Community involvement in maternal health care financing scheme: Experiences from rural Bangladesh

The maternal mortality ratio is comparatively high in Bangladesh. Though it has declined from more than 600 in 1980 to 322 in 2004, it is still one of the highest in the world. Studies suggest that utilization of maternity care can reduce maternal mortality significantly. However, the utilization of maternity care provided by trained professionals during and after delivery is alarmingly low in Bangladesh. Several experiences reveal that community participation can improve health delivery care system and utilization of services. Financial assistance to poor women to avail pregnancy related services has been tested in an operations research project conducted by Population Council in 2008 where community participation was ensured at every stage of the project. The present study aimed to investigate the effects of community involvement in maternal health care financing scheme to improve utilization of pregnancy and delivery care from trained service providers. Findings reveal that community members played a critical role in selecting poor pregnant women, creating awareness in the community through several behavior change communication activities and organized regular monthly meetings to identify barriers and possible solutions to improve utilization of maternity care. Community members contributed significantly to strengthen health facility to provide quality maternal health care services. Along with documentation of community members' activities, in-depth interviews with women were conducted. Findings suggest that utilization of ANC, delivery and PNC from trained providers has increased significantly due to involvement of community groups.