Attachments
Executive Summary
Introduction
In July 2017, 10 children died of an unknown disease in Tripura Para, a village in Sitakunda Upazila. In response GoB Institute of Epidemiology, Disease Control and Research (IEDCR) was sent to area. It was later found that the children had died due to measles and undernutrition. GoB initiated a measles vaccination campaign in Kumira and Sonaichori unions in Sitakunda Upazila. In Tripura Para village, MoH established a Community Clinic that is operational 2 days a week. Despite availability of GoB health facilities in Sitakunda district, area like Tripura Para have been deprived from health care services including immunization and treatment of common illnesses. Especially indigenous population living in Sonaichori and Kumira unions have difficulties accessing health services due to the difficult geography (hilly), distance and barriers in language. It’s assumed that due to the existing poor health and nutrition status and poor access to health facilities of the population in Sitakunda Upazila, the nutrition status of the population is likely to further deteriorate and may resulting in more unnecessary deaths if nutritional treatment is not made available.
The overall objective of this assessment was to assess the feasibility and facilitating environment of Sonaichori and Kumira unions and Upazila health complex for implementing the CMAM through existing government health facilities. The assessment was conducted by a technical team comprising Upazila Health Complex (UHC), Action Against Hunger and UNICEF representatives from 20-23 August 2017. The approach involved conducting Key Informant Interviews (KIIs) with staffs of 6 health facilities, visits to field sites to 1 Upazila health complex, 1 Union Health and Family Welfare Centre, 2 Community Clinics, 1 union rural sub health centre and 1 NGO Clinic, observations, review of records and community Focus Group Discussions (FGDs).
Methodology
The assessment was performed through direct observation of six health centres, individual interviews of six key persons from health centres and two from community, two FGDs and review of secondary data. Assessment themes were derived from the WHO six building blocks namely nutrition governance, nutrition financing, health service delivery, human resources, equipment and supply, referral, monitoring and supervision mechanism. Findings were compared with national CMAM guideline.
Results
The government of Bangladesh has developed inpatient SAM guidelines and CMAM guidelines, and a policy offering free-of-charge health care for under-five children. Out of the 6 health centres of Sonaichori and Kumira unions of Sitakunda including UHC and 1 private clinic assessed, 5 were active and 1 was temporary setup with limited services, among which 1 centre (UHC) delivered inpatient services, 6 outpatient services and 5 outreach services.
These were regarded as opportunities to include CMAM activities in the existing service delivery.
Almost 20% of the required positions to provide quality health services were vacant. Existing health workers were not trained on management of acute malnutrition. Equipment and supplies did not meet the operational recommendations for management of acute malnutrition.
However, after the outbreak at Tripura Para of Sonaichori union, IPHN with support from UNICEF supplied F-75 and F-100 on an urgent basis but those were not in use.
The epidemiological data and FGDs suggest that the key morbidities in community are Diarrhoea, Acute Respiratory Infection (ARI) and Measles, with higher relative incidence rates in the children U5. Infant and young child feeding practices were not up to the mark. The population has severe limitations in access to and availability of quality health and nutrition services. Poverty, literacy, geographical distances, user fees at health facility level (claimed by community people), lack of awareness and poor health seeking behaviour are the key barriers to access at the community level. The findings also suggest that there are needs in mental health and WASH which could be integrated with health and nutrition service delivery facilities.
Conclusions and recommendations
The assessment identified the needs of the community for strengthening health and nutrition service delivery as well as mental health and WASH activities. It is feasible to set up a stabilization centre at Upazila level hospital in Sitakunda. However, the roll out of Outpatient Therapeutic Programme (OTP) sites will need additional support from Mobile Health and Nutrition teams, with community level outreach services through Community Nutrition Volunteers (CNVs). Building technical and infrastructural capacity complemented by community buy in and social mobilisation will be imperative for successful programme implementation. Key programmatic challenges could be (but not limited to); recruitment and retention of quality staff especially at SCs, coordination with Community level health workers and social mobilization.