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4.1 Community Health Worker Model
The need:
Ensure essential, life-saving interventions to bear the greatest burdens of preventable disease especially in the LMICs
Shortage of health workforce suffer from impaired provision of important, life-saving interventions, such as immunisation, antenatal care for pregnant women, and nutrition services that can result in a significantly higher level of disease burden, health inequalities, mortality, and morbidity
The numbers of health workers and quality healthcare are positively correlated
Shortage of healthcare-related human resources, the use of (CHWs) has become increasingly important in many LMICs
Community Health Worker program under the Government of Bangladesh - A historical overview
Community Health Worker program under the Government of Bangladesh - A historical overview
In 1998 the government established a national network of community clinics. This decision was squarely in accordance with an emerging global consensus that building effective community-level facilities can powerfully complement the work of CHWs.
The community clinics were staffed by CHWs and provided a crucial link to basic medical services in rural communities and small towns. A change in national administrations resulted in a shutdown of the clinics in 2002 until they reopened in 2009.
4.2 Midwidery in Bangladesh
Bangladesh is among the few nations that have made notable progress in the development of maternal health; however lack of trained midwife at the time of birth remains particularly a great concern. Bangladesh Demographic and Health Survey (2014) indicates that the trained midwife aided deliveries increased from 16 percent in 2004 to 42 percent in 2014; nonetheless, seeking midwifery guidance is alarmingly low among the less educated people living in remote areas.
There are above five thousand pregnancy-related deaths of women and seventy-six thousand neonatal deaths, and more than eighty stillbirths are reported every year in Bangladesh
WHO reports, in Bangladesh, about 63.9 percent of women in their pregnancy visit antenatal care (ANC) at least once, against a minimum standard of four-time visits. Near about 60 percent of the deliveries do not happen in health facilities.
Medically trained cadres, such as doctors, nurses, family welfare visitors, midwives, and other medical assistants support only 13% of the deliveries.
Further, the severe deficit of nurses in Bangladesh limits existing registered nurse-midwives from being entirely utilized for midwifery activities.
Barriers faced by midwives in Bangladesh
Barriers faced by midwives in Bangladesh
Social Barriers
The social barriers preventing midwifery quality care falls outside the parameters of Bangladeshi cultural norms that have been shaped by beliefs associated with religion, society, and gender norms. This puts midwives in a vulnerable position due to cultural prejudice.
Professional Barriers
Professional barriers include heavy workloads with a shortage of staff who are not utilized to their full capacity within the health system. The reason for this was a lack of recognition in the medical hierarchy, leaving midwives with low levels of autonomy.
Economic Barriers
Economical barriers were reflected by lack of supplies and hospital beds, midwives earning only low and/or irregular salaries, a lack of opportunities for recreation, and personal insecurity related to lack of housing and transportation.
house far from the upazila health complex creates safety concerns
Education Barriers
Gap between their theoretical knowledge and practical experience and there were no clinical teachers.
Further Reading
Exempalrs in Global Health, " How did Bangladesh implement?",
https://www.exemplars.health/topics/under-five-mortality/bangladesh/how-did-bangladesh-implement#workingMuhammad Rehan Masoom , " Ensuring the First Breath: A Growing Accountability of Midwifery in Bangladesh", International Journal of Population Research, Mar 2017, https://www.hindawi.com/journals/ijpr/2017/1539584/
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