPDR) system is now being scaled-up in Bangladesh since it was piloted in Thakurgaon district in 2010. Read this case study about the pilot.  Recent developments include:

  • To date, MPDR is being implemented in 14 out of Bangladesh’s 64 districts.
  • In the later part of 2015, the Ministry of Health & Family Welfare revised the existing MPDR guidelines to reflect a countrywide scale-up, which was also highlighted in the Government’s fourth Health Sector Development Programme (2016-2021). As part of these revisions, a simpler version of community verbal autopsy and facility death review tools on maternal and newborn deaths were developed from existing MPDR tools.
  • The MPDR death notification system has been incorporated into the online District Health Information System (DHIS-2) by the Directorate General of Health Services (DGHS). As a consequence, the health system is gradually notifying each maternal and neonatal death from the community into the DHIS-2 database routinely. Read this case study about the transfer to DHIS-2.
  • In 2015, professional experts at the periphery medical college hospitals, including consultants of obstetricians/gynaecologists, paediatricians, and neonatologists,   undertook training to improve the analysis of causes of deaths taken during verbal autopsies at the district and sub-district level.

Update from Dr Animesh Biswas, PhD, Senior Scientist, Reproductive and Child health Unit at Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.

Facility death review of maternal and neonatal deaths in Bangladesh

This article by Animesh Biswas and colleagues in PLoS ONE presents findings of a qualitative study with healthcare providers involved in Facility Maternal and Newborn Death Reviews (FDRs) in two districts in Bangladesh: Thakurgaon and Jamalpur. The study aimed to explore healthcare providers’ experiences, acceptance, and effects of carrying out FDRs.

The study found that there was a high level of acceptance of FDRs by healthcare providers and there were examples of FDRs leading to improvements in quality of care at facilities, such as the use of FDR findings in Thakurgaon district hospital which ensured that adequate blood supplies were available, which saved the life of a mother who had severe post-partum bleeding. The article also identified gaps and challenges in carrying-out FDRs to consider for future efforts, including ensuring incomplete patient records and inadequately skilled human resources to carry out FDRs.

The authors conclude that FDRs are a simple and non-blaming mechanism to improving outcomes for mothers and newborns in health facilities.

To read more about maternal and newborn death reviews in Bangladesh, take a look at several case studies: two from the MDSR Action Network website: “Mapping for Action” and “eHealth to support  MPDRs”; and another in the WHO’s global MDSR report here.