Involving community in improving reproductive health service delivery in Bangladesh

Despite remarkable progresses in several reproductive health indicators in Bangladesh, the supply-driven reproductive health programs have fallen short in reaching underserved populations. An operations research project was conducted to create demand and increase utilization of services. The project adopted a multi-pronged approach. The key intervention was to select and train volunteers, termed as “peer promoters”, for reproductive health promotion in the community. The other major intervention was to involve local stakeholders in health service improvement by forming community support group (CSG). The primary responsibility of CSG was monitoring local reproductive health services. In addition, they extended support to fieldworkers and peer promoters in organizing awareness raising activities. As a result of the interventions, people were more likely to understand the importance of reproductive health. Ninety percent of the respondents could recognize the government health centers in their localities. Interventions increased utilization of reproductive health services from local health facilities by males. Similarly, the number of women receiving maternal health services from facilities increased. Clients receiving antenatal care increased from 41 to 89 percent due to interventions. The proportion of deliveries assisted by trained providers increased from 6 to 22 percent. Clients receiving postnatal care increased from 10 to 60 percent. Increase in the utilization of family planning services was also observed. Over the one-year intervention period, the use of modern contraceptive methods increased by 3.4 percentage points. If community volunteers participate in service delivery and community leaders monitor services, there will be increased demand for services, resulting in higher utilization.