In Bangladesh, ACCESS aims to increase the practice of healthy maternal and neonatal behaviors at the household level. The overall objective of the program is to increase the practice of healthy maternal and neonatal behaviors in a sustainable and potentially scalable manner. Specifically, ACCESS implements behavior change for maternal and newborn health at the home level and community mobilization at the community level, and engages in policy and advocacy activities to strengthen maternal and newborn health care services. ACCESS is scaling up lessons from the community-based newborn care study project Projahnmo, supported by USAID and the Saving Newborn Lives Initiatives.
ACCESS is implementing this project in seven upazilas (sub-districts) of Sylhet district, covering a population of 1.5 million people. ACCESS is collaborating with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) and two national nongovernmental organizations, Shimantik and Friends in Village Development Bangladesh, to implement the project. Community and religious leaders, members of women’s groups and local officials play a critical role in involving community members at the local level.
To meet the program objectives, ACCESS is conducting home visits with trained counselors to all pregnant women in the program area, mobilizing community support to facilitate the work of the counselors, and developing an appropriate communication strategy to encourage and support behavior change. ACCESS is also strengthening the capacity of the implementing nongovernmental organizations to provide services, counseling, community mobilization and leadership. To effect change at the policy level, ACCESS is conducting advocacy activities to build commitment, mobilize and leverage resources, and ensure ultimate sustainability and scale-up.
The most effective means for behavior change, as lessons learned from Projahnmo study programs, has been shown to be interpersonal communication (IPC) in or near the household, which ACCESS is scaling up in its program area. IPC is done to involve the whole range of important decision-makers with the target group of pregnant women. Most negotiation about specific household barriers and solutions take place at home level. Some of this knowledge can be built through generalized communications, for widespread practice it is necessary to identify barriers and motivators within the household, and address them through negotiation. ACCESS does not provide direct services but depends on basic and comprehensive services for mothers and newborns that are provided by the GoB and NGOs.
The work of the counselors is supported and facilitated through the community mobilization initiative. Community mobilizers work with women’s and men’s groups in the community to encourage and educate them on appropriate home care techniques for both mother and newborn, the need for a birth and newborn preparedness plan for every expectant mother, and their rights as a community to adequate health care. Community mobilizers also encourage the groups to work for change and to feel empowered to make a difference.
In Bangladesh, ACCESS-FP is working with the Johns Hopkins Bloomberg School of Public Health to support the development and testing of birth spacing messages in two unions of Sylhet District in Bangladesh. The study will offer an opportunity to integrate postpartum family planning activities in community-based newborn care program.
About ACCESS:
The ACCESS Program is the U.S. Agency for International Development''s global program to improve maternal and newborn health. The ACCESS Program works to expand coverage, access and use of key maternal and newborn health services across a continuum of care from the household to the hospital—with the aim of making quality health services accessible for women and newborns. Jhpiego implements the program in partnership with Save the Children, Constella Futures, the Academy for Educational Development, the American College of Nurse-Midwives and Interchurch Medical Assistance.
