Table of contents

I. CONTEXT

II. FRAME WORK OF THE METARNAL HEALTH STRATEGY

III. ESSENTIAL MATERNAL HEALTH SERVICES

iv. HUMAN RESOURCE PLAN TO SUPPORT ESTABLISHMENT OF SERVICE

v. QUALITY ASSURANCE

vi. ADVOCACY, BEHAVIOR CHANGE COMMUNICATION AND COMMUNITY PARTICIPATUON

vii. RESEARCH, ASSESSMENT AND EVALUTION

viii. INTER-SECTORAL LINKAGES ABD SYNERGY

ix. COST AND FINANCING

x. NEXT STEPS

xi. LIST OF CONTRIBUTORS

xii.ANNEX

xiii.REFERENCES

Ministry of Health
Government of the People’s Republic of Bangladesh
 

I. CONTEXT

• Outline the essential services that will be established to meet the needs of women during pregnancy, child birth and puerperum.
• State the human resource development and management plan for establishing the services.
• Provide a guideline for quality assurance, management, communication and social mobilization.
• Give an idea of financial investment needed to put the plan in place.
• Provide direction and basis for the preparation of annual operational plans.

• Section I provides the context and process of development.
• Section II lays out the vision and goal and specifies aims and objectives for achievement by the year 2010
• Section III details the services, their delivery mechanism and management
• Section IV provides the human resource development and management plan
• Section V outlines the principles and priorities for quality assurance
• section VI details advocacy, BCC and community participation
• section VII suggests research topics and evalution
• section VIII provides an estimate of the costs that would be required to implement the strategy in it’s entirety
• Annexed are the matrices produced by the working groups

Through the strategy focuses on the MOHFW service delivery system, which is primarily rural based, it provides a framework for functions in the urban services delivery points an wherever possible references and partnerships have been highlighted.

Aims
To strengthen the provision of essential (including emergency) obstetrical care and improve referral and utilization of services.	Objectives(by 2010)
To improve the nutritional status of women and adolescent girls	Increase met need of EmOc to 70% from 27%  Increase uptake of ANC (3visits ) to 60%  Increase Skilled Attendance at birth to 50% from 13%  Increase PNC to 30% from 2%  Increase CPR to 72% from 53.8% with larger proportion of clinical (particularly long-term) methods and    discontinuation rates reduced  Reduce unsafe abortion practices and provide post-abortion care  Accredit ate facilities as woman friendly with provision of services for women subject to violence
Ensure the right people with the right skills are trained to provide quality maternal health services (MHS) at all levels of the health system	Ensure skilled human resources to provide midwifery and Comprehensive EmOC services in all district hospitals, district level MCWCs and 40% Upazila Health Complexes; midwifery and Basic EmOC services in remaining 60% UHCs and 50% UH&FWCs and Upazila and union level MCWCs   Provide skilled birth attendants (community midwives) – one for every 18,000 community clinics-with appropriate back-up services   Ensure appropriate personnel in every static centre are able to provide the full package of appropriate MHS   Ensure capacity and quality of training institutes through accreditation
To promote women friendly health services     Aims	To make health service providers more sensitive to women’s needs and concerns   To make women more aware of their rights in the health care system   To establish the policy of zero tolerance of violence against Objectives (by 2010) women in all facilities providing health services

IV. Quality of Services

Quality of services affects women’s access to services as well as achievement of the desired result from the investment in providing services. The strategy includes

  Development of a common understanding of quality of care

 Involvement of professional bodies

Development of Common Understanding of Quality of Care

Various approaches may be taken to quality of care but the strategy uses the elements of quality of care developed by Judith Bruce.

Involvement of professional bodies

Active participation of the private practitioners and professional bodies has potential for strong influence over professional practice and behavior. The experience of working with this group has been particularly rewarding in the context of setting up EOC. The Obstetrical and Gynecological Society of Bangladesh (OGSB) is the highest professional body in the field of maternal health, both the health and family planning wings have traditionally drawn on their expertise, they have played a pioneering role in the establishment of EOC in Bangladesh and they have developed a system for training and monitoring of EOC activities involving their members working in Medical Colleges, District Hospitals and the private sector. This body remains open to addressing all areas of a woman’s health including issues such as violence.

The vision….
All Bangladesh women with their heads held high, smiling in the fulfillment of their right to safe motherhood.

The mission….
To nature a socio-cultural movement that reduces maternal mortality and morbidity as a woman’s right, and also enhances her self-esteem and status.
The experience in Bangladesh shoes that reducing maternal mortality and morbidity is both an output and an entry point for addressing key strategic issues associated with woman’s rights, such as violence (medical and social aspects). Efforts will also reduce morbidity and the long term suffering of the millions women who survive obstetric complications. However, strategies and interventions will require focus on efforts to enhance woman’s status, dignity and self-esteem, if effective are to be obtained.

2.2 Principles / Priorities
The strategies for maternal mortality reduction- communication, social mobilization, caring practices, decision making at home level and service delivery—will be designed in a way that it will also enhance the woman’s self esteem, status and protect her rights. HPSP aims to reduce maternal mortality and morbidity through:

1. Focus on Emergency Obstetric Care for reducing maternal mortality
Given the global and Bangladesh experience with reducing maternal deaths the following lessons have been learnt:
  

• All pregnant women are at risk of developing life threatening complications
•  Most complications can neither be predicted accurately nor prevented
• Once a woman develops complications she needs prompt access to emergency obstetric care services (EOC) if death or disability is to be prevented

The “Three Delays” framework of factors, which hinder a woman receiving the service required, provides a basis for strategic interventions. The “three delays model” will be used to design, implement and monitor strategic activities. The elements of the model will not be used in isolation. Rather, it will be addressed as a system.

11. Provision of Essential obstetric Care/ Basic maternity care services for promotion of “good Practices”, early detection and appropriate referral of complications

The availability of Em0C services is ideally backed up with family planning, ante-natal care, skilled birth assistance and post-natal care. The appropriate provision of these services serves to:

•  Provide women with a skilled birth attendance including community midwives
   
•  Provide the opportunity for communication with the woman and her family, among other reasons to help promote the appropriate use of hospital care as over 90% births take place at home
•  Prevent complications such as septic abortion (by meeting unmet needs of contraception)
   
• Detect complications such as toxemia of pregnancy and prevent development of eclammpsia in such cases
• Facilitate a referral system for complications such obstructed labor or hemorrhage
   
• Reduce socio-economic differentials in access and use of essential obstetric care services
   
• Improve access to EMOC and sexual and reproductive health care including MR by adolescents, as the MMR for girls aged 15-19 is twice as high as those 20-34.

111. Promoting Women’s Access to Resources

Services are being provided but the utilization is limited. For the management of violence against women, the hospital is the public institution most likely to be accessed by affected women. Within the family, women are socialized to restrict their use of resources, including food, without realizing the consequences for themselves and their children.

The Strategy

• Builds on established initiatives and
   
• Promotes stakeholders participation and specially focuses on the role of men
   
• Emphasizes communication for behavior change and development.

The initiatives include are:

National Nutrition Programme addresses maternal health through a number of initiatives including the formation of various community as well as food and micro-nutrient supplementation and health education

Communication Programme for Reduction of Maternal Mortality and Violence Against Women has already been developed. It complements ongoing efforts to establish life saving emergency obstetric care services, it breaks the silence on violence against women, and, it addresses the structural issues, which influence the status of women in society. The strategy calls for further messages to be added especially in relation to maternal nutrition.
Women Friendly Hospital Initiative is part of the overall strategy aimed at overcoming a situation of high maternal mortality. It has evolved from the reality of 14% maternal deaths being associated with violence. A key area of the initiative is the management of violence against women. Training courses for doctors developed through a process of multi-sectoral consultation. The focus is on effecting a change in perceptions, emotions, attitude, knowledge and skills of providers, nurturing leadership.

Community Clinics are the front line service and the Community Groups are seen to have a vital role in motivation of families to improve maternal health.

Government–NGO/Private Cooperation calls for innovative measures to ensure that vulnerable women (e.g. those from urban slums) can avail emergency obstetric services. Village doctors, homeopathic doctors and other private practitioners have an important role in ensuring appropriate referrals. Previous local initiatives to involve these practitioners have proven effective in increasing referrals and decreasing poor practices. In order to improve access in urban areas, it is particularly important that this collaboration be prioritized.

2.3 Aims and Objectives
The goal of the maternal health strategy is to reduce maternal mortality and morbidity. The aims and Objectives are as follows:

The Essential Service package (ESP) of the HPSP comprises elements critical to the survival and well-being of women, particularly the poor, who are faced, with the rigors of pregnancy and childbirth. Reproductive Health Care is one of the five components of ESP. The ESP will provide increasingly sophisticated services at each level of the system, with a capacity to perform caesarian sections at all levels of facilities at the district and Upazila level. Eight sub-areas have been defined under reproductive health care of which the first four have particular relevance to maternal health.

• Safe Motherhood will focus on creating the conditions necessary for preventing maternal death and disability with emphasis on provision and utilization of quality ANC, safe and birth practices, PNC and EOC services together with prevention of unsafe abortion and services for cases of violence against women. We further have added the dimension of referral.
• Family Planning services will focus on provision of services and provisions to increase CPR of modern methods, reduce discontinuation of contraceptive use and to encourage gradual transition to long-term and permanent methods. Emphasis will also be on improved management of side-effects and complications.
• Preventing Unsafe Abortion will be addressed through improved MR services and family planning services
• Maternal Nutrition improvement will focus on counseling and supplementation of iron-folic acid and vitamin A
• Prevention and control of RTI/STD/AIDS
• Adolescent care
• Infertility
• Neonatal care

3.1 Plan for Services at all levels

Over the decades Bangladesh has continued to struggle with attempts to reduce maternal mortality. Intensified efforts in the field of TBA training and focus on increasing ANC have not brought about the desired outcome. Founded on these attempts, increasing the availability of EmOC has been recognized as a key intervention to reduce maternal mortality. The assessment of availability and utilization of EmOC services in Bangladesh has been based on internationally recognized process indicators and according to the Guidelines for Assessment of Availability and Utilization of Obstetric Services to summarize the findings:

• The coverage of both basic and comprehensive EOC services has increased from 1 per 3.6 million populations to 1 per 1.9 million populations
• The unmet need of EmOC – proportion of women with obstetric complications treated at facilities – has reduced from 95% to 75%.
• Private sector facilities are a major source of EmOC services. Of concern is the fact that though 25% of women experiencing obstetric complications avail private sector services, half of the caesarean sections are performed in this sector, raising questions on the indication for caesarians and the access to this service by the poor.
• Though coverage has improved, the volume of EmOC services provided in facilities varies greatly. The 59 district hospitals show a wide range in the performance of facilities – Total deliveries (0 – 2,226) Assisted vaginal deliveries (0 – 220) Caesarean deliveries (0 – 598), Cases of obstetric complications (0- 1,758)
• The situation of record keeping and reporting is far from adequate and requires urgent action.
• Non-availability of services in district hospitals is primarily a function of availability of consultant – either obstetrician or anesthesiologist of GPs trained in these specialties.
• In UHCs the non-availability of services is a function of both human resources and equipment/drugs.

The need for ensuring skilled attendance at birth is well recognized. The challenges remain in identifying appropriate cadres, training the required numbers and ensuring back-up services.

While all services needed are mandated within the various policy documentation and frameworks, there are certain issues which require focus if the gap between policy and implementation is to be avoided. These include:

• Mode of maternal health service delivery, particularly in urban and rural deprived areas
• Addressing violence during pregnancy
• Need for improving utilization of services through communication and social mobilization
• Transportation (community and facility)
• Coordination on required administrative action and focus of effective referral
• The adolescent group, particularly married adolescent girls, is especially vulnerable to the risks of pregnancy and childbirth and will need added focus.
  These and other factors have resulted in the following situation of the services:

Priority actions of HPSP (up to 2000)

While the strategy takes a ten-year perspective, the following will be needed to be addressed in a priority basis in the remaining period of HPSP.

Emergency obstetric Care
• Building a pool of trained Mos
• Clarification on technical standers and job responsibilities
• Placement of full team, retention and ensuring residential (in-station)status o providers
• Emergency preparedness of facility
• Quarterly status monitoring
• Ensuring technical support and quality monitoring of trained medical officer at UHC by senior professionals district and tertiary level
• Interaction with pregnant women and their families to ensure timely decision to seek care for obstetric emergencies

ANC
• Clarification on technical standards and job responsibilities
• Supply of BP equipment, scala $ uristix an other necessary equipment
• QoC and monitoring checklist
• Interaction with pregnant women and their families to ensure ANC uptake an popularization and service delivery mechanism
• Use ANC for birth preparedness

Skilled birth attendance
• Build capacity of FWAs and female HAs as community midwives
• Strengthen existing FWV training in midwifery and incorporation of six months midwifery in FWV basic training
• Finalize strategy for accelerating HRD
• Optimize utilization of available trained nurses
• Create awareness on critical need for skilled attendance at birth and SBP
• Develop social marketing o safe birth kits

PNC
• Clarification on technical standards and job responsibilities
• Birth registration
• QoC and monitoring checklist
• Interaction with pregnant women and their families to ensure PNC visits

Family Planning
• Emphasis on increasing up-take of long-acting and permanent methods and meeting unmet need
• Training and motivation of doctors for sterilization/Norplant and other providers on long acting methods
• Improving provider communication with clients and strengthening IEC activities
• Three years rolling plan for uninterrupted supply
• Strengthen male involvement
• Follow-up to reduce drop out / discontinuation rates
• Strengthening training to ensure proper skills
• Quality control
• BCC on appropriate timing for availing service
• Decreasing provider multiple-use of syringes

Services for women and girls subject to violence
• Finalize and approve standard operating procedures (SOP) by relevant ministries (health, Women’s affairs, home)
• Final approval of training curriculum on management of VAW and sexual violence by curriculum committee
• Training of all Civil Surgeons and other concerned district and Upazila officials
• Strengthen inter-sectoral group including magistracy

Involvements of private sector and NGOs:
• Private sector and NGOs are increasingly playing a role in service delivery. The MOHFW will need to take a strong regulatory function. To promote a greater interest in building occupational skills e.g community mid-wife), there is need o set-up a system whereby the govt. offers training and overall regulatory function. Nursing council will provide certification. This may encourage unemployed nurses to take their own “private” service and certified providers will be responsible for reporting performance to appropriate local authority.
• Clear policy will be determined on what should be the roles and means of involving NGOs in ESP service delivery, especially, maternal health programming. This is particularly important in the urban context.

3.2 Management of services

While human resource development is key to ensuring the availability of services, management issues will be addressed adequately for optimal utilization of the human resources.

3.2.1 Referral system

While the desired functioning of all levels of service facilitates have been defined, it needs to be appreciated that the actual functioning status will determine referral linkages. The aim of referral for obstetric emergencies will be to ensure that women reach a suitably functioning facility in time. To ensure this the following systems will be focused on:
• Increasing awareness, preparedness and prompting action when danger signs appear – through birth planning
• Making specials arrangements for transportation – from community and from one facility to a higher level one
• Popularizing the services available in function facilities – among services providers and communities, between facilities, use of logo, etc.
• Upazila and district based review of referrals – time, mechanism, appropriateness, etc.

3.2.2 Placement o skilled services providers and technical/mentoring support

This remains one of the most challenging dimensions of ensuring round the clock availability of critical maternal health services. Facilities where EmOC will be provided have been identified. Ensuring the availability of the requisite human resources will entail appropriate selection, administrative rigor in posting and placement and providing career-building incentives to promote retention. A particular concern remains on retaining female doctors in rural areas and his will be addressed by providing accommodation, making security arrangements and wherever possible encouraging placement of couples. In areas (geographical) where back-up services have been established, development of the whole referral chain will be concentrated upon.
It is essential for the trained medical officers to have access to specialist and advice, particularly in times of unforeseen complications. Steps will be taken to develop a system of technical support and mentoring by Consultants/Seniors of district and Medical Collage Hospitals.

3.2.3 Logistics, supplies, and constructions/renovation

Experience over the years has resulted in the development of detail procurement lists and specifications of equipment and supplies needed for ensuring critical services. On many occasions a lack of synchrony between placement of skilled services providers and the supply of critical drugs and equipment has resulted in absence of critical live saving services. A details procurement and distribution plan will be prepared tailored to match the HRD plan to ensure synchrony. In-facility capacity in management of equipment, drugs and supplies will be strengthened.

3.2.4 Management information system

Proper record keeping and reporting is critical availability of services and provide a basis for in facility and central level/sub-national management review. Under HPSP standards registers and reporting formats have been developed (for facilities and field staff) which will meet the minimum information needs for tracking and reviewing performance. Modalities for obtaining information of private facilities performance on a routine basis will be worked out.

3.2.5 Supervision and Monitoring

Supportive supervision-both technical and managerial – is essential to ensure smooth and uninterrupted delivery of services. Central, divisional, district and upazila level personnel will conduct supervisory visits to critical facilities (at all levels). The use of checklists will be promoted and feed-back will be provided for improvement. In addition, the availability and utilization of services will be monitored during regular monthly meetings at Upazila, District, Division, and Central level.

3.2.6 Financial management

In order to ensure the availability of critical drugs and supplies, to meet transportation costs for poor women to a higher referral level, to mobilize communication and to ensure round the clock services, particularly emergency services, facility managers will be provided with an adequate annual fund based on the local level plan.

3.2.7 Management structure

Because of the cross cutting nature of maternal health, it is incorporated in several operational plans.
• It is core component of output 1 (ESP)-currently split between health and family planning wings at the central and district level.
• In terms of output 3, integrated support system- skill mixes to meet maternal health requirements at all levels (midwifery training, more female health workers etc.), the upgrading of facilities to be used by women, and an MIS which can track maternal health monitoring indicators are all important components. Logistics and procurement of essential drugs and EmOC equipment are also essential. BBC (maternal mortality reduction, warning signs in pregnancy and delivery and post-partum, violence against women, prenatal health etc.) and quality assurance are also fundamental aspects of maternal health.
• In output 4 on hospital services EOC is a key feature, as is a functioning referral system.
• Output 5 on sectors wide management requires the roles of NGOs and civil society as well as stakeholder representation in the implementation process- all of which are important contributors of maternal health programming which cuts across all levels from community to tertiary care facility. Similarly there are many issues of policy and research, which can support maternal health, in addition, the need to develop better links with the Nursing Directorate (also in the sector but marginalized) is necessary to co-ordinate midwifery training.
• Output 7 including nutrition (reduction of low birth weight) requires additional emphasis in view of chronic problems in maternal under nutrition, even though these are also outlined in the ESP.

Which such a deep interconnection between several outputs in HPSP, maternal health is very vulnerable to bottlenecks in HPSP implementation. Particularly when there is need for synchrony in training, placement, procurement, etc. in the interest of establishing and maintaining services. To date, various mechanisms have been tried out, with little success.
The following critical steps will be instituted for ensuring coordination and synchrony:
i. A separate Director be assigned for maternal Health Services

ii. Till a director is assigned for maternal Health Services, one senior level official of the directorate, possibly additional director general(ADG),be assigned responsibility of maternal health services. The ADG will meet with all concerned Line Directors and Programme Managers every other month for an update on the situation and providing necessary support and guidance.

The following services will be set up for reducing maternal mortality and improving maternal health:

iii. Quarterly review meetings will take place chaired by the secretary MOHFW with participation of concerned officials and agencies. This review meeting will also provide the opportunity for brining the voice o civil society through the participation of key NGOs and women’s health activities.

In areas where services are successfully established, there will be inter-personal communication and social mobilization activities aimed at increasing the knowledge of danger signs, practice of birth planning and prompt action in case of obstetric emergencies.
 

3.3 Annual Operational Targets for EmOC

DH: District Hospital; UHC: Upazila Health Complex;
MCWC: Maternal and Child Welfare Center; UH&FWC: Union Health and Family Welfare Centers

The effective delivery of the Essential Services Package (ESP) calls for a wide range of integrated and co-ordinated support services. Human Resource Development (HRD) is one of the seven sub-components of the support services and is most complex and most crucial element for the overall success of the sector wide management approach for the Health and Population Sector Programme (HPSP).
The long frame output for the HRD component of HPSP is a “..Comprehensive needs and gender based HRD programme designed and implemented showing staffing patterns, job profiles for a unified service structure: training, supervision and performance incentives provided for public, private and NGO staff...” .
HRD aims at having the right people with the right skills in the right place at the right time. The right skills and training is needed to embrace an understanding of the complex process by which various factors that make up a situation interact. Skill goes with appropriate services and is obtained and retained with a continuous process of training and retraining.
Post training support and organizational adjustment to provide working conditions conducive to meeting the needs for maternal health services is essential in attaining high level of quality. Improved logistics, supply and drugs and other requirements are essential for the measurement of performance against service delivery protocols (quoted under personal administration section). Accountability and supervision at all Levels is also needed. Job description should also have standards and measure achievements/accomplishment and also to eliminate ambiguity, including appropriate authorities to make decentralized decisions. Demarcation/clarity of roles and responsibilities would also be required in addition to appropriate job description – this should also be part of training.

4.1 Core Human Resource Development Functions

The five core HRD functions that will receive priority attention under the strategy for Maternal Health Service include:

i. Staffing Patterns with the focus on ensuring an adequate supply of staff to achieve the objectives within the existing pool:
• Determining the number of mix of personnel to be trained;
• Designing measures leading to an appropriate use of posted staff; and ,
• Ensuring and adequate fit between training of personal and positions assigned to them.

ii. Education and training with a focus and producing appropriately skilled personal to meet the needs of the maternal health services:
• Definition of the training standards: and,
• Mechanism for continuous assessment and re-assessment of performance based training needs with respect to both pre-service and in-service education.
• Selection of trainee
• Quality of TOT

iii. Performance Management with a focus on optimizing the quality of the work and technical efficiency :
• Developing and implementing monitoring and supportive supervision; and,
• Determining a transparent and appropriate performance appraisal system.

iv. Personal administration with a focus on providing working conducive to meeting he needs for maternal health services
• Developing job descriptions for all health workers based on actual job responsibilities and service delivery protocols/technical standards at each level of the service; and,
• Determining transparent condition of work: modes of recruitment, modes of remuneration, posting and transfer etc.
• Career building incentives, especially for specialized training. These are essential to ensuring field based services. This needs to be built into the human resource development plan. A clear-cut career advancement and plan linked to higher education, needs to be spelt out.
• Need-based criteria for govt. employment, for example certified community experiences --- especially for nurse midwives.

v. Institutionalization of training with focus on creating a standardized program for training on maternal health services which will be adapted and implemented. For effective use of HR, it is essential to ensure, maintain and evaluate quality of training, especially when different training organization will be expected to provide training and at different levels. The training plans are also ambitious with the existing training institution thus the training for service providers and managers in delivering maternal health services has to be a concerted effort of GoB, NGO and the private sectors institutions. Existing training institution (FWVTI, RTC, Nursing institute, MATS, NGO institutions) be linked to service facilities (e.g. District Hospitals) to develop and deliver quality training programmes, particularly for training FWVs and community midwives.

4.2 HRD needs for meeting service delivery targets

The following table provides an outline of the essential training requirements for the next ten years that would be necessary to ensure that maternal health care is able to be provided for on daily basis at the current staffing levels for the various levels of the health system.
 

A detail annual training plan will be prepared based on the required skill mix, existing skills of service providers, capacity of available training facilities, and priority of training activities. This plan will priorities the EmOC training needs and will also highlight the long term plan for ensuring availability of skilled birth attendance within and closet to the community.
In addition, it will be necessary to develop a comprehensive master plan which will take account of the staffing and training requirements necessary for ensuring in the long-term full coverage of mental health care, particularly in those centers that are or will be required to provide 24 hour coverage. This would also take into account additional staffing that would be required as performance increases.

Utilization of Trained TBAs – Special Note
There has been a conscious decision not to rely too much on the services of trained TBAs or to invest further in training this category of provider. However in selected areas/instances where TBAs are providing a quality services, are linked to GO/NGO skilled providers and are recognized as a valuable provider by the community, local manager will support them through ensuring continuing education, supportive supervision, etc. it is envisaged that they will play the role of advocate and motivator and will act as a referral linkage.

Skilled Attendance at Birth and Community Midwife – Special Note
In order to increase coverage of skilled birth attendants, nurses will be posted to UH&FWCs and steps taken to ensure their retention and popularization of their services. Further, the UH&FWCs have the infrastructure to provide delivery services and necessary equipment and logistics will be supplied. The FWV basic training curriculum (18 months) will be modified to include six months midwifery training.
A special initiative will be undertaken to build the capacity of FWAs, Female Has and other NGO/ private sector, in conducting normal home delivery in appropriately referring complicated cases. They will be provided special six months training and will be popularized as “community midwife” (appropriate Bangla nomenclature to be decided upon) linked to community clinic. Also, based on skills and potential, FWAs/Female HAs will be selected for FWV training as a career building opportunity.

Training and career building of Medical Officers – Special Note
A special initiative has been undertaken to train medical officers in obstetrics and anesthesia for duration of one year. The training builds capacity to enable the teams to provide Comprehensive EmOC in UHCs and also provides them with a year of recognized training which is counted should they later move on for post graduate-degrees. These medical officers are posted in UHC for a bonded period of two years and are expected to provide quality services round-the-clock. It is important that they realize the important role they play and they need for their motivation and commitment. Towards this end, they will be designated as “specialist” at their place of posting. Further career building incentives will be provided to Specialist based on their performance. These incentives will be include selection for fellowships support in pursuing higher education and special capacity development visits and tours.

4.3 Human resource management for maternal health services
Given the large number of personal who will be trained and the need for ensuring appropriate posting, placement and career development, it is critical to have optimum management and coordination. The planned MIS will be regularly updated and all HRD interventions will be planned annually and quality will be ensured. To ensure quality and coordination, there will be one designated official to HRD&M Maternal Health Services.

4.4 Behavior Change Communication for managers and service providers
As efforts to ensure the availability of EmOC services progress, the need is for concentrating on the other factors which influence the delivery and utilization of a quality, well managed service that respects women’s right to life and health. Behavior change communication activities will aim at influencing provider’s attitude, service provision environment and Client or recipient attitude. There will be orientation of providers and management on vision and mission of the progrmme, particularly women’s right, with a call to action. It will aim at identifying unwanted practices and generating actions for establishing positive norms and practices. It will also be linked to system that acknowledges achievements and good performance.

v. QUALITY ASSURANCE

In recent times, there is growing concern among policy makers, program planners and managers in the health and population sector, on the quality of care provided different levels of service delivery points. The concerns are fully justified in consideration of economy, efficiency, spread-effect and client satisfaction that is expected to accure from good quality services. The quality assurance for National Maternal Health Strategy is based on elements of Judith Bruce’s quality of care with some additions done to it to make it an appropriate one and that is as following:
• Choice of services/accessibility/access
• Information given to client
• Technical competence of providers
• Interpersonal relations
• Mechanism to ensure continuity of services
• Appropriate constellation of services

The above elements are all process in nature. Quality of services cannot be evaluated with process indicators only. We also need to develop outcome indicators such as percentage of ANC or PNC visits; prevalence of anemia is pregnant women, and maternal mortality rate. The above mentioned Judith Bruce’s modified elements along wit a set of indicators that will have to be developed, will be able to provide us a framework of assessing and improving quality of care in connection with maternal health services.

5.1 Analysis of Strength and Opportunities for Quality Assurance

An analysis of the strengths and opportunities that exists follows:
 

Strength

Opportunities

• Large network of UHCs and DHs • Large cadre of FWVs • BGD has lots of human resources • Large number of professional bodies • 13 medical collages around the country • training institutes all around the country • Strong NGO presence • Large number of Union Parishads

• Potential for offering greater choice • Professional bodies to be active in standard setting • Develop the skills of nursing and midwifery • Provide incentives system to attract people to rural areas • Growth in service usage if demand potential is tapped • Active community involvement in overseeing health services delivery for fostering user/consumer groups • Service providers to be involved more in research • Developing career paths in nursing, and midwifery • New UMIS ready for use • Private-public partnerships can be explored

5.2 Approaches/principles to assess and improve quality

The maternal health and family program will require approaches, and tools to identify problems and design and implement service quality improvement and assurance activities. The principles that will have to be followed for problem identification, designing resolution activities, and evaluate quality level are as following:
• Quality assessment and improvement shall have o be a continuous effort.
• All quality improvement activities shall have to be local level in nature with support of a facilitative supervisory system.
• The local providers and managers for problem identification should work in teams and a self-assessment methodology.
• The local level providers and managers should not only identify problems but also try to find out solutions and alternative options.
• On a periodic basis client perspectives should be gathered, analyzed and used for any kind of service delivery modification etc.
• Assessment of quality improvement should be based on written technical standards and service delivery guidelines. The standards should be available to the providers.
• All training programs should be developed based on the technical standards. Training programs for development of skills and knowledge of the providers and supervisors shall have to be on a continuous basis.

5.3 Priority intervention for addressing quality assurance

• Within the health service delivery system specific staff at different levels will has to be assigned through the formation of QA Teams to continuously assure and monitor quality based on a set of Standard Operating Procedures or service delivery guidelines. Already service delivery guidelines on EOC are available in different forms and fragmented. These will have to be standardized, in some cases translated into Bangla, and put into a user-friendly form; the QA Teams will have to be provided with TOR and specific training.
• Different kinds of simple data and information related to QOC will have to be collected at the service delivery sites, used locally for resolving issues, reported to HQ and feedback obtained. All of these will be a part of UMIS. The data collection shall have to be based on a set of well-defined indicators and variables. The indicators of quality should be defined inn such a way that the outcome should be measurable.
• A system of local level planning and management of services be introduced with components of introducing user fees and authority to use the money generated according to the set guidelines and Financial Information System (FIS). The local level planning should be based on the principles of self-assessment, working in teams and identification on problems and finding out resolution. In Bangladesh in this connection a simple approach with the acronym called COPE (Client Oriented Provider Efficient) exercise has been tried and found to be useful.
• While ensuring access and choice the different components of maternal health services are available according to the levels, service providers are available at sites, and the poorest of the poor are served free. For poorest of the poor a safety net shall have to be always worked out and put into use.
• Trained staff should be providing maternal health services with basic EOC available at the union level. Training shall to be an ongoing and continuous process. The quality assurance component at all levels will have to interface and keep a close link with HRD.
• The medical and nursing regulatory bodies need to function in collaboration to each other for which training curricula needs to be revised and the regulatory bodies require to be reconstituted. The regulatory bodies will have a district role in instituting a system providers and sites on a periodic basis.
• Quality improvement shall have to be a continuous effort. A process of evaluation of the incremental improvement of quality will have to become an integral part of the health service system. Regular Medical Service Review and Audit, verbal autopsy of all maternal deaths etc. will become a part of the quality assurance system.
• All relevant stakeholders involved in different ways with maternal health services are identified and involved in local level planning, implementation, monitoring and supervision.
• A model mechanism of service delivery using the private – NGO – public partnership will be developed based on the experiences of UPHCP, STD/HIV partnership sponsored by DGHS and FP-MCH service delivery partnership sponsored by DGFP and implemented on a wider scale.
• For sustainability of maternal health service involvement of local stakeholders is essential which is include very specific activities like setting up community transportation, blood donation and drug revolving funds etc.

Efforts to bring reduction of maternal mortality higher on the public and political agenda has resulted in the H’ble Prime Minister declaring 28 May (international day for action on women’s health) as Safe Motherhood Day in 1997. The event has been observed for the past three years with a focus on the role of the husband, family and society in preventing the tragedy of maternal deaths. The linkage between women’s status and maternal mortality has been popularized and the issue is being addressed as a women’s right.
The PIP of HPSP has laid great emphasis on BBC as a cross cutting intervention investment on which would match the immense financial losses created by the continuing gaps in public perceptions and behaviors, particularly those related to pregnancy and childbirth. The HPSP envisages that various BCC interventions will allow target clients, specially the poor, to understand their need for and entitlement to the ESP, and demand it (ESP). More specifically, the aims of the BCC component have been stated to be:

• Changing attitude and behavior of people to improve their health status
• Building effective community support for health seeking behavior
• Changing attitude and behavior of service providers to provide client centered service
• Promoting men’s respect or the special situation of the women and girl child in the society.

6.1 Behavior, Attitudes and Practices: The National Context

At birth, girls are slightly smaller than boys and the difference increases with age, in part due genetic differences but exaggerated by social practices related to the distribution of food within the family. These social practices are based on the value placed on girl’s life. To her natal family, she is destined for another family and is seen as a liability but in her husband’s family; she has least claim on family resources while bearing the greatest burden of domestic work. Her value is related to her childbearing role but this role must be fulfilled without any added cost to the family or else she is worthless. There is little recognition of the special need of pregnant and lactating women and of the stress of these states on the women’s health. Superstition and myths about food for pregnant women further effects maternal nutrition. All these factors promote early marriage, early pregnancy, and violence against women and malnutrition, which in turn has impact on maternal health.

Both men women have been socialized with this attitude and past them on to the next generation. Women are the ones who distribute the food within family according to the established practice. Interestingly, research has shown that in households where women make decisions, women spend more money on medical care and food and make better food choices. In these households, both women and children fare batter nutritionally. Efforts have been made in the past to educate the women on the need for family planning, good nutrition and antenatal care. However, women often do not have the power to decide on these matters.

Power is the issue behind violence against women within the family and in the community. 13.8% maternal deaths are due to injury and violence. Violence is also a factor in other issues that impact on maternal health. Social insecurity and social pressure lead the early marriage. As pregnant women are unable to carry out fully their usual heavy domestic load, they are more often subjected to physical assault. The maternal distress of abused women affects their appetite, further wreaking them. Many women have no control over their fertility and are forced to keep unwanted pregnancies or to have repeated MRs.

Poverty is a major factor in the entire family’s health. It influences nutrition and care seeking practices. It also increases the stress and the tension within the family so that violence also increases. Efforts at poverty alleviation are important to improve maternal health but the health facilities also have a role to play in ensuring that unnecessary burdens are not put on the access of the poor health care. These include attitudes to male doctors, the lack of privacy and respect shown to women and the ignorance of the risks and danger signs in pregnancy.

6.2 Advocacy with Policy makers, Planners and Social Leaders

Leadership in advocating for all women realizing their right to safe motherhood is of essence. There is a need for enrolling senior policy makers and planners in the Government and NGO sectors along with prominent members of civil society (e.g. parliamentarians, educationists, social workers, etc.) in the mission to bring about a change in the lot of women. A particular group is the marriage registrars, “Kazi”. They have an important role in preventing underage and forced marriages and also in social promotion of key messages and issues. A work-plan will be developed for effectively involving all societal influences.

6.3 Scope and objectives of the BBC and Community Participation Strategy

While ideally, the strategy should address all stages of a women’s life, in the interest of producing a more effective strategy would focus on:
• The role and value of women in society and the discrimination she faces throughout her life cycle
• Dignity and self esteem of women
• Early marriage and marriage registration
• Use of EOC services, with emphasis on 5 danger signs and 3 delays
• Promoting Birth Planning- Ante-natal care, preparedness for obstetric emergencies (when, where and how to access service), trained birth attendance.
• Safe Birth Practices and use of PNC
• Essential newborn care
• Participation of husbands, mothers and mothers-in-law, and community in general in pregnancy related matters
• Changing attitudes and approaches of service providers
• Breaking the silence surrounding violence against women
• Filling in the gaps left out in other BBC initiatives in the area of Safe Motherhood
• Preventing unsafe abortions
• Promoting small family norm and addressing son preference

It is to be recognized that social marketing methods will need to be deployed in reaching the desired BCC objectives and hence, will require a mechanism for utilizing the available.

BBC objectives have been developed for each of the priority issues identified.

6.4 Priority Activities (up to 2003)

• Implementation of BCC strategy that has been developed for reducing maternal mortality and violence against women
• Design and implement social marketing for ensuring clean and safe delivery through use of skilled attendants and Safe Birth Kits.
• Promotional campaigns of centers which provide EOC services including familiarization of community leaders with location of centers providing EOC services by arranging centre visit/ presentation celebrations , functions, functions etc.
• Women friendly design of the service centers
• Institute a system for recognition of ‘best provider and ‘best manager at union, Upazila, district and divisional levels
• Organization/availability of emergency transport for all obstetrics and newborn emergencies
• Analysis of event violence against pregnant women
• Maternal health service reviews and maternal death auditing
• Highlight the violence of neglect
• Signboards to identify houses of skilled providers of safe delivery
• Identify an recognize role models of ‘caring husbands’ and progressive mothers and mothers-in-law
• Female opinion leaders specially female UP members, peer counsel their counterparts in the community
• Institute an innovative fund at all community clinics, to be managed by the Community Group of the respective community clinic, for arranging emergency transportation of obstruct cases and neonatal emergencies to centers with EOC facilities
• Networking, lobbying and other advocacy strategies with all related Ministries for integrating issues related to misconceptions and wrong practices in their existing interventions/activities

Though much literature is available on the experiences and situation in Bangladesh, there is a need for some specific investigations. These will help in clarifying issues and contribute to policy and strategy implementation. Research is particularly needed to define:
• Modalities for improving QoC and retention of trained personnel in the remote district and upazila health Complexes
• Factors that will enhance utilization of ANC skilled attendance at delivery
• Modalities for encouraging un-employed nurses to take up midwifery as profession and link to referral facilities
• Issue and options relate to zero tolerance on VAW

Assessment and evaluation of initiatives is critical for tracking progress and ensuring necessary course correction is made. Critical topics for periodic assessment include:
• Establishment of round the clock functioning CEmOC facilities
• Training FWVs and community midwives for providing skilled attendance at birth
• Functioning of community clinics and role of community groups

The focus of this activity will be on tracking the progress of process indicators for reviewing the coverage and utilization of emergency obstetric care services. A 1994 benchmark has been established and reviewed in 1999. This will from the basis for comparison in any assessment or evaluation.
Additionally, emphasis will be given on in-facility review, maternal death audit and regular reporting. The experience of monitoring the collection and reporting of information on caseload and quality of care will provide the basis for necessary modification. This component will also be strengthened as part of the managerial capacity building of service providers. The methodology will include special surveys; analysis of routine reports and the focus will be on objectives and process indicators.

Importantly, the annual performance indicators of HPSP have defined a set for maternal health services, which include:

• MMR
• Amount of CEmOC and BEmOC services
• Met need for EmOC
• ANC coverage
• Percentage of births attend by skilled birth attendants
• CPR and method mix

The estimates for these indicators will be obtained from service statistic and special/routine surveys.

Bangladesh as signatory to the ICPD, Beijing Platform for action, CRC and CEDAW has taken on the obligation of eliminating discrimination against women in the enjoyment of all civil, political and cultural rights. Together with the obligations of these conventions, an essential framework is provided for promoting and protecting the rights of girls and women throughout the life cycle, and for attempting to eliminate inequality, discrimination and gender based disparities.

Reducing maternal mortality, morbidity and violence against women cannot be achieved through the health sector interventions alone. While the health sector will concentrate on increasing availability and utilization of quality essential services, the following matrix providers an overview of sectors will need to be involved intensely and the types of activities that will need to be incorporated into their existing programmes:

Coalition building between and within sectoral and community groups will be aimed at enrolling stakeholders groups at the national, sub-national and facility level. Through a process of building a shared vision and defining areas and actions, there will be the development of coalitions which will act as stalwarts for facilitating and monitoring the provision of a quality service which prevents the unnecessary deaths of women and respects their privacy, dignity and self-esteem.

Networking within the country will provide the opportunity for cross fertilization of ideas and activities among the facilities/areas undertaken in this initiative. This will be done in the form of periodic events, exchange visits and other innovative methods.

The financing of the estimated costs will draw heavily on both revenue and development funds. However, this will not be enough. Linking the women and their families to the essential maternal health services will require community action, particularly with regards to transportation, emergency funds and blood donation.

 x. NEXT STEPS

The process for formulation and building on the National Maternal Health Strategy has been an experience of intense deliberations, drafting and has resulted in partnership and team building. The momentum generated will be used to takes steps, which will result in operationalization of the strategy. The following key activities will be focused on:

• Listing of priority actions and incorporation in relevant Operational Plans for current and next two years
• Implementation of recommendations and administrative arrangements
• Supervision and Monitoring of implementation
• Commitment and mobilization of resources
• Institution of inter-sectoral mechanism

LIST OF CONTRIBUTORS

Core Group Members   1. Mr. Mir Shahabuddin Mohammad, Joint Secretary (Family and Development), Ministry of Health and Family Welfare, Bangladesh Secretariat, Dhaka (Chairperson of the Core Group) 2. Dr. A. S. M. Kamal, Director (MCH Services) and Line Director (ESPRH), Directorate of Family Planning, 3/2 Asad Gate, Mohammadpur, Dhaka (Member Secretary) 3. Dr. M.A Baqui, Line Director, ESP, Office of Director General of Health Services (DGHS), Mohakhali, Dhaka 1212 4. Mr. Shaiduzzaman, Joint Chief, Health Wing, Planning Commission 5. Mr. Qasem, Joint Chief, Policy Research Unit, Ministry of health and Family Welfare, Clinic Building, Bangladesh Secretariat, Dhaka 6. Dr. S. M. Asib Nasim, Deputy Team Leader, Program Coordination Cell, Ministry of Health and Family Welfare, Priyo Prangon, Paribag, Dhaka 7 . Chief Advisor, or Representative Management Change Unit, Ministry of Health and Family Welfare, Priyo Prangon, Paribag, Dhaka 8 . Additional Director General and Line Director (IST), Office of Director General Health Services (DGHS), Mohakhali, Dhaka 9 . Director (Hospital), Office of Director General of Health Services (DGHS), Mohakhali, Dhaka 1212 10 . Mr. Akhteruzzaman, Director (IEM) and Line Director of Family Planning, Azimpur, Dhaka 11. Dr. Abdur Rahaman Khan, Director (ADMN), Office of director General of Health Services (DGHS), Mohakhali, Dhaka 1212 12. Dr. Mamunur Rashid, Director, Institute Of Public Health Nutrition (IPHN), Mohakhali, Dhaka 1212 13. Dr. Ranjit Kumar Dey, Director (planning), office of Director General of Health Services (DGHS), MoHakhali, Dhaka 1212 14. Directo (planning), Directorate of Family Planning, Azimpur, Dhaka 1212 15. Dr. Nurul Anwar, Line Director (UMIS), Office of Director General of Health Services (DGHS), Mohakhali, Dhaka1212 16. Ms. Momataj Begum, Director, Directorate of Nursing Services, 14-15 Motijhil Comercial Services, Dhaka 17. Ms. Mobasherwa, Deputy Secretary, MOHFW 18. Ms. Bitra Sorensen, Office of Population, Health and nutrition, World Bank, Paribag, Dhaka 19. Dr. Frank Atherton, DFID, British High Commission, Dhaka 20. Mr. Kevin Smith, CIDA, Canadian High Commission, Dhaka 2. WR, World Health Organization (WHO), Dhanmondi R.A. Dhaka 1209 22. Country Representative, UNFPA, IDB Building, Agargaon, Dhaka 23. Country Representative, UNICEF, Hotel Sheraton Annex Complex, Minto Road, Dhaka 24 . Ms. Yamada, JICA 25. Representative, PPD, IPH Building, Mohakhali, Dhaka 1212 26. Dr. Zafurullah Chowdhury, Gonoshasthya Nagar Hospital, Road No. 6, Dhanmondi R.A, Dhaka 1209 27. dr. Halida Halum Akhtar, BIRPERHT, Dhanmondi R.A, Dhaka 1209 28. Director Health Program, BRAC, BRAC Center, Mohakhali, Dhaka 1212 29. Dr. Momena Khatun, Progrm Manager (MHS), Directorate of Family Planning, 3/2 Asad Gate, Mohammadpur, Dhaka (Focal Point) 30. Prof. A. Bayes Bhuiyan, OGSB 31. Dr. Yasmin Ali Haque, UNICEF, Hotel Sheraton Annex Complex, Minto Road, Dhaka 32. Ms. Priti Dev Sen, Policy Research Unit, Ministry of Health and Family Welfare, Clinic Building, Bangladesh Secretariat, Dhaka 33. Dr. A. J. Faisal, Engender Health, Dhanmondi R.A.

1) BCC and Community Participation: Mr. Akhteruzzaman, Director (IEM) and Line Director (UBCC), DFP 2) Maternal Nutrition andSocial Issues: Prof. mamunur Rashid, Director, IPHN Facilitators: 1) EOC, Other Services and Referral: Dr. Yasmin Ali Haque, UNICEF 2) HRD: Prof. A. Bayes Bhuiyan, OGSB and Dr. Shabnam Shanaz Pathfinder International (Co facilitator) 3) Management and Quality: Dr. A. J. Faisal, Engender Health 4) BCC and community Participation: Dr. yasmin H Ahmed, Marie Stopes Clinic Society 5) Maternal Nutrition and Social Issues: Dr. Jennifer Mary Clarke, UNICEF EOC, Other Services and Referral Work Group Members 1. Dr. Anwarul Haque, Line Director, Hospital, DGHs   2. Dr.Mozammel Haque, Ex-line Director, Hospital, DGHS 3. Dr. Yasmin Ali Haque , UNICEF 4. Dr. Belayet Hossain, PM, DGHS 5. Dr. Abdul Jalil Mondal, DPM, DGHS 6. Dr. Momena hatun, PM, MHS, DFP 7. Ms. Rebeka Khatun, Directorate of nursing Service 8. Dr. Yasmin Rhaman, DPM (MCHEOC), DGHS 9. Prof. Md. Khalilur Rhaman, Professor of Anesthesiology, DMCH 10. Dr. Ferhana Dewan, Sr Consultant, ObsGyn, DMCH 11. Dr. Jafar Ahmed Hakim, PMCLFPS,DFP 12. Mr.S M Magfoor Hassan, Asst. Chief,MOHFW 13. Ms. Rose Johnson, WHO 14. Ms. Tahera Ahmed, UNFPA 15. Dr. A. N. Zafarullah, CIDA 16. Dr. Istiaque Bashir, ICDDRB 17. Dr. Syed Izaz Rasul, SCF (USA) 18. Dr. Uzma Syeed, SCF (USA)   19. Representative from OGSB, OGSB 20 . Ms. Zaheda Ahmed, BOHC Management and Quality Work Group Members   1. dr. Abdur Rhaman, director (Admn), DGHS 2. Dr. A. J. Faisal, Country Director, Engender Health 3. Dr. Lutfar Rhaman, Asstt. Director, TTU, DGHS 4. Dr. ASM Nizamul Haque, DPM, Directorate of Family Planning, 3/2 Asad Gate, Mhammadpur, Dhaka 5. Mr. H. M. Towhidul Islam, Sr. Asstt. Secretary (Dev-1), MOHFW 6. Dr. Mhabubur Rhaman, Supervisor/QAT, Directorate of Family Planning 7. Ms. Alia Hossain, Health Economics Unit, Ministry of Health and Family Welfare 8. Ms. Janet Jackson, UNFPA, IDB Building, Agargaon, Dhaka 9. Dr. Rafiqus Sultan, Consultant, UNFPA, Dhaka 10. Dr. Md. Mohiuddin, UNICEF 11. Dr. Rena Yasmin, Marie Stopes Clinic Society   12. Dr. Greet Dieltiens, Public Health Sciences Division, ICDDRB, Mohakali, Dhaka 13. Dr. Rabeya Khatun, UFHP, Gulshan, Dhaka 14. Dr. Ishtiaque Mannan, Partners in Population and Development (PPD) 15. Dr. Saqui Khandakar, BPHC, Dhanmondi R A, Dhaka HRD Work Group Members 1. Prof. Md. Mizanur Rhaman ADG and Line Director (IST), DGHS, Mohakhali, Dhaka 1212 2. Prof. Shah Monir Hossain Ex-ADG and Line Director (IST) DGHS,Mohakhali, Dhaka-1212 3. Prof. A. Bayes Bhuiyan, President, OGSB, Dhaka 4. Dr. Ashraf Ali, DPM (MSD), ESPRH, Directorate of Family Planning 5. Ms. Aleya Parvin, Directorate of Nursing Services, 14-15 Motijheel C.A., Dhaka 6. Ms. Khadiza Begum, Directorate of Nursing Services, Dhaka

7. Dr. A. Wahab Howlader, NIPORT, Azimpur, Dhaka 8. Mr. Raisul Islam Mondol, Sr. Asst. Secretary, WHO-1, MOHFW   9. Ms. Tahera Ahmed, Assistant Representative, UNFPA   10. Ms. Rose Johnson, WHO. Dhanmondi RA, Dhaka 1209   11. Prof. Samina Chowdhury. Institute of Child and Maternal Health, Matuil, Dhaka   12. Dr. Ferdousi Begum, Associate Professor, ObsGyn, SSMC Mitford Hospital, Dhaka   13. Mr. Hasanul Islam, FPO, DFP   14. Ms. Morag Humble, CIDA   15. Dr. Shabnam Shanaz, Pathfinder International   16. Dr. Tajul Islam, UNICEF   17. Dr. Enamul Kabir, Save the Children (USA)   18. Mr. Jalaluddin Ahmed, Program Coordinator Essential Health, RDP, BRAC   19. Dr. Akramul Islam, BRAC   20. Dr. Hashrat Ara Begum, Marie Stopes Clinic Society   21. Dr. Rukhsana Haider, UFHP, Gulshan, Dhaka   22. Dr. Wahidul Islam, BPHC   23. Ms. Juliet Fleischl, GTZ BCC and Community Participation Work Group Members 1. Mr. Akhteruzzaman, Director (IEM) and Line Director (UBCC), Directorate of Family Planning, Azimpur, Dhaka 2. Dr. Yasmin H Ahmed, Marie Stopes Clinic Society 3. Mr. Mirza Abul Hasnat Enamul Bari Faruque, DD, BCC Unit, DFP 4. Mr. Khondokar Mahafuzur Rahaman, Health Education Bureau, UBCC 5. Dr. Shushil Chandra Sutradhar. Directorate of Family Planning 6. Dr. M. A. Jalil Mondal, DPM, DGHS 7. Mr. Anwarul Islam Khan, PM, BCC 8. Ms. GAZI Akhter Zahan, DPM, BCC, DFP 9. Ms. Farida begum, DD, DFP 10. Ms. Syeda Selina Parveen, Information Officer, BCC, DFP 11. Mr. Mosharaf Kamal, PCO, BCC, DFP 12. Dr. Sayed Moshfiqur Rhaman, Medical Officer, MCH Training   Institute (MCHTI), Azimpur, Dhaka 13. Ms. Ayesha Begum, Asst. Chief, MOHFW 14. Ms. Nilufar Ahmed, World Bank, Pribag, Dhaka   15. Dr. Jahangir Hossain. CARE   16. Ms. Mayeeda Chowdhury, UNICEF   17. Mr. Nurul Amin, UNFPA, IDB Building, Agargaon, Dhaka   18. Dr. Mohsena Akhter, BIRPERHT   19. Ms. Parveen Rashid, Social Marketing Company   20. Dr. Shehlina Ahmed, PLAN International Bangladesh, House 58, Road 7A, Dhanmondi RA, Dhaka 1209   21. Mr.Md. Shajahan, Chief of Party, Bangladesh Center for Communication Programs (BCCP)   22. Mr. Shaikh Masudul Alam, Executive, BCCP   23. Mr. Ramendu Majumder, Expressions Ltd.   24. Mr. Md. Selim, Director, Expressions Ltd   25. Ms. Bably Siddique, Expression   26. Ms.Sarah Zaker, Asiatic MCL   27. Ms. Zobida Akhter Asiatic MCL.   28. Dr. Reena Yasmin, Marie Stopes Clinic Society   29. Mr. Wahiduzzaman Chowdhury, Marie Stopes Clinic Society Maternal Nutrition and Social Issues Work Group Members 1. Dr. Mamunur Rashid, Director, IPHN 2. Dr. Jennifer Mary Clark, UNICEF 3. DR. Rokeya Khatun, DPM, Reproductive Health, DGHS 4. Dr. Bishnu Pada Dhar, DPM, ESP, RH, DFP 5. Mr. Md. Nurul Abedin, PD, MSPVAW, Ministry of Children and Women Affairs 6. Representative from Ministry social Welfare 7. Ms. Hosne Ara Begum, Sr. Asst. Chief, MOHFW 8. Dr. Shamim Ahmed, IPHN 9. Dr. Sabnam Shahnaz, Pathfinder International 10. Mr. Alec Mercer, DFID 11. Dr. Sukanta Sarker, Engender Health 12. Ms. Shirin Jahangir, World Bank 13. Ms. Nasreen Haque, Naripakkha 14. Dr. Zeba Mahmud, BRAC 15 . Dr. Harunur Rashid, BRAC 16. Md. Shariful Haque, Grameen Bank, Mirpur 2, Dhaka 17. Dr. Julia Ahmed, BWHC 18. Mr. Yuki Shroishi, UNICEF 19. Dr. Sayeeda Begum, UNICEF 20. Mr. Salaiman Sarkar, BRAC Synthesis and Editorial Work Group Members 1. Dr. Momena Khatun, DFP 2. DR. Yasmin Ali Haque, UNICEF 3. Prof. A. Bayes Bhuiyan, OGSB 4. Dr. Jahiruddin Ahmed, Engender Health 5. Dr. A. J. Faisel, Engender Health 6. Dr. Yasmin H Ahmed, Marie stopes Clinic Society 7. Dr. Jennifer Mary Clarke, UNICEF 8. Dr. Md. Khairul Islam, PLAN International Bangladesh

Workshop Participants
Divisional Workshop at Rangpur:
August 30,2001

1. A. K. M. Muniruzzaman Representative CARE-Bangladesh
2. A. K. M. Sahadat Hossain UFPO Sadar Rangpur
3. Arun Shill Reporter ATN Bangla
4. Bilkis Khatun FWV Rangpur
5. Dipcandro Nath Ray PCH SMSF
6. Dr. A N M Faizul Alam Clinic Manager Marie Stopes Clinic Rangpur
7. Dr. A Wahab Howlader DD (CT) NIPORT
8. Dr. A K F Mojibur Rahaman UH&FPO Jaldhaka, Nilphamari
9. Dr. A S M Kamal Director (MCH-s).LD (ESP-RH) DFP
10. Dr. Abu Hena Mostafa Kamal MO Dupdchachia, Bogra
11. Dr. Azizul Islam Prof. Gynee &Obs Rangpur Medical Collage
12. Dr. Gulam Moula Consullant RG Hospital, Lalmonihat
13. Dr. Hasina Khatun Mo (MCH-FP) Sujanagar, Pabna
14. Dr. Humaka Islam President UPHS Rangpur
15. Dr. Jahir Uddin Ahmed Technical Advisor Engender Health
16. Dr. Khirul Islam PSM Plan International
17. Dr. M. Fazlur Rahman Director Health, Rajshahi
18. Dr. Md. Afjul Hossain MO (CS) Bogra
19. Dr. Md. Ashraf Ali DPM (MSD) DFP
20. Dr. Md. Delowar Hossain Secretary BMA, Rangpur
21. Dr. Md. Didrarul Islam Deputy Director MOH&FW
22. Dr. Md. Ferdous Hosain AD(CC)& Rs (FPCST/QAT) Family Planning, Bogra
23. Dr. Md. Nazibur Rahman UH&FPO Syedpur Nilphamari
24. Dr. Md. Rafiqul Islam Civil Surgeon Lalmonirhat
25. Dr. Md. Selim Reza MO (MCH-FP) FP, Rangpur
26. Dr. Md. Shukuruddin Mridha Civil Surgeon Rajshahi
27. Dr. Mohaddes Hossain Civil Surgeon Rangpur
28. Dr. Momena Khatun Deputy Director (MCH) DFP
29. Dr. Parvin Akhtar MO (CL) MCWC, Jaypuhat
30. Dr. Reazul Islam AD (CC) FP Dinajpur
31. Dr. Reena Yasmin Prog. Dev. Manager Marie Stopes
32. Dr. S.A. Fida Hasan Rejional Supervisor FPCST/QAT
33. Dr. S.K.M Bari MO Rangpur
34. Dr. Serajul Islam DPM (MHS) DFP
35. Dr. Umacharan Ray Village Doctor Rangpur
36. Dr. Yasmin Ara Haque MO (CL) MCWC, Rangpur
37. Dr. Zafar Ullah Representative CIDA
38. Dr. Zahidul Islam MO (MCH-FP) Sayedpur, Niphamari
39. Md. Abdul Latif School Teacher Rangpur
40. Md. M. A. Matin Lecture, Govt Collage Rangpur
41. Md. Abdur Rashid Secretary BGH, Rangpur
42. Md. Abu Bakar Miah Health Asst Sadar Rangpur
43. Md. Abu Taher Shakh Admin Officer DFP
44. Md. Abu Taleb Vice President Press club, Rangpur
45. Md. Ahasan Jamil Worker Rangpur
46. Md. Alamgir Worker Rangpur
47. Md. Alauddin Health Asst Rangpur
48. Md. Ali Asraf Reporter Press club, Rangpur
49. Md. Aujaul Hossain FPI Rangpur
50. Md. Bashir Ullah Accountant DFP
51. Md. Kabir Uddin DD (FP) Rangpur
52. Md. Mozammel Haque Chairman Jaldhak, Nilphamari
53. Md. Nazrul Islam Asst. Director DFP
54. Md. Noor Nobi Finance Officer DFP
55. Md. Raisul Alam Mondol Sr. Asst. Secretary MOH&FW
56. Md. Reazul Karim Member BMA, Rangpur
57. Md. Rezaul Karim Computer Operator DFP
58. Md. Rezaul Karim Khan Holly Quran reciter Rangpur
59. Md. Shamsul Alam UFPO Singra, Natore
60. Md. Shamsul Haque FPI Syedpur, Nilphamari
61. Md. Sukur Ali Health Asst Rangpur
62. Most. Nazmun Nahar SACMO Rangpur
63. Mr. Abdus Sobhan AHI Sadar Rangpur
64. Mr. Amjad Hossain Asst. Regn. Director Bangladesh Radio,Rangpur
65. Mr. M A Rahim UHFPO Rangpur
66. Mr. M Nasimul Haque SACMO Rangpur
67. Mr. M M Alam Health Asst Rangpur
68. Mr. Mafizul Islam FMP Rangpur
69. Mr. Mahamudul Bari MO (CS) Rangpur
70. Mr. Shafiqul Haque AD (CC) FP, Serajgonj
71. Mr. Mir Shahabuddin Mohd. Joint Secretary MOH&FW
72. Mrs. Rawsanara Begum UP Member Rangpur
73. Ms. Abida Sultana FWV Rangpur
74. Ms. Fatfah Banu PCO DFP
75. Ms. Gulnahar Begum FWV Rangpur
76. Ms. Halima Khatun Sr. FWV Rangpur
77. Ms. Jenny Clarke Facilitator UNICEF
78. Ms. Lily Begum Dai-Nurse Sadar Rangpur
79. Ms. Mahmuda FWA Sadar Rangpur
80. Ms. Manu Rani Dai-Nurse Rangpur
81. Ms. Mimabi Rani Social Worker Rangpur
82. Ms. Momena Begum UP member Jaldhaka, Nilphamari
83. Ms. Monsura Begum FWA Sadar Rangpur
84. Ms. Saleha Khatun Sr. FWV Rangpur
85. Ms. Shikha Sarkar Sr. Visitor (incharge) CCDB, Rangpur
86. Ms. Sukhamay Assan DPO FPAB, Rangpur
87. Ms. Sultana Project Director UFHP, Rangpur
88. Ms. Taslima Khatun Director FP Rajshahi
89. Ms. Zosna Begum VGD Rangpur
90. Nirmal Kanti Bhattacherjee A.H.I Sadar Rangpur
91. Rabindra Nath Sarkar School Teacher Rangpur
92. Sunil Saha Chairman Tetulia UP, Chirirbandar
93. Ms. Shirin Jahanger World Bank
94. Dr. Jebun Nessa Rahaman NPPP UNFPA

Divisional Workshop at Sylhet:
August 19, 2001

1. A.K.M. Muniruzzaman Representative CARE-Bangladesh
2. A.K.M. Abdus Subhan UFPO DGHS
3. Abdul Kader News Editor Newspaper
4. Abdul Kasem Worker Sylhet
5. AHM Faisal Ahmed Executive Director NGO
6. Ahmed Kabir Haidari DD-FP, Sunamganj DFP
7. Anukul Chandra Roy HI DGHS
8. Auvizaz Vottacharjo HA DGHS
9. Ayesha Begum Asst Chief MOHFW
10. Basanti Rani M.A. DFP
11. Bilal Ahmed Chief Executive Director NGO
12.Dr. A. Wahab Howladar DD(Clinic & trg) NIPROT
13. Dr. A.A. Biswas Head Dept. Anthropology University
14. Dr. A.N. Zafar Ullah SPM CIDA
15. Dr. A.S.M. Kamal Director (MCH-Services) DFP
16. Dr. A.Z. Mahabub Islam DCS Sylhet
17. Dr. Abul Bashed Medical Officer DFP
18. Dr. Bilkish UP member Sylhet
19. Dr. Biswajit Bhower MO(MCH-FP) DFP
20. Dr. Dada Roy Village Doctor NGO
21. Dr. Dipak Lal Banik UH&FPO DGHS
22. Dr. Haridas Chakravarty AD (cc) DFP
23. Dr.Hosna Afruz Ratna MO (MCH-FP) Sadar, Sylhet
24. Dr. Iqbal Hasan Chudiry UN&FPO DGHS
25. Dr. Jahir Uddin Ahmed Technical Advisor Engender Health
26. Dr. Jebun Nessa Rahaman NPPP UNFPA
27. Dr. Jennifermary Clark Sub Group Facilitator UNICEF
28. Dr. Lutfun Nahar MO (MCH-FP) Sadar, Sylhet
29. Dr. M. Quasisul Hassain MO DFP
30. Dr.M.A. Mannan UFPO DGHS
31. Dr. Md. Abdul Kabir MO DFP
32. Dr. Md. Golam Rabbani Civil Surgeon DGHS
33. Dr. Md. Hadi Hassain Consultant, Moluvibazar DFP
34. Dr. Md. Khirul Islam National Consultant Plan Int.
35. Dr. Md. Serajul Islam AD (MCH) DFP
36. Dr. Momena Khatun DD (MCH) DFP
37. Dr. Nasima Khanam MO (Clinic) DFP
38. Dr. Nazmul Islam MO (CC) Sylhet
39. Dr. Nilufar Jahan MO DFP
40. Dr. Raj Gopal Bask Civil Surgeon, Sylhet DGHS
41. Dr. Reena Yasmin Proj, Dev, Manager MSCs
42. Dr. Shafique Uddin Ahmed Civil surgeon DGHS
43. Dr. Shamim MO(Clinic) MCWC, Sylhet
44. Dr. Shamim Ahmed Asst. Director IPHN
45. Dr. Shelina Ahmed Health Advisor Plan Int.
46. Dr. Syed Akhtar Hossain AD(CC) DFP
47. Dr. Sayed Mosfiqure Rahman MO(Pae) MCHTI, Dhaka
48. Dr. Tariqul Islam PN NM
49. Dr. Md. Ashraf Ali AD(MCH) DFP
50. Fatema Begum VGD Card Holder
51. Hasna Begum TBA
52. Hosne Ara Begum DD-FP, Sylhet DFP
53. Liaquat Ahah Fardus Reporter Daily Jugantar
54. Lila Das Sr. FWV DFP
55. M.A. Musaber CC Land donor Sylhet
56. Manik Chandra HI Sadar, Sylhet
57. Maya Bibi VGD card holder Sylhet
58. Maymon Ness Khanm FWV DFP
59. Md. Abdur Rahman CC Land donor Sylhet
60. Md. Abu Taher Shaikh Admin. Officer DFP
61. Md. Abu Wbaid Chowdhury HA DGHS
62. Md. Aeder Ali SCAMO DGHS
63. Md. Anique Mansud Pharmacist Sadar, Sylhet
64. Md. Jhangir Kabir Khan FPI Sadar, Sylhet
65. Md. Mujibur Rahman FPI DGHS
66. Md. Mukhlesur Rahman lascar Divisional Director Ctg-Sylhet
67. Md. Musa Mia Chairman, Jaintapur Chhatak, Sunamgonj
68. Md. Noor Nobi Finance Officer DFP
69. Md. Rezaul Karim ESP-RH DFP
70. Md. Shajahan Dist. Prog. FPAB
71. Mishbauddin FPI DGHS
72. Ms. Begum FWA Barikandi, Sylhet
73. Motilal Das FPI DGHS
74. Nurunnahar Begum Sr. FWV DFP
75. Poresh Chandra Nath AHI DGHS
76. Rani Begum VGD card holder
77. Reva Rani Das FWV DFP
78. Rina Deb FWA Sylhet
79. Saleha Begum FWV DFP
80. Salma Akheter MO DFP
81. Samsul Islam Chairman Sylhet
82. Samsul Islam AHI Sadar, Sylhet
83. Santi Nath TBA DFP
84. Shahnaj Begum FWV DFP
85. Sharadindu Dey DD-FP Moluvibazar DFP
86. Siddiquer Rahman AHI DGHS
87. Sochitra Mallik PO NGO

Brainstorming Workshop:
January 24, 2001

1. Dr. Jahiruddin Ahmed Director (MCH)&LD (ESP-RH)
2. Dr. S.M. Jahangir SUPT. MCHTI
3. Mr. S.M. Magfoor Hassan Asst. Chief MOHFW
4. Mrs. Tahera Ahmed Asst. Rep. UNFPA
5. Dr. Takako Yamada Chief Advisor HRDRH JICA
6. Dr. Tofayel Ahmed DD and PM, UMIS DGHS
7. Dr. A. Wahab Howlader DD (CI. TRG.) NIPORT
8. Ira Dibra Nursing Instructor, Directorate Of Nursing Services
9. Dr. Birte H. Sorensen Sr. Public Health Specialist, World Bank
10. Ms. Janet Jackson Dep. Rep. UNFPA
11. Mr. Victor Gomez Consultant SCF- USA
12. Dr. Md. Ziaul Karim DPM/ DFP
13. Dr. Shabnam Shanaz Deputy Director Pathfinder
14. Dr. Asharf Ali DPM Maternal Health
15. Dr. Yasmin H Ahmed Country Director Marie Stopes Clinic
16. Dr. Shofia Nilufar Consultant OB-GYN. MCHTI
17. Dr. Uzma Syed Institute of Health Economic DU
18. Dr. Enamul Kabir Save the Children USA
19. Dr. Khurshid Talukdar ICMH
20. Dr. Greet Dieltiens ICDDR, B unmet obstetric needs project
21. Dr. Munir Ahmed Program Co-ordinator Health Nutrition and population BRAC
22. Ms. Nasreen Huq HKI
23. Dr. Dil Afroze BWHC
24. Dr. Rafiqu Sultan ESP- RH DFP
25. Dr. Jahangir Hossain CARE Nirahpadma Project
26. Dr. Sameena Chowdhury Associate Professor OB-GYN. ICMH
27. Mrs. Shireen Jhangir WB Sr. Operations Officer (HNP)
28. Mr. Shmim Hasan Asst Chief. UBCC
29. Dr. Sabera Rahman Director MFSTC
30. Dr. Jafar Ahmed Hakim PM Clinical FP Services, ESP-RH
31. Dr. Mirza A.H.M. Bareque PM FPS, ESP- RH
32. Dr. A.J Faisal Chief of Party. QIP. AVSC
33. Dr. Md. Belyet Hossain PM Reproductive Health
34. Dr. Wali Ahmed Fateh BAVS
35. Ms. Suriya Akhter BAPSA
36. Dr. Yasmin Ali Haque UNICEF
37. Dr. Yasimn Rahman Hospitals Services DGHS
38. Dr. Ishrat Jahan UFHP/JSI
39. Md. Sharif DFP/Azimpur
40. Dr. Japhet Killelo Head, Reproductive Health Program, ICDDR. B
41. Dr. Carine Ronsmans Senior Lecturer, ICDDR,B/LSHTM
42. Dr. Jubenessa Rahman UNFPA EOC-DFP
43. Dr. Momena Khatun DD (MCH) DFP

Follow-up Workshop:
April 4, 2001

1. Alec Mercer DFID, B, Mohakhali
2. Dr. Sayed Moshfiqur Rhamn Medical Officer, MCHTI, Azimpur, Dhaka
3. Mr. Ishtiaq Bashir ICDDR, B, Dhaka
4. Greet DielTines ICDDR,B
5. Mr. Jalaluddin Ahmed Program Coordinator BRAC
6. Mrs. Shirin Jahangir World Bank, Dhaka
7. Dr. A.J. Faisal Engender Health
8. Dr. Yasmin Ali Haque UNICEF
9. Dr. Md. Mohiuddin UNICEF
10. Professor Sameena Chowdhury ICMH
11. Dr. Zafar Ullah CIDA
12. Professor A,B. Bhuiyan OGSB
13. Dr. Suniti Acharya WR/WHO
14. Ms. Priti Dave Sen Ministry of Health and Family Welfare
15. Dr. Zahir Uddin Ahmed Director (MCH) DFP
16. Ms. Yasmin H Ahmed Marie Stopes Clinic Society
17. Dr. Yasmin Rahman DPM (MCH.EOC) DGHS
18. Dr. Mohesena Akhtar BIRPERHT
19. Dr. Momena Khatun PM (MHS) ESP-RH, DFP
20. Dr. Ashraf Ali DPM (MSD), ESP-RH, DFP
21. Dr. Shabnam Shanaz Pathfinder International
22. Dr. Uzma Syed Save the Children (USA)
23. Dr. Enamul Kabir Save the Children (USA)
24. Dr. Zahangir Hossain CARE
25. Morag Humble CIDA – TAU

 

Participants of the National Consensus Workshop
September 18, 2001, BIAM, Dhaka

Sl # Name Designation Organization

1. A M Zakir Hossain PAS, UPHCP MOLG RD & ADB
2. A H M Towhidul Islam Sr. Asst Secretary MOH&FW
3. A K M Noor Hossain Director (FP) Khulna Division
4. A K M Wahed Nabi Director (planning) DGFP
5. A T M Hafiz Secretary UNFPA
6. Abdul Bashar Accounts Officer PPC
7. Abdul Hai Khan AGM Grameen Bank
8. Adete Beerhing Representative Suiss Red Cross
9. Anwarul Azim Representative BWHC
10. Arvin H. Boiragee Representative World Concern
11. Ayesha Begum Asst. Chief MOH&FW
12. Basanta Kumar Biswas Accountant DFP
13. Brig.(Rtd) Dr. M.A. Malik Honorable Advisor MOH&FW
14. Cathrine O Brien Health Delegate IFRC, Int, Fed, RC/RC
15. Dr. A K M Samsuddin Director Health DGHS
16. Dr. A K M Samsuddin
17. Dr. Abdul Wahab Howldar Dy. Director (CL…Trg.) NIPORT
18. Dr. ABM Ahsanullah Director General DGHS
19. Dr. Abul Kasem Joint Chief MOH&FW
20. Dr. AN Zafar Ullah CIDA
21. Dr. Bishnupada Dhar DPM ESP-RH
22. Dr. Dil Afroz Rahman ADG (cc) DGHS
23. Dr. Ferdouse Begum Sr. Technical Officer Pathfinder Int.
24. Dr. Hafizur Rahman Khan Director (H) Dhaka Division
25. Dr. Indrani chakma Representative UNICEF
26. Dr. Jafar Ahmed Hakim PM ESP-RH
27. Dr. Jahangir Hossan Coordinator CARE
28. Dr. Jahir Uddin Ahmed Technical Advisor Engender Health
29. Dr. Jebun nessa rahman NPPP UNFPA
30. Dr. Jennifer Mary Clarke Facilator UNICEF
31. Dr. Kabir Uddin Ahmed RH Advisor Plan International
32. Dr. Kaniz Fatema Consultant MCHTI

33. Dr. kasem Ahmed Plan Inter.
34. Dr. Khaled Islam Consultant HRD GTZ
35. Dr. Lutfur Haidar Asst. Director MFSTC
36. Dr. M. Akram Hussain Representative CIDA
37. Dr. M. Hafizur Rahman Acting Director BIRPERHT
38. Dr. M A Baqi director (PHC&DC) DGHS
39. Dr. M A Jalil Mandal DPM DGHS
40. Dr. M K Miah Director Barial Division
41. Dr. Mahamuda Khatun Prof, Gynae & Obs DMCH
42. Dr. Mahmudur Rahman Consultant MCHTI
43. Dr. makhduma Nargis Joint Secretary MOHFW
44. Dr. Md. Abdur Rhaman Consultant MCHTI, Azimpur
45. Dr. Md. Abdur Rahman Khan Director Admin DGHS
46. Dr. Md. Anwarul Haque Director DGHS
47. Dr. Md. Ashraf Ali AD (MCH) ESP- RH
48. Dr. Md Lutfar Rhaman Assistant Director DGHS
49. Dr. Md. Mizanur Rhaman Program Manager Shimantik UPHCP
50. Dr. Md. Ziaul Karim Principle FWVTI
51. Dr. Mirza A H M Bareque PM DFP
52. Dr. Moazzem Hossain Program Head SC-UK
53. Dr. Mohsena Akhtar Coordinator BIRPERHT
54. Dr. Momena Khatun PM (MHS) ESP-RH
55. Dr. Mominul Haque Coordinator ICMH
56. Dr. Monira Pervin Consultant MCHTI
57. Dr. Munir Ahmed Asst. Chief UMIS, DGHS
58. Dr. Najmul Sahar. Sadez Sr. Program Officer UNFPA
59. Dr. Nilufar Kamorez Jahan Coordinator PRIME/INTRAH
60. Dr. Nurul Anwar Director DGHS
61. Dr. Parveen Haque Chowdhury Deputy Director MFFSTC
62. Dr. Raisul Alam Mondal Sr. Asst. Secretary MOH&FW
63. Dr. Ranjit Kumar Dey Director (Planning) DGHS
64. Dr. Rukia Khatun AD (PHC) DGHS
65. Dr. S M Asib Nasim DT Leader PCC
66. Dr. S M Kamal Teem Leader CWFD/QIP
67. Dr. Shaheen Representative DASCOH
68. Dr. Shalini Shah TAT PRIME/ INTRAH
69. Dr. Shamim Ahmed AD IPHM
70. Dr. Shehlina Ahmed Health Advisor Plan International
71. Dr. Sofia Nilufar Consultant MCHTI
72. Dr. Sohail Aliy Dy. Director & PM(MN-ADH) DFP
73. Dr. Sumana Shafinaz Representative ICMH
74. Dr. Sayed Ahmed Asst. Prof. ICMH
75. Dr. Syed AKM Hasan Alam Director MFSTC
76. Dr. Sayed Azizur Rhaman Research Fellow LSHTM
77. dr. Syed Moshfiqur Rhaman MO MCHTI
78. Dr. Tazneen Waris MO(MCH-FP) Mirpur FP Office
79. Dr. Uzma Syed Associate PM SC (USA)
80. dr. Yasmin Rhaman DPM DGHS
81. Dr. Zomila Begum Director (H) Rajshahi
82. Dr. Aftab Uddin Prime-HPSP DGHS
83. Farhad Mahmud Reporter Sangbad
84. Farida Begum DD BCC
85. Farida Yasmin Research Officer DDFP
86. Feroza mannan Editor BTV News
87. Gazi Akhtar Jahan DPM BBC
88. Hafiza Khatun Deputy Chief MOWCA
89. Halida H. Akhtar PM Partners
90. Hosne Ara Begum DC (FW) MOH&FW
91. Iqbal Anwar Representative ICCDDR,B
92. Japhet Killewo Representative ICDDR,B
93. Kahlilur Rahman Prof. of Anaesthesiology DMCH
94. Kamal Abdul Wases Chowdhury Deputy Secretary MOHFW
95. Kazi Shaswati Islam Project Associate Centre for Policy Dialogue
96. Khagendra Nath Biswas Director (Finance) DGFP
97. Khondker Mahfizul Haque Chief DGHS
98. Linda Holst Nizzsew Representative World Concern
99. M. Shaher Uddin Molla Director, FP Barishal Division
100. M. Tabibur Rahman Director (admn) DGFP
101. Mamataz Begum Director Nursing Services
102. Md. Abdul Awal PO ESP (RH), DFP
103. Md. Abdul Zalil Associate Chief BCC
104. Abu Taher Shaikh Administrative Officer DFP
105. Md. Altaf Hossain Director BAPSA
106. Md. Aminul Islam Health Economics Dhaka Univercity
107. Md. Ashraful Alam Representative Bangladesh Betar
108. Md. Ebadat Ali Deputy Secretary MOH&FW
109. Ms. Shirin Jhangir World Bank
110. Md. Gias Uddin AD (MCH) ESP (RH),DFP
111. Md. Gulam Faruque PO ESP (RH),DFP
112. Md. Hasanul Islam HRM DGFP
113. Md. Hossain Bhoiyan Asst. Secretary MOH & FW
114. Md. Khalequzzaman Joint Secretary (Admn) MOH & FW
115. Md. Mizanur Rahman Mijud Dy. Secretary MO Religion Affair
116. Md. Mokshed Ali Asst. Chief DFP
117. Md. Montaz Ali Sarkar Director (Audit) Dte. Of FP
118. Md. Mukleshur Rhaman Director FP Chittagong Division
119. Md. Nazibur Rhaman DDP DGFP
120. Md. Nazrul Islam AD(P-I) DFP
121. Md. Noor Nobi Finance Officer DGFP
122. Md. Shaib Miah Security To advisor MOH & FW
123. Md. Shiduzzaman Joint Chief Planning Commission
124. Md. Wahid Jr. HEO BCC unit
125. Mir Shahabuddin Mohammead Joint Secretary MOH & FW
126. Mirza Abul Hasnat Enamul Bari Faruque Director (L&S) DGFP
127. Mobaswara Begum Deputy Secretary MOH & FW
128. Mofizul Alam Asst Director DFP
129. Mr. Fazlur Rhaman Secretary MOH & FW
130. Mr. Mark A Rabins PRIME-HPSP DGHS
131. Mr. Mir Shahabuddin Director General DGFP
132. Nancy Piet Consultant Population Council
133. Nazma Begum Project Manager Naripokkho
134. Prof. Qazi Shahidul Alam Director Medical Education DGHS
135. Prof. A Wadud Khan Director NIPSOM
136. Prof. A. B. Bhuiyan President OGSB
137. Prof. Mamunur Rashid Director IPHM
138. Prof. Md. Mizanur Rhaman Additional DG DGHS
139. Prof. Samena Chowdhury OB/GYN ICMH
140. Prof. T.A. Chowdhury BIRDEM
141. Renata Pors First Secretary Netherlands Embassy
142. Rose Johnsen WHO
143. Rukshana Shaheen SDT Officer Management Change Unit
144. Sakhawat Hossain Director (FP) Dhaka Division
145. Salim Khan Director NIPORT
146. Salma Khatun N. Nurse Consultant N. Care
147. Shaikh Abdud Daiyan Representative Grameen Kalyan
148. Sharif Md. Shazedul Alam PO (L&S) ESP-RH DFP
149. Shehlina Ahmed Health Advisor Plan International
150. Suraiya Begum Social Welfare Officer Shuwarddy Hospital
151. Syeda Selina Parveen Information Officer BCC
152. Taslima Khatoon Director FP Rajshahi
153. Taufique Jahan Representative BCCP
154. Ubaudur Rob Coordinator Population Council
155. Yasmin H. Ahmed CD Marie Stopes Clinic

ANNEX

REFERENCES