5) Description of health product/service offering: Family Planning Association of Bangladesh (FPAB), a member associate of International Planned Parenthood Federation (IPPF) is the oldest and largest SRHR providing non- government organization in Bangladesh established in the year of 1953 under the dynamic leadership Dr. Humaira Sayeed. The association is governed by a National Executive Committee of 21 members. The organization has historical role to pioneer the family planning activities in Bangladesh. It always supplements and complements with government family planning and SRHR programme from its inception. FPAB has made significant achievement in creating awareness among the eligible couples about family planning and annually contributes 7% of the total national family planning performance. In 2004 FPAB with the active support and cooperation of the volunteers and staff implemented 17 projects of diverse nature and provided comprehensive SRHR information and services to about 1.5 milliom beneficiaries in 120 Upazillas of Bangladesh and out of them one million are receiving FP services. The Project has been implemented in 33 urban slums and 242 rural areas through 20 Branches of FPAB and 13 Special Work Units by deploying 400 Field Volunteers (FV), 1,010 Community Volunteers (CV) & 400 Community Birth Assistant (CBA). Each FV, CV and CBA will be responsible for roughly 4,000, 2,700 and 1,600 population respectively for the year 2006. The service providers will provide information/education on SRH & FP among about 5 million population having 900,000 WRAs. It includes FP methods, gender, nutrition, ECP, sign and symptoms of high risk pregnancy, the consequence of unsafe abortion, RTI, STI and HIV/AIDS. They will motivate, counsel, supply & re- supply oral pill, condoms and ECP among the target groups through interpersonal communication.

6) Description of innovation: The total approach is innovative in nature involving the community. The community level field volunteers and CBA are empowered and they able to sentitize the community women on very sensitive issues like abortion as a component of women reproductive right. There is combination of capacity building and performing in a continuous fashion and to link with partners and government. It has two way approaches; Firstly, activities will seek to strengthen FPAB’s clinical capacity by undertaking a comprehensive audit of staff capacity to provide quality MR and MR related services. Based on finding strengthening capacity of all levels of healthcare staff in MR and MR related services will follow.

Secondly, it will strengthen referral mechanism of MR and related services including longterm and permanent method of family planning, ECP by increasing the capacity of volunteers and staff especially in rural hard-to-reach areas. Currently, FPAB provides SRH care including emergency contraceptive services in 31 districts, which it has done since 1965. Recognizing the growing demand for safe abortion /MR services the field level volunteers will be involving with the project for improving access.

7) Operational model: Provide 5 days’ long training on SRHR, the consequence of unsafe abortion, ECP and PHC for1,810 grassroots level service providers (FVs, CVs and CBAs), Motivate, counsel and distribute contraceptives among 900,000 WRAs, Create demand through appropriate BCC programme and distribute ECP, Refer clients for MR and post abortion complication management to higher facilities and Client transportation and support fees, Refer 15,000 clients to clinics for long acting methods, 200,000 for ESP services and 300,000 for immunization including TT, Refer pregnant women for institutional safe delivery, Organize a day long 40 workshops in 40 locations under 20 Branches involving 50 community/religious leaders in each workshop (Total 2,000 participants) to sensitize the health hazards of clandestine abortion, Conduct a day long 40 orientations with newly weds and would be married to provide appropriate information on safe abortion and ECP involving 50 participants in each program (Total 2,000 participants) in 40 locations under 20 Branches, Provide complete and accurate information on sexual and reproductive health, nutrition and gender among community people through group meetings, Establish functional linkage with GO and NGOs for SRH services, clinical contraception and emergency obstetric care, Provide primary level of clinical care and diagnostic care to women for example pregnancy test, distribute oral saline, iron tablet among the beneficiaries at the rural and field level, Collect and distribute BCC materials to reducing maternal morbidity and mortality caused by clandestine abortion & increasing access to ECP, House-hold listing and provide birth certificate for newly born babies with the target beneficiaries, Monitoring and supervision and organize monitoring meeting

8) Human resources: The initiative has been supported from a central wing of 2 specialised person and then there are 20 branch level manager to support day to day work and finally, the implementers are 1800 field volunteers and 400 community borth assistants. At the central level the team leader is a medical doctor with post graduation in Health Econimics, She has been assisted by one more staff of FP backrgound. The 20 branch manager are graduate and has public health experiences. The impleneters are from community and their education level varied from class v to class 12.However, the capacity building process of implementers are on going process to improve their quality to deliver the required services to the community.

9) Key operational partnerships: Government of Bangladesh is the key partner in this project to provide the FP commodities and ECP. There are partnership with community based organization. The workers of community based organization act as volunteers to support this project.

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: At community distribution system the beneficiaires entitle to get services free of changes but for clinic they are paying according to a price list generated through a participatory discussion among with field managers and central level staff. However, there are always scope of considering the affordability. The basic policy is no one return from clinic with our getting desired services for money.

          • Earned incomes as a percentage of operating costs: 5

          • Other funding sources: The source of funding is IPPF but the commodities are provided by Bangladesh Government.The project is not self sustainable but the impleneters could earn money if they wish using their expertise after work and it helps and encourage women to be financially empowered.

          • Strategy for long-term sustainability: The strategy of Community health care financing system will ensure the financial sustainability of the project. The honorarium of the implementers is the major cost item but if the community support to the implementer for their own need to get FP suppilies, to get care of maternal health, child health and to get information of referal centers the initiative will be financially sustainable.

11) Current and Future Impact

          • Total number of clients: 1.5 million

          • Clients in the past year: 0.5 million

          • Percentage of low-income clients: 60%

          • Impact: The first impact that the project and FPAB able to make is awareness raised on reproductive health issue in general and the women group are in particular now came in to the domain of health care. Accessibily to service delivery points has creased due to behaviour changes. Women are now able to take decision at least on using FP method and birth spacing. The male behaviour has also been gradually changing on women role in the family and then society. Men can accept women to see as an organizers, managers ot decision makers. The policy makers at local rural level has also shifted from their traditional ideas of policy formulation. Community participations are encouraged to formulate policy at local level. The project also influenced the policy makers on women participation in health field.

          • Overall "market": The magnitude of demand of services is high among the women and adolescents, the newly wed couples and the women in reproductive age. The secondary beneficiaaries of the project are the family members of the women targeted. The project has target to cover 1.5 million of people through primary and secondary care of services provision. This is notable that the geoghraphical areas where the project works are dieperse in nature and no other NGO and government has facilities to provide services there. Government allocated the geographical locations to the project becuase its limited capacity to go there. Therefore, the demand is very high from population.

12) Scaling up strategy

          • Stage of the initiative: Mature stage.

          • Expansion plan: To cover more areas with more comprehensive fashion.

13) Policy change: The service providers do not need to have sex identity. it could be either male or female to provide any kind of FP services including IUD and injectable contraceptive. The male service providers should allow to give injection to female clients. In adition, women can able to take decision of their fertility control. Unmarraied women can able to access contraceptive services. If policy can be changed for women the accessibility women will be enhanced and health for all will be ensured. FPAb urges for pro- women policy and its implementation.

14) Origin of the initiative: It is the IPPF in large and the South Asian Regional Office of IPPF located at Delhi. Then The Director General of FPAB and me, Dr. Nadira Sultana. It is thefore a team effort. The pro-women policy idea that I mentioned is being used by me for the first time.I never heard any one talked about pro-women policy in Bangladesh. However, the initiatived started at 1987 with the support of IPPF and FPAB is the implementing agency. The FPAB governing body drove the idea of field programme at remote rural area.

Contact Information:
Nadira  Sultana
Ashoka Fellow
Director, Safe Motherhood
Family Planning Association of Bangladesh (FPAB)
(NGO)
2, Naya Paltan, Dhaka 1000
Bangladesh
Tel: 880-2-9354238, 8802-9354213
Fax: 8802-8313008
Email: nadira@fpab.org
Website: fpab.org