Intervention(s)
In Bangladesh, the Connect project layers light-touch interventions, called “enhancements,” onto a larger USAID-funded project, called MaMoni MNCSP, and existing government supported platforms. Connect supported the Ministry of Health & Family Welfare (MOH&FW) to introduce a targeted PNC approach, including PPFP, at facility and community levels. Connect began small-scale testing in two upazilas in the Noakhali District (Kabirhat and Companiganj) in January 2021.
For the cluster randomlzed controlled trial (cRCT), the activities were expanded to two new upazilas in Noakhali (Begumgonj and Subarnachar) starting in June of 2023 and introduced in two upazilas in Madaripur (Sadar and Kalkini) starting in December of 2023.
Community Level
At the community level, Connect enhancements build on standard FWA home visits implemented by the government (not MaMoni supported) and pre-existing courtyard meetings implemented by the Government of Bangladesh.
Courtyard meetings are one of the strategies that the Bangladesh family planning (FP) program uses to disseminate FP messages and provide access to contraceptives. These meetings, which are led by FWAs, are convened monthly in the FWAs’ catchment area Courtyard meetings are implemented by the Expanded Program on Immunization (EPI), an existing government platform. These meetings are open for all community members to participate. FWAs facilitate discussion on maternal and child health and family planning and sensitize all participants to the importance of accessing maternal and child health services across the continuum of care. They also provide access to short-acting FP (e.g., condoms, contraceptive pills, second dose of Injectables) and referrals for long-acting methods (i.e., implants, IUD) during these meetings. Connect enhanced these meetings by reinforcing the regularity of these meetings, ensuring they occurred as scheduled. In addition, Connect provided additional training to FWAs to sensitize them to the needs of first-time parents and to particularly encourage attendance of first-time mothers (see more detail under home visits).
Home visits are conducted by FWAs and Paid volunteers (PVs) across all communities. FWAs and PVs identify women who are currently pregnant or recently gave birth in their assigned catchment areas through regular rotations. During home visits, FWAs and PVs provide information to new mothers on ANC, PNC, and PPFP; and distribute short-acting FP methods (e.g., condoms, contraceptive pills, second dose of injectables) and provide referrals for long-acting methods (e.g., implants, IUD). Connect enhanced these home visits by adjusting the procedure for targeting mothers and the content provided during those meetings. First, FWAs are provided a risk-stratification assessment checklist (algorithm) to identify at-risk mother-baby dyads to prioritize for home visits. In particular, first-time mothers and mothers who give birth at home are prioritized for these visits. Second, FWAs and PVs are provided additional training on the needs of first-time parents. They are trained to provide referrals to facility-based providers for ANC, delivery, and PNC; to encourage facility delivery; to advertise the existence and timing of courtyard meetings, and to involve other family members during the home visit. Third, Connect introduced two materials that are distributed during these home visits: an invitation card that provides information on the nearest facility, encourage FTMs to attend the facility for ANC, delivery, PNC, and PPFP and link the mother with the facility-based service providers and a mother-baby booklet that provides mothers with reference information on the continuum of care, from ANC to PNC and PPFP and role of other family members towards FTM. These materials are also distributed by facility-based providers during facility visits.
Facility Level
At the facility level, Connect enhancements build on standard provider training on PPFP counselling, PNC and postpartum intrauterine contraceptive device (IUD) insertion. Connect introduces a PNC Quality Improvement bundle and a pre-discharge counselling checklist that provide guidance on recommended actions depending on the condition of the FTM after giving birth at a facility and outlines information to provide the FTM around best practices for taking care of herself and her baby after going home, warning signs to watch out for, postpartum family planning, and when to return to the facility for PNC.
Interventions being evaluated by the cRCT
The cRCT is specifically focuses on evaluating enhancements at the community level delivered by the FWA.