Bangladesh_Female doctor with white coat and hijab
Photo: Josh Estey/CARE

5 Min Inspiration: Women keep each other alive

CARE Bangladesh’s SHOUHARDO III program prioritized the Local Service Provider (LSP) model to ensure sustainability with the aim that the program can leave behind a system that functions on its own without program interventions. The LSP model is a decentralized extension model whereby local actors are trained to provide extension services such as knowledge, technology transfer, and training, especially for the poor and extreme poor (PEP) population, in return for a service fee.

The program developed LSPs by building their skills, providing them with resources, and establishing linkage with the Government of Bangladesh (GoB) and private sectors to ensure service delivery. Moreover, LSPs are motivated as this is an income-earning opportunity to improve their livelihood. SHOUHARDO III introduced Private Community Skilled Birth Attendants (PCSBA) (all female) in early 2021 as LSPs to support pregnant and lactating women (PLWs) in the remote char and haor areas in northern Bangladesh.

The program trained 75 PCSBAs to provide services such as safe delivery, Antenatal Checkup (ANC), Postnatal Checkup (PNC), Growth Monitoring and Promotion (GMP) services, PLW counselling, and referral services. From 2015-2022, SHOUHARDO III aimed to help improve gender equitable food and nutrition security and resilience for 170,298 Poor and Extreme Poor (PEP) households living in eight districts of Northern Char and Haor wetland areas of Bangladesh.

Bangladesh_Doctor performing medical check on pregnant woman

Photo: Josh Estey/CARE

What did we accomplish?

  • Increased access to healthcare services in hard-to-reach areas. PCSBAs are successfully meeting the healthcare needs of PLWs located in the remotest of areas where formal healthcare facilities are limited. Pregnant and lactating mothers are able to receive health services at a low cost at their own doorstep. In FY22, the program reported that 84 percent of pregnant women received pregnancy care support such as additional food and daytime rest during their pregnancy period. In addition, around 72 percent of program households mentioned that they have used health and nutrition services in the past year.
  • Sustainable employment opportunity for women. In the past 12 months, PCSBAs trained by the program have earned a total income of BDT 1,723,939 (USD 17,024) with an average monthly income of BDT 5,000 to 10,000 (USD 49-98) per PCSBA. This income comes from service provisioning with set user fees and performing common tests such as pregnancy and blood glucose tests. PCSBAs also make an income from selling health and nutrition commodities such as common over-the-counter drugs and sanitary napkins. One of the major motivations for PCSBAs to provide services is the income they are earning to contribute to family expenditure as well as increased social dignity, respect, empowerment, and reputation in the community for the service they are providing.
  • Strong linkage established between PCSBAs and government health institutes. GoB health service providers utilized PCSBAs in government health-related initiatives such as COVID-19 vaccination program, Vitamin A plus campaign, and GMP services for children under the age of five. The Health and Family Planning officials also ensured the placement of PCSBAs in government health facilities such as Community Clinics and Union Health and Family Welfare Centers to provide services. The support from government health officials to utilize the services of PCSBAs has made it easier for communities to avail services from them.

“Attending the PCSBA training was a great opportunity for me. I was very determined about becoming a skilled birth attendant from my youth as I saw many pregnant women suffer. A lot of women did not have the required nutritious food because they believed that it would increase the child’s weight in the womb resulting in a difficult birth. I also saw many deaths during birth. I wanted to do something about this while also supporting my family. As a trained PCSBA, I am now earning about BDT 20,000 (USD 210) every month and I contribute to my family’s livelihood by helping manage the educational expenses of my children along with other needs,” – Mst. Shabana Khatun.

Bangladesh_Doctor sitting with woman on stoep checking blood pressure

Photo: Parvez Ahmad/CARE

How did we get there?

  • Provide the necessary training to establish skilled birth attendants. In collaboration with the Directorate General of Health Services (DGHS) of Bangladesh, the program organized a six-month-long residential training on Community Skilled Birth Attendant (CSBA) with facilitation support from the Obstetrics and Gynecological Society of Bangladesh (OGSB) and district-level Ministry of Health and Family Welfare (MoH&FW) representatives. The program selected female participants, between the ages of 18 to 45, residing in the program areas who have at least studied till Grade 10. SHOUHARDO III also provided additional training on GMP and ‘Life Skill and Social Business’.
  • Establish platforms to facilitate PCSBAs linkage with health governing bodies. Through the introduction of the Skill Lab Learning Sharing Meetings, PCSBAs regularly receive direct technical capacity-building support. These critical meetings also strengthen networking linkages with the MoH&FW departments. Being recognized and supported by MoH&FW has helped establish the presence of PCSBAs at the community level and has led community members to actively seek out their services. Government health departments acknowledge that PSCBAs are providing services in remote communities where skilled healthcare providers are limited.

“PCSBAs of SHOUHARDO III program are providing safe delivery and anti-natal care and postnatal care services for safe motherhood in remote and isolated areas which is an advantage for poor people, so we applaud the initiative. If any PCSBA wants a seat at the community clinic or upazila health complex, they will be provided the space and other logistics and technical support to practice,” - Dr. Sorwar Zahan, UH&FPO of Char Rajibpur.

Bangladesh_Doctor checking blood pressure on woman

Photo: Parvez Ahmad/CARE

Where do we go next?
“Whether there is a project or not, diseases and needs will remain. I believe people will take services from me as long as they need health care because I provide services at a very low cost. Therefore, even if there is no project, they will take my services on payment. This is my livelihood and my dignity. I shall definitely continue my work, and hopefully, I shall not face any problems in providing my services,” - PCSBA, Gaibandha.
As there is a demand both from the service users’ end, PCSBAs and their service will continue to thrive even without any intervention of the program.

Want to learn more?
Check out the impact brief here.