Scaling-up Community Mobilization in Sylhet District, Bangladesh: An innovative strategy of community empowerment

Background:

Sylhet, a north-eastern district of Bangladesh, is generally considered “conservative” area. 94% deliveries take place at home; U5 mortality is 50 % higher than national average. To improve maternal and newborn care household practices and increased utilization of MNH services in this conservative society, ACCESS is scaling-up with an improved community mobilization strategy.

Design and Evaluation Methods:

The community mobilization strategy is based on community action cycle. ACCESS trained over 110 CM facilitators using cascade approach and local NGOs are implementing this large scale project. The ability of groups is assessed through weekly visits and monthly reports during which various information is collected in community meetings, MNH issue prioritized, action taken, challenges faced, lessons learnt.

Results/Outcome and Challenges/Solutions:

ACCESS is engaging over 1,174 groups in CAC in over 616 villages, each village having a male and a female group. Each group has 15-20 participants representing most affected and vulnerable communities. At the end of January, 2009, total 18,610 community meetings conducted with average 25 participants in each meeting. As per the findings of community monitoring, total 13,814 pregnant women and 9,220 delivery notified by the group members. 1,364 PW/newborns identified with danger signs. 46% groups generated emergency funds for seeking emergency care for mothers and newborns. 57% groups developed emergency transportation system for referring mothers and newborns to nearby hospital by community transport. 04 Satellite clinics and 02 EPI centers re-opened by the group initiatives. Over 60% of most affected and vulnerable peoples are engaged with groups to change their life. 100% meetings are held at community households or mosques/school premises without any incentive expressing community commitment.

Conclusions:

The bottom-up approach of community mobilization is essential for sustainability of the program. The community groups are becoming capable of both supporting home care messages and advocating with local government authorities to improve quality and coverage.

Lessons learnt:

1. One Facilitator simultaneously facilitates 16 groups and it has been extremely beneficial for him/her to share the experience from one to other and handle challenges.

2. Cascade training has helped the program to train more people in a short period of time.