UNFPA Midwifery 2017-2021
Contribution ID : SE-0-SE-6-52170012This website displays open data about Swedish aid, which shows when, to whom and for what purpose Swedish aid is paid out, as well as what results it has produced. This page contains information about one of the contributions financed with Swedish aid.
UNFPA has submitted a project proposal for financial support to the implementation of the program “Strengthening Midwifery – led continuum of care in Bangladesh”. Over a four year period (2017-2021) Sweden will provide SEK 61 500 000 to support the introduction of the Midwifery profession in Bangladesh by UNFPA in cooperation with the Ministry of Health (MOHFW...
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UNFPA has submitted a project proposal for financial support to the implementation of the program “Strengthening Midwifery – led continuum of care in Bangladesh”. Over a four year period (2017-2021) Sweden will provide SEK 61 500 000 to support the introduction of the Midwifery profession in Bangladesh by UNFPA in cooperation with the Ministry of Health (MOHFW). The funding allocation covers three specific outcomes: i) increased number and capacity of midwives, ii) increased availability of quality of Emergency Obstetric Care (EmONC), and iii) Increased access to family planning and services with a particular focus on adolescents. SEK 500 000 are earmarked for an external evaluation that will be carried out at the end of the programme. SEK 15 000 000 are specifically earmarked for expanding sexual and reproductive health care to girls, women and adolescents living in areas affected by the Rohingya crisis. The intervention will complement the work of the Government of Bangladesh in developing midwifery workforce in which UNFPA has comparative advantage, and will positively impact on result area four (4) on improved basic health in the Swedish Result Strategy with Bangladesh 2014-2020. In particular, the intervention will be targeting the sub-results i) more women with access to good maternal health care, ii) more people with access to sexual and reproductive health and rights and iii) reduced child mortality. In addition, the proposed contribution gives continuity to existing interventions in the health sector financed by Sweden.
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Result
The Swedish supported UNFPA midwife project has been done during a time when the midwife profession was recently introduced in Bangladesh. During the project period Bangladesh celebrated 10 years with midwives (year 2022). During this period UNFPA has played a key role in establishing not only the midwives politically in the government but also professionally in the health care facilities. Relevance of the Project: The project has been clearly designed in accordance with the priorities and strategies of the Government of Bangladesh (GOB). The findings demonstrate that the Theory of change and the RRF were relevant and responsive to the need of the target populations and the project strategies were fully aligned with the UNFPAs 9th Country Plan for Bangladesh. Effectiveness of the Project: Overall, the UNFPAs project on Strengthening Midwifery-led Continuum of Care in Bangladesh has been successfully implemented according to the RRF (Ref: Project Proposal 2017-2022), proposal, implementation plan, and the intended goals and objectives of the project. The project has been effective in already achieving most of theplanned outcomes and outputs. Sustainability of the Project: The concrete outputs of the project such as midwifery curriculum, different guidelines, SOPs, and the CPD packages have already been approved and therefore continue to be the part of the midwifery higher education programme in Bangladesh. It is also clear thatother benefits midwifery led comprehensive SRH component would be sustainable beyond the project period. The first outcome of the project focuses on strengthening midwifery education and the development of the midwifery profession in Bangladesh. Currently there are 19 new government midwifery institutes added- to a total of 60 (National). The process for BSc in Midwifery has been finalized. 4 national schools with a total of 80 slots (with 4 international students). Two PhD candidates enrolled and started their studies in Bangladesh. The finance for their 4 year study is allready allocated from UNFPA within this project. The purpose of their PhD is to be the academic leaders for the first master courses in Bangladesh. Masters curriculum drafted for 2 institutes in 2024. Ongoing in-service orientation/ training Accreditation of educational institutions is starting to take place Mentorships: district hospitals, urban, education. Standard Operating Procedure for midwives in Bangladesh has been developed. Licensing exam held (1373) 98% passed- the practice mock test has helped Technical support to DGNM and BNMC Accreditation process has been initiated by BNMC. The tool for accrediting midwifery educational programs has been revised based on the initial data gathered to align with the current nursing accreditation and global standards. This tool has been approved by the Ministry of Health and Family Welfare (MOHFW). In coordination with other stakeholders, the accreditation process has been initiated at Dhaka Nursing College A new revised SOPs was approved by the government. Re- licensing after 5 -years has been introduced. The Bangladesh Midwifery Society (BMS) election was successful. BMS later gave adviceto the Bangladesh Nurses Association got advice on how to do their elections. Six sub-committees have been formed in the BMS. Media outreach has been increased with the help of Royal College of Midwives. A discussion was held with UNFPA if BMS could be used in ant-corruption mitigation. 120 midwives have completed comprehensive SRHR including stabilization of emergencies and telemedicine Training and mentoring continuous Faculty mentorship has been initiated where a dialogue has started with GoB to initiatemidwifery faculty positions. In addition, the online platform for Bangladesh Midwifery Society (BMS) members to access courses is ongoing, including a portal for the Massive Open Online Course (MOOC) at Dalarna University. The MOOC has now taken on new importance as learning is all virtual so many more faculty and students have developed virtual competence and have thus been able to complete the MOOC certificate. . The seven new young leaders at the BMS as well as the current board members have been very active in the COVID-19 response through assessing the needs of the deployed midwives, supporting pregnant mothers, distributing PPE and other needed equipment, and providing support to midwives who have tested positive for COVID-19. The second outcome of this project focuses on improving the quality of emergency obstetric and newborn care (EmONC) services. This was done by frequent training and mentorship on COVID-19 safety including triage, infection control, personal protection, and separate maternity areas in 24 UHCs in the Sida supported districts. In addition, work focused on increasing the reception and stabilization of women with postpartum hemorrhage (PPH) and eclampsia at the district hospitals (DHs) and UHCs continues. Much of this work is performed through mentors deployed through the DGHS focused on improving EmONC and midwifery-led care now in the context of COVID-19. In addition, as part of the COVID-19 response, 60 roving midwives were placed in four medical college hospitals in Dhaka City Corporation, four district hospitals, and 22 sub-district hospitals. This deployment helped all four district hospitals and 19 of the sub-district hospitals to return to, and in some cases increase, their pre-COVID numbers for labor and deliveries. The midwives are ensuring the continuation of essential services and supporting improved care quality on the maternity wards. All the targeted 15 UHCs (100%) provided EmONC services without stock-outs of life saving drugs in the last year. All of the facilities are currently using partographs and in this reporting period. The third outcome of this project focuses on ensuring greater capacity and accountability for family planning service provision in the target districts. A total of 159 healthcare providers have been trained during this period on issues such as postpartum family planning and adolescent friendly health services. Regular field visits by UNFPA field officers and family planning facilitators to health facilities to monitor and provide technical guidance and counselling on inserting postpartum IUDs have contributed to ensuring that 40% of the targeted UHCs are providing postpartum IUDs through midwives. A total of 133 service providers including FWVs and SACMOs from Coxs Bazar and Sunamganj districts and 46 midwives from Noakhali district have received training on adolescent friendly health services. Two Family Planning Counsellors was deployed at Noakhali DH and Chatkhil UHC. Total 2674 women were counselled and 1278 have adopted FP methods during the reporting period. Refresher training for FWV and SACMO on Adolescent Friendly Health Services (AFHS) at Noakhali and Sunamganj. Total Participants were 131 among them 68 from Noakhali and 63 from Sunamganj. A team of 60 roving midwives were deployed to four urban hospitals with designated COVID-19 maternity wards and 20 Upazila Health Complexes (UHCs) that were required for additional support due to staff illness, patient overload, and the need for separate COVID-19 staffing. These midwives moved based on the needs of the health facilities. Project data shows that, normal deliveries in 26 hospitals have increased from 9,484 in January-June 2020 to 14,765 in July-December 2020. Similarly, less maternal deaths were reported from those facilities during July to December 2020. In addition, ambu bags and PPE were purchased for all UHC to support designated Covid 19 maternity areas. To ensure maternity services with a focus on avoiding risk of virus transmission, Directorate General of Nursing and Midwifery with technical support from UNFPA is implementing phone/mobile based remote ANC, PNC services as a pilot programme. It is based on the WHO recommendations on number, timing and type of interventions during ANC and PNC through remote contacts (using mobile phone) to reduce risk of exposure and transmission. A total of 70 midwives were trained virtually and 20 midwives physically from UHCs of five SIDA districts on telemedicine services. Under this telemedicine pilot a large number of women received services. This includes 4,194 ANCs, 1390 PNCs, 4194 GBV Screening and 19 GBV case referrals between January to March 2021. Also the support allowed Midwives to have proper PPE protection and seperate delivery rooms for suspected infected mothers with Covid-19.
The main goal is to improve the health of mothers and adolescents in selected districts of Bangladesh. The main outcomes are: 1) Increased number and capacity of midwives; 2) Increased availability and quality of Emergency Obstetric Care; 3) Increased access to family planning information and services with a particular focus on adolescents. The outputs that the project will achieve are identified as follows: Output 1.1: Midwives well educated and trained to international standards. Output 1.2: Midwives regulated to international standards. Output 1.3: Midwives are represented by a national recognized professional association. Output 1.4: Midwives contribute to assuring greater equity in health systems. Output 2.1: Models for district level Emergency Obstetric Care improvement established. Output 2.2: Increased coverage and quality of Basic Emergency Obstetric Care services in supported locations. Output 2.3: Improved quality of Comprehensive Obstetric Care. Output 3.1: Improve availability of modern contraceptives in the community and health facilities. Output 3.2: Improved capacity of service providers on adolescents sexual and reproductive health. Output 3.3: Increased awareness and demand for family planning. A third amendment with 4,6 MSEK additional covid19 support and a costed programme extension of 23 MSEK April 2021 - March 2022 was assessed in July 2020. UNFPA requested in March 2020 to reprogramme 230 000 usd funds from 2020 that could not be spent due to the present pandemicas well as 500 000 USD additional covid19 funding. The reprogrammed and additional funds for covid19 were directed to the activities at Upazila Health Clinics, UHC, and clinical facilities for midwives in the Swedish supported districts and Dhaka cc. All the activities within the Covid-19 response fall under Case Management and Infection Prevention Control (IPC) Pillars and Risk communication/awareness and community engagement pillars of the CPRP including the continues use of roving midwives to reach pregnant mothers during the pandemic. With the Covid pandemic reaching record number of infection and deaths during march-april 2021 and with the risk of a longer lock down UNFPA requested new support in the form of 700,000 USD. The goals of the Covid response will be: Outcome 1. Increased utilisation of quality of SRHR services in the context of COVID-19. Outcome 2. Continuation of RMNCH services (ANC, PNC, delivery care, FP and GBV), through telemedicine and emergency hotlines to be in compliance with global COVID maternity guidelines. Outcome 3. Infection prevention and control (IPC) and effective triaging system established for separate maternity areas. Outcome 4. Transport for midwives supervisors, health care providers and pregnant women for referral.
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