Project Title: Nutrition Interventions for vulnerable Rohingya and Host Communities in Cox’s Bazaar, in particular Children Under five, Adolescents, Pregnant and Lactating women

 

Coverage of Areas: Camp 10, Camp 12 and Camp 18 at Ukhiya Upazila

 

Coverage of Health Facilities:    Primary Healthcare Centre (PHC) 096 at Camp 10, Health Post (HP) 117 at Camp 12, Health Post (HP) 183 at Camp 18

 

Donor : World Bank through UNICEF Bangladesh

 

Duration: 26 Months (15 January 2020 to 28 February 2022)

 

Population focus: Under 5 Children, Adolescent boys and girls, Pregnant Women, Lactating Mothers and Caregivers

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Since September 2017, PHD has been operating nine health facilities in different camps of Ukhiya Upazila jointly with the Health Section of UNICEF Field Office in Cox’s Bazaar. PHD delivers day-time Out-patients’ Maternal Neonatal Child and Adolescent Health (MNCAH) Services through seven Health Posts (HPs), and 24/7 In-patients’ and Out-patients’ MNCAH Services through two Primary Healthcare Centres (PHCs).

Out of the nine health facilities, two HPs and one PHC are supported through a grant from the World Bank. Under a collaborative arrangement with the Nutrition Section of UNICEF Field Office in Cox’s Bazaar, in these 3 World Bank funded health facilities PHD implements nutrition interventions in line with the National Nutrition Service Operational Plan (NNS-OP), particularly for improving Maternal, Infant and Young Child Feeding (M-IYCF) practices.

Objective

Objective of the integrated Nutrition Intervention is to reduce burden of malnutrition among Under 5 Children, Adolescent Boys, Adolescent Girls, Pregnant Women, Lactating Mothers and other vulnerable groups through strengthening and scaling-up of malnutrition prevention interventions

Expected Outputs

  1. Equitable access to and utilization of quality M-IYCF promotion improved in targeted health facilities with special focus on MNCAH and nutrition for Rohingya refugees
  2. Equitable access to and utilization of quality M-IYCF promotion improved in community through household level promotion of maternal, neonatal and child health and nutrition for Rohingya refugees
  3. Effective and efficient program management in place
  4. Needs which might appear related to Nutrition Interventions during the emergency COVID-19 situation responded immediately through a contingency fund

Key Interventions

  • PHD deploys M-IYCF Counsellor in each of the 3 Health Facilities to deliver counselling to Lactating Mothers and Caregivers of children less than two years of age on quality nutrition, to the Pregnant Women and Adolescents Girls on provision of Iron Folic Acid (IFA) and Maternal Nutrition as part of consultation, and to the Pregnant Women and Lactating Mothers on antenatal care (ANC) and post-natal care (PNC).
  • PHD engages 80 Community Health Workers (CHWs) under the guidance of 3 Supervisors for increasing awareness among community people in camps through one to one counselling, community gathering and education sessions on ANC and PNC, self-care during pregnancy, essential new-born care (ENC), exclusive breast feeding, supplementary foods, personal health and hygiene, malnutrition, institutional delivery, early marriage, dowry, violence against women (VAW) and children, trafficking etc.
  • PHD plans to utilize the contingency fund for improving Infection Prevention and Control (IPC) measures including hand-washing, use of mask, social distancing practices, enhancing maternal nutrition and M-IYCF practices among Pregnant Women and Lactating Mothers, strengthening caregivers’ capacity to provide support to Pregnant Women and Children during quarantine situation, increasing Human Resources, Logistics and Transportation to minimize additional work load, and addressing unforeseen requirements based on situational demands.

 

Project Title- Community Based Maternal, Neonatal Sexual & Reproductive Health Program for the Rohingya & Host Community, Cox’s Bazar.

 

Coverage of Areas - Total 22 camps and 5 Unions in Ukhiya and Teknaf Upazilla.

 

Donor - UNFPA Bangladesh with multi-donor support

 

Duration - July 2018 to December 2024

 

Population focus-    Pregnant Women, Lactating Mothers and Caregivers, Adolescents Girls, , Under 5 Children and others.

The Rohingya population after the last recent influx since August 2017 became about 1 million; of which 52 percent comprises of women and girls and 55-60 percent is children. There has been a serious lacking of knowledge regarding their sexual and reproductive health rights and information among this community people, found by humanitarian organizations. And also found that the likelihood of death for the women and children is 14 times higher than a man.https://alamin.datasoft24.com/phd/admin/upload/generated_file_link/upload/uploaded_file/FILES_16_06_2020_3014025223555598850_1444680748419418475.JPG

With immense previous experience working with Rohingya community on the Maternal, Newborn Sexual and Reproductive Health Program issues and the vast experience in community mobilization in the crisis-affected community on their rights to health, especially SRHR etc. made PHD a major actor in this project.

PHD holds the highest number of CHWs (350) and largest working areas, approximately 30% of the population in the camp and host community in Ukhiya & Teknaf sub-district. These PHD-CHWs visit around 4200 houses every day. Their visits include communicating health messages and refer pregnant mothers for ANC, delivery, PNC to the nearby facilities. They also counsel for facility delivery, maternal and neonatal care, family planning, GBV, CMR, STI/RTI, adolescence by PHD.

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Objective

The overall objective of the MNRHP project is to develop awareness on sexual and reproductive health among the community people by recurrent and reinforced counseling and develop their health seeking behavior and consciousness, reduce maternal and child death, thereby promote hale and hearty family in the long run. As well as, PHD seeks to develop a given number (300) of adolescent girls as skilled girls and peer educators after providing comprehensive sexuality education for one year, who will be practicing rights on sexual and reproductive health in their own lives and counseling as well as influencing the other neighborhood girls simultaneously and ultimately reduce the rate of early marriage and early pregnancy in the long run.

Expected Outputs

  1. Increased awareness and capacity of the community people to receive integrated and equitable sexual and reproductive health services, including STIs/HIV,GBV, FP in development and humanitarian context.
  2. Improved awareness & capacities of adolescent girls to practice SRHR and access to SRH services autonomously and reduce child marriage & early pregnancy among adolescent girls in the community.

Key Interventions

  • Daily Domiciliary Visits by CHWs: CHWs visit door to door 6 days in a week to make the community people aware regarding the services on maternal care, institutional delivery, neonatal care, family planning, STI/RTI, GBV, ASRH, CMR through counselling, motivate and refer the community people to receive services from health facility on their respective needs.
  • Community Based SRH information assembly with RHAG:  CHWs and their Supervisors disseminate information about Antenatal care, Postnatal care, Essential Newborn Care, Family planning, Child marriage, GBV, Child protection and other SRH related information by using FLIPCHART with the RHAG (Reproductive Health Awareness Group, consists of community leaders) members.
  • Court Yard session: Supervisor and CHWs conduct courtyard session with 12 pregnant mothers usually in order to aware them regarding maternal and neonatal care and other SRH services.
  • Advocacy with Government stakeholders meeting in CCs (15 CC) and FWCs (5): To maintain a good liaison with government stakeholder, CHWs, Supervisors and FCs attend meetings at CCs and FWCs regularly
  • Mortality Surveillance & reporting in 6 sectors: information from community level through different steps analyse and compiled by the MIS team report to six sectors such as; UNFPA, KOBO CDC, CHWG, DDFP- Cox, EWARS, WRA VA KOBO.
  • Community Dialogue with Majhis & Caregivers: The program is conducted with the caregivers of the adolescent girls and Majhis (community leaders).
  • ASRHR Weekly session: There are 3 learning centres in 3 camps of PHD for total 300 adolescent girls. Besides, ASRH Mentors visit household of girls every day for better response from the community.

 

Project Title- Provision of Comprehensive Primary Health Care Services to Rohingya Refugees in Cox’s Bazar

 

Area Coverage-                           

8 Rohingya Camps at Ukhiya Upazila of Cox’s Bazar District

 

Health Facility Coverage-         

Three (3) Primary Healthcare Centre (PHC)- i) 071 at Camp 8W and ii) 096 at Camp 10. Six (6) Health Post (HP)- i) 117 at Camp 12, ii) 183 at Camp 18, iii) 033 at Camp 3, iv) 032 at Camp 4, v) 134 at Camp 13, and vi) 165 at Camp 16

Joint Collaboration-                  

UNICEF Bangladesh with support of multi-donor agencies

 

Duration-         

Phase 1- 12 Months (16 September 2017 to 15 September 2019)

Phase 2- 20.5 Months (16 September 2019 to 31 May 2020)

Phase 3 - 7 Months (May 2020 to December 2020)

Phase 4 - 12 Months (January 2021 to December 2021)

Phase 5 - 12 Months (January 2022 to December 2022)

Phase 6 - 12 Months (January 2023 to December 2023)

Phase 7 - 12 Months (January 2024 to December 2024)

 

Population focus-               

Women, New-borns, Under 5 Children and Adolescents

Since 25th August 2017, targeted violence against Rohingya communities forced them to flee from their homes in Rakhine State of Myanmar. Around 671,000 Forcibly Displaced Myanmar Nationals (FDMN) crossed the border and sought safety in our country. The People of Bangladesh and the Government expressed resounding solidarity with these people. The situation incurred Heath Sector for immediate response with emergency Primary Health Care including SRH, MNCH Care, and Outbreak Preparedness. The collaboration between UNICEF and PHD initiated a response in line with the Joint Humanitarian Response Plan. Joint response to new Rohingya Settlements for MNCAH Services has three key components, i) Out-patients’ Services, ii) In-patients’ Services, and iii) Community Health Interventions.

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Objective

According to the Country Program Document (CPD) Output 1, UNICEF has committed to strengthen the quality of integrated service delivery and effective coverage in national and subnational health systems to support the well-being of children under 5 years and their mothers. It also includes people infected and affected by HIV, emergency and non-emergency situations in both rural and urban areas. The joint response has been intended for the emergency situation in Cox’s Bazar to provide life-saving basic assistance in Rohingya Camps.

Expected Outputs

  1. Improved Access for FDMN Women, Newborns, U5 children and Adolescents to Comprehensive Maternal, Newborn, Child & Adolescent Health and Nutrition (MNCAHN) Services
  2. Capacity of service providers in PHC and HP enhanced  for ensuring continuous care among the registered PWs, NBs and U5 Children
  3. Improved Referral services for General Patients, PWs with complication, Sick New-borns and U5 Children  to appropriate health services
  4. Quality Improvement (QI) Initiatives in PHCs and HPs in place and standardized
  5. Effective and efficient program management in place

Key Interventions

Component 1- Day-time Out-patients’ Service Delivery in HPs

PHD operates 6 HPs with adequate numbers of skilled workforces to deliver the following services-

  • Curative Care to male, female and children as per Bangladesh Essential Service Package (B-ESP)
  • EPI inclusion for Children under 2 according to the Government guidelines and supplies
  • MNSRH Care to women and adolescents, which covers- ANC/PNC, Family Planning, Distribution of IFA/Zinc/Calcium distribution, GBV/CMR/MR/PAC referral
  • C-IMCI Services to manage and refer sick New-born & Under 5 Children with Diarrhoea, ARI, Ear Infection and Fever
  • ORT and BF Care to diarrhoea patients and lactating mothers through separate corner in HP
  • PMTCT Care in selected HPs with counseling, screening, syndromic management, HIV tests and referral
  • Mini Pharmacy for dispensing medicines as per supply of drugs under ESP protocol
  • Lab Facilities in selected Health Posts with few strip-based investigations
  • Patient Registration, Management and Reporting as routine works
  • Referral Care to selected cases from HP to PHD’s PHCs and other appropriate facilities with dedicated ambulance including post-referral follow-up and patient back support
  • Limited special cares for children with ECD and for adolescents who are at risk of pregnancy
  • Generating evidences through HMIS for programme planning and implementation

Component 2- Out-patients’ and In-patients’ Service Delivery in PHCs

PHD operates 2 PHCs with adequate numbers of skilled workforces to deliver the following services-

  • Curative care to male, female and children including nutrition screening, first aid with stabilization and dressing, treatment of emergency cases, Inpatient curative care for mild and moderate conditions
  • MNH Services that include ANC, PNC, Normal Vaginal Deliveries (NVD), B-EMONC (Signal Functions), ENC including KMC services, Management of Low-birth weight, sepsis management, Post-abortion care, Postpartum FP, Td vaccination and IFA supplementation
  • Child Health and Immunization that include IMCI, Routine Vaccination (0-5 years), Growth monitoring, Participation in deworming & Vitamin A campaign (5-15 years)
  • Adolescent Health Care that include Adolescent Friendly Services, personal hygiene and sanitation, Td Vaccination and IFA supplementation
  • Gender-Based Violence (GBV) that include Provision of first line support and Clinical care for sexual violence (CMR) and facilitating referrals to other service providers
  • Maternal Nutrition and IYCF with skilled counselor for systematic detection of acute malnutrition among Children (6 to 59 months) and PLWs and for identifying and referring of SAM/MAM Cases to OTPs/TSFPs
  • Special services on communicable diseases, psychosocial advices, non-communicable diseases, Laboratory, Pharmacy, Waste Management and Infection Prevention
  • Referral Care for C-EmO & NC Cases and patients with severe sickness with dedicated 24/7 ambulance services including post-referral follow-up and patient back support
  • Semi-permanent minimum Infrastructure with 24/7 power supply, running water supply, medical waste management, Male/Female toilets, bathing facility, minimum 15 beds (5 Male, 5 Female & 5 New-born) for inpatient care, Delivery Room, Isolation room, breastfeeding corner and Doctor & Nurse Station

Component 3- Community Health Interventions at Camps

PHD engages 10 Community Health Workers (CHWs) per HP and 25 CHWs per PHC under the guidance of 5 Supervisors for promoting MNCH care at home and improving MNCAH care seeking behaviours among the targeted population through following interventions-

  • Register PLWs and their Children under 2 years of age from the catchment
  • Conduct household visits and group education sessions
  • Refer registered PWs to Health Facilities for ANCs
  • Refer PWs to Health Facilities for seeking Delivery Care, ENC, PNC and FP
  • Refer registered Children under 2 years of age for Routine Immunization
  • Promote Exclusive BFand IYCF practices
  • Refer suspected malnutrition cases to eHHealth Facilities for Nutrition Screening