Reaching underserved populations with reproductive health services: What works

Although Bangladesh has a comprehensive service delivery structure in rural areas, the utilization of facilities for family planning, maternal health and reproductive health services is alarmingly low. Several operations research studies were conducted to identify innovative, participatory and effective service delivery models for increased use of those services. Each of the studies used specific interventions, along with several generic interventions: strengthening health facilities; capacity building of service providers and fieldworkers; conducting targeted BCC activities; involving community in developing, implementing and monitoring.

A voucher mechanism was tested to address demand-side barriers, by providing financial assistance in the form of vouchers to poor pregnant women for receiving life saving obstetric care. Introduction of voucher scheme increased the utilization of trained providers during pregnancy and delivery by poor women. Another model investigated the feasibility of introducing male and youth friendly reproductive health services in female-focused service delivery points by establishing male and youth friendly corner and ensuring male service providers in these facilities. Due to interventions, clients flow to facilities increased remarkably and use of modern FP methods reported by the married men increased. A service delivery model was introduced to increase rational use of modern contraceptive methods according reproductive life cycle, which examined a combined involvement of fieldworkers and community volunteers for creating demand among eligible couples. This model yielded in an increase in the utilization of long-term and permanent methods. Overall, tailored demand-based strategies are necessary to increase utilization of services provided that facilities are well-functioning.