In Bangladesh, there are a number of hard to reach areas, where communication infrastructure is rather poor. One such locality is a union named Badalpur, situated on the bank of the river Kushiara. Badalpur is a union of Ajmiriganj upazila of Habiganj district. The union is completely a haor, 34 kilometres away from the district town and 19 kilometres from the upazila sadar.
Road communication is almost nonexistent during the rainy season. Local boats are the only transport at that time. During winter people travel from one place to another by chander gari (locally repaired jeep) or motorcycle. It takes 2-3 hours to reach the upazila sadar and at least 4 hours to the district town.
Communication worsens during the interval between winter and the rainy season. Walking is the only way to reach any place during that period. So, coming by any kind of health care from outside the union is very rare. In the past, there was no knowledge about the overall healthcare issues among the villagers, especially those related to maternal and newborn health.
Badalpur has a population of 25,000 approximately. But as there was no health care centre to serve these people, they were being deprived of any kind of basic health care. Specifically, maternal, neonatal and child health care facilities were scant. Most of the deliveries were handled by untrained traditional birth attendants (TBA) and as such complications during labour and postnatal period were very common there. The skilled birth attendant (SBA) delivery rate was 18.5 (First Round PBS tracer survey) and in the last two years (January 2013- December 2014) three mothers and 22 newborn died due to delivery related complications, according to a DGFP MIS report. And According to the BDHS 2011 report, Sylhet division has the lowest proportion of births delivered at a health facility (21 percent, respectively).
Considering this unmet needs for easy accessible maternal and newborn health care, USAID's MaMoni, a health system strengthening project, planned to establish a Union Health and Family Welfare Centre (UH&FWC) in 2012 to provide round the clock SBA delivery service and appropriate maternal, newborn and child health care in this 'hard-to-reach' area. As a result of MaMoni's work, the people residing in Paharpur village donated land to construct this FWC. The construction commenced with immense help from local people, members of Union Parishad, Health and Family Planning department and MaMoni project staff.
The construction work of a two-storied building was completed in June 2014 with funding from Save the Children UK and was handed over to DGFP, Family Planning Department, Habiganj in September 2014. Soon after the handover process was completed, the government's Family Planning Department appointed a Family Welfare Visitor (FWV) to serve the centre. MaMoni-Health Systems Strengthening projects also deployed a paramedic to provide 24/7 delivery services for pregnant women.
Simultaneously, MaMoni-HSS organized a series of activities with Union Parishad members, UP standing committees and related stakeholders about the real situation of Maternal, Newborn and Child Health (MNCH) of this area to make them aware of their role, responsibility and importance of their involvement in ensuring continued delivery of required health services in time and with quality. These activities include awareness meeting, training, orientation, etc.
As an immediate result of these initiatives, especially working with the UP standing committee for health, Union Parishad allocated Tk 170,000 from its budget (Union Parishad Health Fund) as support for improving maternal, neonatal and child health situation. A good amount of emergency medicine and along with that locally made non-motorized transport was procured from this allocation to support the safe delivery service in the centre.
Additionally, MaMoni-HSS provided a water ambulance to get faster the emergency referral to an appropriate facility during complications. Till date, this committee has been working intensely and recognizing MNCH problems of the local area and soliciting their solution. With all these efforts now the UH&FWC is contributing immensely in reducing maternal and neonatal death. This centre is very much appreciated by the local people and elected public leaders.
Recently, in February 2015, the centre conducted its first delivery. A mother named Smriti Rani Das gave birth to a healthy child in this UH&FWC on February 10 with the help of its paramedic Mrs Ambia Khatun and FWV Mrs Minoti Rani Das. She became aware of this centre while she was receiving ANC from an FWV in a satellite clinic. She got motivated by this information and decided to go there for her delivery. After the safe delivery the mother stated, "If all mothers can give birth in this hospital then all mothers of this area will safe from sufferance. From now, we do not need to go anywhere else for delivery. I wish that all the people associated with this hospital are blessed by God".
Till February15, five deliveries have been conducted. Every month since September 2014 (when UH&FWC handed over to the DDFP) 200 mothers have been receiving ANC and 80 mothers have been receiving PNC. Therefore, the dream of safe delivery has come true forthe people of Badalpur.
Local lawmaker Abdul Majid Khan commented, "It's a dream come true and that happened due to the immense and noble work done by USAID's MaMoni Project. I will always keep my eyes on it and will be continuing to support this centre to function smoothly, all the time." r
Saifunnahar Sumi is Staff Correspondent, The Daily Observer