Other Key Areas of Programming
Created 2011-11-03 13:24:35 Last Modified 2013-05-23 12:26:08
HPNSDP & SWAp
The Health, Population and Nutrition Sector Development Programme (HPNSDP 2011-2016) is a multi donor-funded initiative in Bangladesh which employs the use of a Sector Wide Approach (SWAp). Initiated in 1998 under the original HPSP (Health and Population Sector Programme), HPNSDP seeks to “define an overall strategic framework to guide investments in the sector [and] is intended to provide the basis for sector development and innovations over the next five years in a consistent direction”.
With the end of HPSP in 2002, the newly formed government at that time revitalized the tenets of the sector program in initiating HPNSP for the period of 2003 -2011. The ending of the first HPSP sector program marked shift away from a multiple ‘project-based’ support, to a complete programmatic, ‘systems’ approach aimed at revitalizing the entire health sector in Bangladesh.
The goal of the Health SWAp is to achieve sustainable improvement in the health, nutrition and reproductive health for vulnerable groups including women, children, the elderly and the poor. Out of the evaluation of the previous HPNSDP (203-2011), key areas of intervention were identified that will be targeted under the next phased program from 2012-2016 in three distint components:
1. Improving overall Health Service Delivery for SRH, MNCH and FP; communicable and non-communicable diseases; mainstreaming essential nutritional services; increasing access to health services
2. Strengthening Health Systems for sector planning/budgeting; health information systems; human resources; financing; quality control; management in the supply chain; facilities development
3. Stewardship and Governance that will enhance the GoB’s effective management and support to the health sector through legal frameworks; policy development; reform on equity and gender; decentralization and enhancement of local level planning.
The next five-year program will also seek to improve and revitalize community health care initiatives that will further improve service delivery; and will seek to move the country closer towards achieving the health-related MDG indicators (i.e. maternal mortality, child mortality, fertility and maternal/neonatal & children’s health, MNCH).
The GoB has committed a significant amount of its revenue budget to the HPNSDP pool fund, where donors also contribute to the total funding allocation made by government. Funds are committed to a core budget which supports the program, and contributors (such as UNFPA, USAID, World Bank, ADB, AuAID, et al) advise the government on the adaptation and implementation of systems-based enhancements to the overall health sector in Bangladesh under country strategies and multi-year planning.
Adolescent Reproductive Health
As young people make up a considerable and growing segment of the demographic in Bangladesh, adolescent reproductive health deserve critical attention in the streamlining of effective Health Sector services and support.
The approaching demographic window, when the sheer size of the working-age populace will reach a critical mass, needs urgent debate and discussion at the policy level concerning social and economic areas of development, international partners and national institutions.
UNFPA, Bangladesh has supported programmes that are aimed at developing a national adolescent reproductive health strategy; increasing the total number of Health Sector delivery points offering information and services for young people and increasing the overall proportion of adolescents who are knowledgeable about HIV/AIDS and STI.
UNFPA employs behavioral change communications (BCC) strategies and public awareness campaigns; promoting the use of condoms amongst commercial sex workers through a Partnership Forum related to HIV/AIDS and sex work; as well as workshop seminars for parliamentarians and capacity training for law enforcement officials and agencies through a detailed HIV/AIDS strategy.
HIV/AIDS, Sexually Transmitted Infection (STI)
Although Bangladesh has a low prevalence of HIV/AIDS (less than 1% among general population), low rates of condom use and low level of awareness about HIV/AIDS have far-reaching implications on HIV transmission to vulnerable segments of the society (e.g. IDUs). Young boys are also particularly vulnerable to Sexually Transmitted Infections (STI) and HIV/AIDS.
Inadequate knowledge and peer pressure many boys get involved in unprotected sex/commercial sex and drug use which make them extremely vulnerable to HIV/AIDS and STI. Access to appropriate SRH information and services for this group remains inadequate, as it does within the general population. Building awareness about HIV/AIDS and STI prevention, particularly the promotion of condom use among youth and high-risk groups is of paramount importance to adolescent SRH, as well as the overall status of SRH for the country.
Midwifery, Nursing and Skilled Birth Attendants (SBA)
While Bangladesh has made gains in maternal health provisions, there are still marked gaps and unmet need for services. In 2010, 76% of deliveries in Bangladesh still took place in the homes (23% in a private, public or NGO-run health facility; doubling the figure between 2001 and 2010).
Medically trained birth attendants were present at 27% of births as of 2010 (qualified doctors, nurses, midwives, paramedics, or other Skilled Birth Attendants, up from 12 % in 2001). It is estimated that 73 percent of births in Bangladesh are attended by non-medically trained persons, directly contributing to the 7,000 maternal deaths which are estimated to occur each year because of pregnancy-related causes—a high figure by international standards, but down from close to 12,000 per year in 2004.
UNFPA supports programs in Bangladesh that are aimed at increasing the number of SBAs in the country. The current government has participated in the development of a roadmap that has outlined the training of 3,000 midwives by 2015; for including midwifery as an integral part of the current Bangladesh Nursing Council (BNC to become Bangladesh Nursing and Midwifery Council, BN&MC), a body which also supports working with government in the creation of a Regulation, Act for the Midwife, to be endorsed by the Ministry of Health and Family Welfare (MoHFA).
Under the HPNSDP (2011-2016), there has been a strong emphasis placed on both volume of training for skilled birth attendants and nurses with midwifery training, as well as advanced certified courses for midwives themselves that enhance the overall quality of training for practitioners. HPNSDP focuses on the following priority activities related to training and capacity enhancement of nurses, midwives and SBAs in the Health Sector:
→ Streamlining recruitment, and promotion opportunities
→ Expanding midwifery education and training
→ Enhance capacity of BNC/BN&MC in monitoring institutes, colleges and training centers
→ Developing institutional standards
→ Hands-on and In-Service training and support
→ Adequate training tools and equipment
→ Permanent placement for certified midwives on need-basis
The demand for skilled birth attendants, midwives and maternal services delivery in nursing has risen steadily. Nursing is presently one of the most centralized services in the public sector, which severely constrains the maternal service delivery at the peripheries and under-served areas of Bangladesh. UNFPA will support the government initiatives to train more adequately qualified, and sufficient numbers of nurses and midwives under its support to HPNSDP, and its MNH Join Programme initiative.
→ UN Joint Initiative Addressing Maternal and Neonatal Health, MNHI
→ UN Joint Program Addressing Violence against Women, JP-VAW
Violence against Women and Girls (VAW/G) and Sexual and Gender-Based Violence (SGBV) underpin a very serious socio-economic and cultural problem in Bangladesh. SGBV has far reaching effects on women’s status in society, and on the development of the country as a whole.
In collaboration with the Government of Bangladesh (GoB), NGOs and Civil society organizations, UNFPA has initiated the Joint UN Programme to Address Violence against Women (JP-VAW); a three-year programme funded by the Spain-MDG Achievement Fund.
Initiated in January 2010, JP-VAW supports the achievement of MDG-3: promoting gender equality and the empowerment of women; and seeks to ensure national ownership by GoB agencies and Civil Society.
Nine (9) UN Agencies and eleven (11) GoB Ministries are working together to achieve the JP outcomes; working together with civil society organizations and NGOs in order to involve stakeholders in addressing a targeted response to SGBV. The strategy uses a three-pronged approach that addresses policy, behavior and protection/prevention by:
(i) Enhancing the overall capacity of GoB institutions to confront the issue of SGBV
(ii) Improving information and awareness related to SGBV and gender discrimination, and
(iii) Promoting active advocacy and monitoring by Civil Society.
The JP emphasizes changing attitudes and behavior of men and boys, while simultaneously confronting the awareness of women and girls on their rights and the availability of support services. Activities target social behavior in order to reduce VAW by raising awareness, developing networks, and key stakeholder capacities; and provide survivors of violence with treatment and rehabilitative support.