MCH Services unit ensured healthy reproductive life of women and adolescent during pregnancy and child birth and throughout the whole span of reproductive life by skill service provider at home and facility to achieve MDG-4 & 5 and also in line with vision 2021.
- To ensure services to provide safe delivery at home and facility
- To provide services to adolescent boys and girls
- To provide services to community people on nutritional aspects of health
- To provide RH services such as MR, PAC, VIA & CBE, Fertility care
- To train service providers to ensure quality of care
- To ensure MSR/logistic supplies to service delivery point and the community
- Minor repair/renovation of service centers
- To introduce new evidence based best practices in the program
- To monitor and supervise the program activities to ensure quality of care
Existing Service Centers
| At National level | Maternal and Child Health Training Institute (MCHTI), Azimpur, Dhaka.
Mohammadpur Fertility Services and Training Centre (MFSTC). Mohammadpur, Dhaka. |
1 1 |
| At District level | Mother and Child Welfare Centers (MCWC) | 60 |
| At Upazila level |
MCH-FP unit at Upazila Health complex (UHC) Mother and Child Welfare Center (MCWC) |
427
12 |
| At Union level | Union Health and Family Welfare Centers (UH & FWC) Mother and Child Welfare Center (MCWC) |
3860 24 |
| At Community level | Satellite Clinics (Per Month) | 30,000 |
| Community Clinics | 12217 |
Main activities of MCH Services unit
-
Maternal Health Services:
- Registration of all pregnant mothers;
- Increase birth planning and antenatal care (ANC);
- Safe delivery by trained service providers at home and at facilities (MCWCs and Upgraded UH&FWCs) with active management of 3rd.stage of labor.
- Ensure24/7 EOC services in all MCWCs and selected UH&FWCs.
- Use of Tab. Misoprostol at field level to prevent PPH
- Use of Mg. Sulph. to prevent Eclampsia.
- Postnatal care (PNC)
- Performance based financing for the service providers;
- DSF for the service providers and clients; and
- Community mobilization activities;
- Reduction of unsafe abortion through safe MR services and Post Abortion Care;
- Syndromes management of RTI/STI through diagnosis and treatment;
- Counseling on RTI/STD, HIV/AIDS and Condom promotion;
- Provide health education for adopting preventive measures against RTI/STTDs with especial emphasis on condom promotion;
- Prevention of unwanted pregnancies through Emergency Contraceptive Pill.
- Early detection of Cervical cancer through Visual Inspection of Cervix with Acetic acid (VIA) and screening for Breast cancer.
- Fertility care services and treatment of infertility.
- Implementation of adolescent health strategies action plans;
- Promotional activities on delayed marriage;
- Counseling and developing awareness of adolescents on personnel hygienic practices, nutrition, puberty, anaemia, RTI/STI, unprotected sexual activities, night wets, drug addiction, accident, violence and sexual abuse;
- Train adolescents on SRH through peer groups;
- Management for minor gynecological problems i.e. dysmenorrhea, and menorrhagia etc.;
- Syndromes management of RTI/STDs, awareness creation on HIV/AIDS and condom promotion for married adolescents;
- Providing consultation and treatment for some reproductive health related problems of adolescents;
- Full immunization of adolescent girls with five dose TT vaccination in coordination with EPI Program;
- Initiation for making all service centers adolescent friendly in phases.
- Promoting integrated approach to address sick Child through IMCI including ARI/ pneumonia, Diarrhea, malnutrition, fevers etc.
- Growth monitoring
- Providing medication of Deforming
- Routine immunization in coordination with EPI Program and Vit-A supplementation
- Ensuring management of drowning, injuries and accident
- Limited curative care for Eye, Ear, Skin infection/worm infestation etc
- New born care :
- Health education for mothers on cleanliness, nutrition, danger signs of both mother and baby, Umbilical cord care, Breast feeding, Thermal control, EPI etc.
- Management of birth asphyxia
- Routine eye care, and
- Special care of pre-term and low birth weight baby
- Exclusive breast feeding
- Complementary feeding
- Growth monitoring
- Vit-A Supplementation
- Iron Supplémentation (Micro Nutrient Powder)
- Zinc Supplementation
- Deworming
- Iron & Folic acid Supplementation for pregnant & lactation woman
- Early initiation of breast feeding
- Postpartum-Vit-A
- Weight monitoring for pregnant women
- Food intake (Quantity & Quality)
- Training of service providers (Doctors and FWV) on Emergency Obstetric Care (EOC) services;
- Midwifery training for FWVs.
- CSBA training for FWAs to ensure safe delivery round the clock at the community level.
- Training on reproductive health activities such as MR, PAC, VIA & CBE etc;
- Training on adolescent health activities to service providers and adolescents and other stakeholders.
- Training on RTI/STI, VAW, Infection Prevention and other RH Services
- Training on Essential Newborn Care
- Training on IYCF and MNP supplementation
- DDS kits, RTI/STDs drugs, drugs for conducting safe delivery and other essential drugs; such as Tab. Misoprostol, Inj. Mag. Sulf.
- Micronutrients Powder (MNP);
- Hospital equipment’s, surgical instruments and MSR such as MR kit, MVA kit, BP machine, Stethoscope, weight machine;
- Service procurement for consultancy, maintenance of hospital equipment’s etc.;
- Printing and Publications of different types of forms, registers and IEC materials.
Component-1
-
Reproductive Health Care services: It include
-
a) Adolescent Health Care Services
b) Newborn & Child Health Care Service
c) Nutrition Services
Maternal, New born nutrition and Child Nutrition activities will be streamlined in the DGFP Program through this OP. The activities are reflected in this-OP but the logistics/supplies will be provided by as part of the “National Nutrition Service” OP. The nutritional activities will be as follows :
Component- 2
- Training
Component- 3
- Procurement
MC-RAH Services including Emergency Obstetric Care (EOC)
70 MCWCs (District-60, Upazila-8 and Union-2) have been providing (i) EOC services (Caesarian operation; management of ruptured uterus, ectopic pregnancy, PPH, and eclampsia; repair of perenial tear up to 3rd degree, assisted vaginal delivery, removal of retained placenta etc.) 24/7 days, (ii) other safe motherhood services (ANC, safe delivery, PNC, MR and Post Abortion Care (PAC), Primary screening for Cervical cancer through VIA method and Breast cancer screening etc. (iii) Family Planning services (VSC, Implant, IUD, Injectables, oral pill, condom, counseling and management on infertility), (iv) Newborn care, Child health care (EPI, management of ARI/pneumonia, diarrhoea, protein energy malnutrition (PEM), fever etc through IMCI approach, growth monitoring, limited curative care, de worming etc.), and (v) Syndromic management and counseling of RTI/STD, reproductive health care services for women, men including adolescents.
Reproductive Health services
In addition to existing EOC-RH services, adolescent friendly health services, primary screening for cervical cancer in 62 MCWCs through VIA, and developing 62 MCWCs as training centers for CSBA.
Upazilla MCH-FP Unit
At present there are 427 MCH-FP Unit at upazilla level for providing MC-RAH services. Apart from the existing service delivery, Post Abortion Care and Visual Inspection of Cervix through Acetic Acid (VIA) and breast screening through CBE of woman are RH program activities will be ensured.
Up gradation of UH&FWCs
At present there are 3860 constructed UH&FWCs at the union level providing services to 25,000 to 30,000 populations. Out of these already 1441UH&FWCs have been functionally upgraded through equipping, furnishing and minor renovation including provision of skill-mixed manpower in phases and rest will be upgraded in phases. To increase 24/7 delivery at UH&FWCs and early detection of complications and referral to higher centers, services such as Safe delivery, Obstetric First Aid (administering parental Oxytocic drugs, Antibiotics, Sedative/Anticonvulsants and referral) as well as basic EOC services are ensured through these UH&FWCs. Midwifery trained FWVs has been posted to those upgraded centers. They will work round the clock for providing Safe delivery along with Active Management of Third Stage of Labour (AMTSL), New-born care with referrals in addition to normal ongoing MCH-RH-FP services.
Services through the Community Clinics
Primary health care for about six thousand population has been started through the community clinics. Government has already started functioning in12217 community clinics. The service provisions from DGFP are provide ANC, PNC and under five child care along with Contraceptive supply to the eligible couples by FWA within the respective community. Family Welfare Visitor from the UH&FWC conduct the satellite clinic in the community clinic and ANC, PNC and other Reproductive Health related services are provided by her. For these activities provision of DDS kits and other RTI/STI drugs are to be ensured.
Satellite Clinic
Family Welfare Visitors conduct the satellite clinic (organized 8 satellite clinics in each union per month and also at urban slums and hard-to-reach areas) and ANC, PNC and other Reproductive Health related services are provided by her.
Services to community pregnant mother through CSBA, FWA
Registration of all pregnant mothers at the community along with their emergency cell phone number will be collected and reported regularly. Tab. Misoprostol to be distributed to all pregnant mothers ( phage by phage ) after 32 weeks of LMP to be used immediately after delivery of the baby except twin pregnancy to prevent the Post-Partum Hemorrhage (PPH) in case of home delivery
Emergency Contraceptive Pill (ECP)
In Bangladesh, about 1.3 million pregnancies (33%) are unplanned each year. Nearly 39% of couples do not use any contraceptive methods, while 10.8% couples use traditional FP methods and 11.7% have unmet need. Approximately 7300 maternal deaths occur each year due to pregnancy related complications while estimates suggest that 2500 women die due to abortion related complications. Much of this suffering could be averted if women knew about, and had access to emergency contraception, that will provide women a chance to avoid unintended pregnancies if unprotected intercourse occurs. Besides, it could also reduce the incidence of abortion and its adverse health consequences.
Considering ECP as a backup support to the Family Planning method, it should be distributed to the eligible couples who need it by Family Welfare Assistant (FWA) free of charge.
Nutrition services through Directorate General of Family Planning
In accordance with the strategic decision of mainstreaming nutrition through the Directorate General of Family Planning, priority nutrition services will be delivered to the young children and mothers both at facility and community level. The services will include infant and young child feeding counseling; prevention and control of anaemia in children, pregnant and lactating women; screening of SAM, MAM; growth monitoring and promotion; behavioral change communication on nutrition; micronutrient supplementation and service related trainings and others. Training
Service centers and staff at the National, District level and below :
- 1. National :
- Maternal and Child Health Training Institute (MCHTI), Azimpur, Dhaka.
- Superintendent
- Consultant
- Medical officer
- Mohammadpur Fertility Services and Training Centre (MFSTC). Mohammadpur, Dhaka.
- Director
- Deputy Director
- Consultant
- Medical officer
- Administrative Center:
Office of the Deputy Director of Family Planning- Deputy Director (Family Planning)
- Assistant Director (Clinical Contraception)
- Assistant Director (FP)
- Medical Officer ( Clinical Contraception)
- Service Centers :
- MCH-FP Unit-
- At the District Hospital :
Staff: Family Welfare Visitor (FWV) Service Available: Antenatal, normal delivery (limited facilities for “at-risk” cases), postnatal, EPI, child care; all contraceptives including sterilization and follow-up care.
- At the District Hospital :
- Maternal and child Welfare Center (MCWC)
- Staff: Medical Officer (Clinic) Family Welfare Visitor (FWV),Assistant Nursing attendant / Dai Nurses.
Services Available: Antenatal care, normal delivery, postnatal, EPI, Child Care; all contraceptives including sterilization.
- Staff: Medical Officer (Clinic) Family Welfare Visitor (FWV),Assistant Nursing attendant / Dai Nurses.
- Administrative Center :
- Upazila Family Planning Office :
Medical Officer (MCH-FP ), Upazila Family Planning Officer, Assistant Upazila Family Planning Officer and Assistant Family Welfare Officer (MCH-FP). - Service Center:
- MCH-FP Unit.
At Upazila Health Complex (UHC)
Staff: MO (MCH-FP), Family Welfare Visitors (FWVs). - Service Center :
2. Districts :
3. Upazila :
Services Available: Antenatal, normal delivery, postnatal, EPI, health education, child health care; Reproductive health care; Nutrition related services , all contraceptives including; sterilization.
4. Union :
-
Union Health and Family Welfare Center (UH&FWC)
Staff: Medical Officer (FW) (not everywhere) Sub Assistant Community Medical Officer (SACMO) Pharmacist (Not everywhere),Family Welfare Visitor (FWV).
Service available: Antenatal (emphasis on screening for “at-risk” pregnancies and referral), safe delivery, postnatal, child care, health education, reproductive health care; nutrition related services and general patients and all contraception.
5. Unit:
Staff: Family Welfare Assistant (FWA)
MCH-FP services through home visits by FWA Family Planning Inspector (FPI) supervises all FWAs in a Union. Ensure safe motherhood including EOC services with provision of Community based Skilled Birth Attendants (CSBA).
Services available: Antenatal screening, referral for safe delivery, contraceptive supply (pill and condom), Nutrition, ARH and EPI related activities. Services are being expanded through satellite clinics at the community level.
